New endocrine therapy options for patients with prostate cancer and medical complications

Explore Xintiandi---MDT Selection Explore Xintiandi is sponsored by the Beijing Medical Award Foundation, guided by the Chinese Anti-Cancer Association Urology and Andrology Reproductive Tumor Committee, and fully supported by Yimaitong
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It aims to promote the communication and interaction of doctors in the field of urinary oncology-MDT resource sharing, academic cutting-edge broadcasts, and improvement of clinical diagnosis and treatment
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Click to watch the highlights of the MDT highlights
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Special report (1): The first-line NHT treatment of mCRPC is deployed in Fujian Provincial Hospital, Professor Wu Jinfeng said that because patients with metastatic castration-resistant prostate cancer (mCRPC) are not enthusiastic about posterior-line treatment, the choice of first-line treatment options It seems particularly critical
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From the results of real-world studies and many meta-analysis, it can be known that in the case of first-line treatment, enzalutamide may bring more overall survival (OS) benefits than abiraterone, and for some poor prognosis For prostate cancer patients, enzalutamide may also have a greater benefit
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Therefore, based on these research results, prostate cancer treatment guidelines are constantly updated, and new endocrine therapy is gradually becoming a first-line treatment option in the field of mCRPC
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Case sharing and discussion (1) Professor Du Yuejun from the Southern Hospital of Southern Medical University shared with us a typical case of new endocrine therapy for prostate cancer.
Multidisciplinary experts entered castration-resistant prostate cancer (CRPC) after standard treatment for prostate cancer.
How to choose the follow-up treatment plan for patients in this stage was discussed
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The patient is 78 years old
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Main complaint: Intermittent dysuria for more than 2 months with elevated PSA
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Auxiliary examination: ◆MRI: prostate cancer with invasion of the bladder and seminal vesicle gland, pelvic and pelvic lymph node metastasis ◆digital rectal examination: moderate prostate hyperplasia, hard, multiple palpable nodules Diagnosis: prostate cancer, Gleason score 4+4=8 Points
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Treatment experience: 1.
In March 2020, androgen deprivation treatment (ADT) + abiraterone + prednisone treatment, combined with zoledronic acid to treat multiple bone metastases
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2.
In May 2021, PSA gradually increased, PSMA suggested that more than two metastases appeared, and the patient was diagnosed to enter the stage of castration-resistant prostate cancer (CRPC), and switched to enzalutamide treatment
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 Case sharing and discussion (2) Professor Wu Xiang from Fujian Provincial Hospital shared with us a case of "T3 stage prostate cancer", similar to the patient in this case, if it is accompanied by medical comorbidities, how can we take into account the combination at the same time in clinical practice? Treatment of disease and treatment of prostate cancer? Regarding this issue, experts from the two houses had an active discussion and each expressed their views
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The patient was male, 75 years old
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Main complaint: frequent urination, nocturia with elevated PSA
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Auxiliary examination: ◆Digital rectal examination: prostate II~III degree large, surface nodular unevenness, diffuse hard MRI: prostate cancer with capsule, right seminal vesicle invasion Past medical history: hypertension, chronic obstructive pulmonary disease ( COPD), coronary heart disease, gout, diabetes
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Diagnosis: prostate cancer
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Treatment experience: 1.
ADT treatment was performed in August 2013
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2.
In October 2015, the patient entered the CRPC stage and switched to enzalutamide treatment.
So far, the PSA control effect is good, and the overall adverse reactions are few and mild
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 For patients with prostate cancer with medical comorbidities in this case, how should clinically choose a new endocrine treatment plan? Professor Tan Wanlong said that for elderly, high-risk prostate cancer patients with medical complications, there are limited clinical options
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First of all, ADT alone is the first choice, but once the disease progresses and enters the mCRPC stage, enzalutamide can be considered
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Enzalutamide embodies the characteristics of a new type of antiandrogen, which can quickly and deeply reduce PSA, and can benefit a large number of patients clinically
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In the special report, why is enzalutamide a better choice for the first-line treatment of mCRPC? In the case discussion, how to choose a treatment plan for patients with advanced prostate cancer with medical complications? Click "Read the original text" below to watch the wonderful special report and MDT discussion
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Click "Read the original text" below to watch the full wonderful special report and MDT discussion