Dr Wang on Reducing Treatment Discontinuation in Older Patients With mCRPC

Jue Wang, MD, professor in the Department of Internal Medicine and member of the Division of Hematology and Oncology at the University of Texas Southwestern Medical Center, outlined key factors contributing to treatment drop-off in older patients with metastatic castration-resistant prostate cancer (mCRPC), as well as strategies to address this challenge and enhance real-world outcomes.

Wang began by noting that mCRPC primarily affects older adults, requiring management of both advanced malignancy and age-associated comorbidities. The gap between first- and second-line therapy is driven by several factors, he stated. Disease progression is a key contributor, particularly when subsequent treatments have similar mechanisms of action, which can result in cross-resistance and diminished efficacy, Wang shared. Decline in performance status is also common; many patients have undergone prolonged androgen deprivation therapy (ADT) and treatment intensification. Androgen signaling inhibitors maximally suppress testosterone, which can contribute to frailty, sarcopenia, and reduced functional reserve, making it more difficult for patients to tolerate additional therapy as they advance through lines of treatment.

To improve outcomes, care must extend beyond pharmacologic interventions to include a holistic, patient-centered approach, Wang emphasized. This requires integrating an understanding of disease biology, tumor heterogeneity, and resistance mechanisms with proactive supportive care. Anticipating the physical toll of treatment and implementing measures to preserve functional capacity are critical. Interventions may include early involvement of physical therapy, nutritional optimization, symptom management, and psychosocial support, he outlined.

Shared decision-making is also essential, Wang continued. Patients should be empowered with clear information on treatment benefits, risks, and trade-offs, enabling informed choices aligned with their values and goals. Wang concluded by highlighting the importance of multidisciplinary care, noting that at UT Southwestern, advanced nurse practitioners and physician assistants play a central role in treatment planning, toxicity monitoring, and survivorship navigation.