Mark J. Mann, MD, assistant professor, Sidney Kimmel Cancer Center, Thomas Jefferson Hospital, discusses the differences between treatment options for patients with prostate cancer subtypes.

For patients with nonmetastatic castration-sensitive prostate cancer, treatment options have been standardized for a long time with androgen deprivation therapy. However, in nonmetastatic castration-resistant prostate cancer (CRPC), studies have not shown many effective treatment options until recently, says Mann. Studies have investigated denosumab (Xgeva), which did not show any efficacy, and zoledronic acid, which showed a similar response.

With newer imaging modalities, a question is whether a patient is really nonmetastatic, explains Mann. Gallium-68 PET/CT scans identify metastatic disease that was previously not visible. That is likely to change the nonmetastatic castration-sensitive and nonmetastatic CRPC treatment landscape. According to Mann, physicians should consider using drugs from the STAMPEDE and LATITUDE trials.

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Dr. Mann on Differences Between Treatments for Prostate Cancer

Mark J. Mann, MD, assistant professor, Sidney Kimmel Cancer Center, Thomas Jefferson Hospital, discusses the future of immunotherapy in prostate cancer.

According to Mann, sipuleucel-T (Provenge) was far ahead of the curve when it was first developed and approved. From the approval of sipuleucel-T and other immunotherapies, physicians have learned that evaluating outcomes based purely on prostate-specific antigen (PSA) values can be misleading.

In PD-L1 inhibitors, there may be a response that is not reflected radiographically; there may be a swelling and flare effect. It’s reasonable to expect that in immunotherapies. This may be why sipuleucel-T was not as broadly adopted when it was approved, he adds.

More recent immunotherapies have shown modest efficacy. Now that physicians understand radiographic flares or PSA values may not be indicative of efficacy, we may be able to evaluate outcome markers such as metastasis-free survival, the same markers that the apalutamide (Erleada) and enzalutamide (Xtandi) studies used as primary endpoints.

Mark J. Mann, MD

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