Stephen J. Freedland, MD, Warschaw Robertson Law Families Chair in Prostate Cancer, director, Center for Integrated Research in Cancer and Lifestyle, co-director, Cancer Genetics and Prevention Program, associate director, Faculty Development Samuel Oschin Comprehensive Cancer Institute, and professor of surgery, Cedars-Sinai Medical Center, discusses a real-world analysis of enzalutamide (Xtandi) in metastatic castration-resistant prostate cancer (mCRPC).

Data from the randomized phase III PREVAIL trial showed a decrease in radiographic progression-free survival and overall survival with enzalutamide versus placebo in men with chemotherapy-naïve, metastatic prostate cancer.

Prior to the 2018 approval of enzalutamide in nonmetastatic CRPC, a retrospective cohort study analyzed the real-world utility of enzalutamide in 931 men with chemotherapy-naïve, mCRPC. Due to the agent’s approval in the nonmetastatic setting in the study time frame, the use of enzalutamide was used as a proxy for mCRPC, says Freedland.

At a median follow-up of 12.5 months and a median of 4 completed prostate-specific antigen (PSA) tests, the median PSA decline was 58%, says Freedland. Moreover, 14.2% of patients had undetectable PSA. Additionally, the median time to PSA progression was 18.5 months (95% CI, 15.6-23.7).

A subset of patients did not respond to treatment with enzalutamide; however, this may be due to inherent resistance to hormonal therapy, explains Freedland.

These findings are comparable to those from the PREVAIL trial, indicating the real-world utility of enzalutamide in this patient population, concludes Freedland.

Videos

Stephen J. Freedland, MD, discusses a real-world analysis of enzalutamide in metastatic castration-resistant prostate cancer.


Dr. Freedland on a Real-World Analysis of Enzalutamide in mCRPC

Stephen J. Freedland, MD, director, Center for Integrated Research in Cancer and Lifestyle, co-director, Cancer Genetics and Prevention Program, associate director, Faculty Development Samuel Oschin Comprehensive Cancer Institute, professor of surgery, Cedars-Sinai Medical Center, discusses nuanced diet and lifestyle interventions in patients with prostate cancer.

Rarely is a quick answer the right answer in terms of diet and lifestyle changes for patients with prostate cancer, says Freedland. The challenge is finding a balanced approach that works for each patient; losing weight, exercising more, and stopping smoking are all part of the equation. A quick fix like cutting red meat out isn’t necessarily the answer. A lot of healthy diets can incorporate red meat, particularly if it’s grain fed, not overcooked, and not processed.

Physicians should work with dieticians and exercise physiologists to improve a patient’s diet to help increase their tolerability to treatment and potentially slow the cancer down.

Dr. Freedland on Diet and Lifestyle Interventions in Patients With Prostate Cancer

Stephen J. Freedland, MD, associate professor, Duke University, discusses an analysis presented at the 2014 AUA Annual Meeting that looked at carbohydrate intake, glycemic index, and prostate cancer risk.

Freedland says this case-controlled study analyzed men undergoing biopsy and had them fill out a questionnaire about their food intake. The trial also looked at men who were screened for prostate cancer but were not recommended to undergo biopsy. Only the men that underwent biopsy and found to have prostate cancer were included in the study.

The study found that men who consumed more carbohydrates with a low glycemic index were at a lower risk of prostate cancer, Freedland says. The study also found that high fiber intake helped protect patients against prostate cancer.

Dr. Freedland on the Association Between Carbohydrates and Prostate Cancer Risk

Stephen J. Freedland, MD, Associate Professor of Surgery, Associate Professor in Pathology, Duke University School of Medicine, discusses the complications faced when treating men with early-stage prostate cancer.

Freedland notes that in the past few years there have been multiple new agents approved for advanced prostate cancer. Overall, the treatment choice for early-stage prostate cancer has remained hormonal therapy and likely will not change in the next 5 years, Freedland believes.

When administering androgen-deprivation therapy there are multiple expected adverse events, such as bone loss, cholesterol issues, and insulin intolerance. Despite the occurrence of these events, not every patient develops a bone fracture or a heart attack and proper preventive measures should be addressed with patients.

As a way to reduce the expected consequences of treating prostate cancer, Freedland stresses that physicians should promote the importance of healthy living and exercise.

Stephen J. Freedland, MD, from Duke University School of Medicine, discusses the complications faced when treating men with early-stage prostate cancer.

Stephen J. Freedland, MD

Articles

Dr. Freedland on a Real-World Analysis of Enzalutamide in mCRPC

Dr. Freedland on Diet and Lifestyle Interventions in Patients With Prostate Cancer

Dr. Freedland on the Association Between Carbohydrates and Prostate Cancer Risk

Dr. Freedland on Treating Early-Stage Prostate Cancer