Natasha Garg, DO, medical oncologist, assistant clinical professor, Department of Medical Oncology and Therapeutics Research, City of Hope, discusses the utility of novel imaging techniques in patients with nonmetastatic castration-resistant prostate cancer (nmCRPC).

Prostate-specific membrane antigen (PSMA) and fluciclovine F18 (Axumin) positron emission tomography (PET) scans are novel imaging techniques that have the potential to redefine and improve treatment for patients with nmCRPC, according to Garg. 

Performing a high-sensitivity PSMA PET scan on patients with nonmetastatic disease will likely identify metastatic disease and lead to reclassification and treatment modification, Garg notes. However, reclassification does not change the available evidence, and as such, conventional imaging is still utilized to classify patients, Garg adds.

Future clinical trials can help clarify the utility of these novel high-sensitivity scans in a way that will help to better inform treatment decisions, Garg concludes.

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Natasha Garg, DO, discusses the utility of novel imaging techniques in patients with nonmetastatic castration-resistant prostate cancer.

Dr. Garg on the Need for Novel Imaging Techniques in nmCRPC

Natasha Garg, DO, medical oncologist, assistant clinical professor, Department of Medical Oncology and Therapeutics Research, City of Hope, discusses the emergence of antiandrogen agents in the nonmetastatic castration-resistant prostate cancer (nmCRPC) treatment paradigm. 

Previously, few treatment options were available for this patient population, according to Garg. However, pivotal trials, including the phase 3 SPARTAN trial (NCT01946204) with apalutamide (Erleada), the phase 3 PROSPER trial (NCT02003924) with enzalutamide (Xtandi), and the phase 3 ARAMIS trial (NCT02200614) with darolutamide (Nubeqa), have revolutionized treatment and expanded options, Garg explains. 

The trials were similar in design, with only minimal differences. All were multicenter, phase 3, double-blinded trials that randomized patients 2:1 to receive either the study drug or placebo, Garg notes. Additionally, all the trials included patients with a prostate-specific antigen (PSA) doubling time of 10 months or less. Androgen deprivation therapy was continued for all participants, Garg concludes.

Natasha Garg, DO, discusses the emergence of antiandrogen agents in the nonmetastatic castration-resistant prostate cancer treatment paradigm. 


Dr. Garg on the Emergence of Antiandrogen Agents in nmCRPC

Natasha Garg, DO, medical oncologist, hematologist, and assistant clinical professor in the Department of Medical Oncology and Therapeutics Research at City of Hope, discusses selecting between antiandrogen agents in nonmetastatic castration-resistant prostate cancer (CRPC). 

Without comparative data, any of the approved antiandrogen agents—enzalutamide (Xtandi), darolutamide (Nubeqa), and abiraterone acetate (Zytiga)—would be suitable for eligible patients with nonmetastatic CRPC, says Garg. However, treatment selection should not be a one-size-fits all approach and choosing between these agents should be based on individual patient characteristics, Garg explains.

Additionally, some patients with nonmetastatic disease and a prostate-specific antigen (PSA) doubling time of less than 10 months may not require treatment with an antiandrogen agent, says Garg. For example, young, fit patients with an 11-month PSA doubling time and high-risk features, such as a high Gleason score, should be considered for treatment, Garg says. Conversely, elderly, frail patients with a limited life expectancy may benefit more from observation based on the potential toxicity and cost of treatment, Garg explains.

Natasha Garg, DO, discusses selecting between antiandrogen agents in nonmetastatic castration-resistant prostate cancer. 



Natasha Garg, DO

Articles

Dr. Garg on the Need for Novel Imaging Techniques in nmCRPC

Dr. Garg on the Emergence of Antiandrogen Agents in nmCRPC

Dr. Garg on Selecting Between Antiandrogen Agents in Nonmetastatic CRPC