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Rising PSA's after treatment - an answer
Prostate Cancer | Last Active: Jan 11 8:59am | Replies (31)Comment receiving replies
Here's some "light" reading... " https://www.urotoday.com/library-resources/mhspc/147798-the-current-state-of-treatment-implementation-for-mhspc-in-north-america.html?utm_source=newsletter_12452&utm_medium=email&utm_campaign=the-underutilization-of-treatments-and-testing-in-advanced-prostate-cancer
For those who don't want to wade through he charts and data...
Conclusions:
Although there appears to be increasing utilization of treatment intensification in the real-world setting, less than half of mHSPC patients receive guideline concordant care. While there may be altruistic reasons to avoid treatment intensification secondary to concerns for patient financial toxicity or concerns for the tolerability of these agents, the proven survival benefit conferred by this treatment paradigm should make this approach the clear standard of care. Based on the current evidence, it appears that patients with synchronous, high volume mHSPC benefit from early treatment intensification with triplet therapy in the form of both an ARPI and docetaxel, whereas the remaining mHSPC subgroups benefit most from doublet therapy with ARPI addition to ADT. Radiotherapy to the prostate is also associated with improved overall survival in mHSPC patients with synchronous, low-volume disease and should be considered in these cases.
Replies to "Here's some "light" reading... " https://www.urotoday.com/library-resources/mhspc/147798-the-current-state-of-treatment-implementation-for-mhspc-in-north-america.html?utm_source=newsletter_12452&utm_medium=email&utm_campaign=the-underutilization-of-treatments-and-testing-in-advanced-prostate-cancer For those who don't want to wade through he charts..."
Where do you find this stuff, Kevin? This is great. Of course, I hope it's irrelevant for a long time for me, but I know it isn't for you and might not be for me. Anyway, thanks.
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That pretty much sums up the point I was making but I was referring to treatment strategies at much earlier stages. So the paper essentially contradicts what I'm advocating but I still question how solid the data is given very few patients probably did triplet when they were pre-(clinical) metastatic. Regarding certain cohorts of mHSPC patients it states:
"While early, aggressive treatment intensification with triplet regimens, with or without primary radiotherapy, may seem attractive in this cohort of patients to maximize survival outcomes, the reality is that such “maximal” treatment intensification is unnecessary in the majority of these patients."