Scott Samuelson, MD, medical oncologist at Utah Cancer Specialists, discusses the comorbidities that may affect treatment decisions for patients with metastatic prostate cancer.

The frontline treatment of patients with metastatic prostate cancer typically includes a taxane-based chemotherapy with docetaxel or an androgen receptor—blocking agent, such as abiraterone acetate (Zytiga). However, there are associated comorbidities that can affect the decision whether to pursue one or the other, explains Samuelson.

Abiraterone is a very well-tolerated drug, but it has significant issues with high blood pressure, says Samuelson. That is a common problem, he explains. Enzalutamide (Xtandi) is also a great drug, but compared with abiraterone, it tends to have more fatigue issues. A lot of patients complain about that, says Samuelson.

With docetaxel, there is already preexisting neuropathy, and diabetes is fairly common in that population. Therefore, when trying to decide the initial therapy or subsequent therapy, Samuelson says that physicians should always look at a patient’s comorbidities.

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A lot of the decision depends on a patient’s performance status, says Samuelson. Whether or not they are a candidate for chemotherapy is a big factor as well. Considering a patient’s eligibility for chemotherapy is very important as it is a very effective therapeutic agent. However, Samuelson states that abiraterone acetate (Zytiga) and enzalutamide (Xtandi) are also great options. For a lot of patients, the decision comes down to cost.

Samuelson takes care of a number of patients who live several hours from the clinic. Oral agents tend to be preferable for these patients. The costs of some of the oral agents, though usually not prohibitive, do pose an additional challenge for some patients. These patients may prefer an intravenous agent that tends to be covered better by insurance, says Samuelson.

Scott Samuelson, MD, medical oncologist, Utah Cancer Specialists, on frontline treatment of patients with prostate cancer and subsequent sequencing.

Scott Samuelson, MD

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