Turning Clinical Results Into Change for Patients with Prostate Cancer
“We don't know what the best treatment paradigm is for a patient whose disease is most clearly manifest on a PSMA scan as opposed to standard imaging,” said Dr. Michael J. Morris. “All that work has yet to be done, and we can only do it once we have the scan available to us as a tool in the United States.”
BY Dr. Michael Morris
PUBLISHED July 08, 2020
In a recent interview with CURE®’s sister publication, Cancer Network®, Dr. Michael J. Morris discussed the results of the phase 3 CONDOR trial, presented during the 2020 ASCO Virtual Scientific Program, and how they will eventually impact patients by changing the way prostate cancer is identified and evaluated. The trial investigated the use of positron emission tomography, or PET, scans specifically targeted to locate accumulations of a protein called prostate-specific membrane antigen (PSMA), indicating that prostate cancer is present.
“Because standard imaging techniques that we have to localize prostate cancer are really inferior to newer molecular imaging techniques such as PSMA-PET,” Morris explained, “CONDOR was designed to be one of two regulatory studies to collect the evidence needed for regulatory approval of PSMA-PET in the United States.”
The prostate cancer section head at Memorial Sloan Kettering Cancer Center went on to explore what the results of this trial mean for patients, and how further research is needed to determine how this imaging can be used to the patient’s best benefit.
I think that to answer that, there's going to be a multi-fold impact on the management of prostate cancer, and even the staging of prostate cancer as PSMA imaging moves, we hope, into the United States and not just as a European platform in which to be performed.
It's probably going to move staging of high-risk prostate cancer for each clinical state so that there will be what is now called “high-risk localized disease.” Some of those patients will be termed metastatic disease: the rising-PSA population, some of those will be found to have metastatic disease. Already, it's been shown that the non-metastatic castration resistant prostate cancer population is predominantly actually a metastatic population when subjected to molecular imaging with PSMA-based imaging. So, our understanding of really where each patient is in his natural history is going to be different.
And then we're going to have a whole host of clinical trials moving forward to determine how to use this information to the patient's best benefit. That really hasn't been done yet. We don't know what the best treatment paradigm is for a patient whose disease is most clearly manifest on a PSMA scan as opposed to standard imaging, and we're going to have to re-sort all of that out in terms of who should be getting systemic therapy, who should be getting systemic and local therapy, who should just be getting a focal treatment; all that work has yet to be done, and we can only do it once we have the scan available to us as a tool in the United States.