Dr. Siddiqui on the Current State of Treatment in Nonmetastatic CRPC

Bilal A. Siddiqui, MD, assistant professor, Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, discusses the current state of treatment in nonmetastatic castration-resistant prostate cancer (CRPC).

Nonmetastatic CRPC is defined by a castrate level of serum testosterone less than 50 ng/dL, rising prostate-specific antigen despite the use of androgen-deprivation therapy, and no evidence of distant metastatic disease by conventional imaging, Siddiqui says.

Currently, the antiandrogen agents darolutamide (Nubeqa), enzalutamide (Xtandi), and apalutamide (Erleada) are FDA approved for use in patients with nonmetastatic CRPC, Siddiqui says. Although cross-trial comparisons are flawed, the agents have demonstrated similar metastasis-free survival and overall survival in patients with nonmetastatic disease. Therefore, factors regarding each agent’s safety profile, drug-drug interactions, and cost need to be considered when selecting between the 3 available agents.

Additionally, as next-generation imaging with PSMA PET CT scans emerge, which have increased sensitivity for distant metastatic disease detection, it is possible that nonmetastatic CRPC will not be a disease state in the next decade, Siddiqui concludes.