Prostate Cancer Advances in Early Treatment and Emerging Therapies

Dr. Daniel P. Petrylak, a professor of Medicine (Medical Oncology) and of Urology, as well as the chief of Genitourinary Oncology at Yale School of Medicine in New Haven, Connecticut, shared his insights on recent developments in prostate cancer care and treatment. He emphasized the importance of genetic testing, personalized treatment strategies, and early intervention to improve patient outcomes.

“Currently, only about 40% of patients are being screened for mutations... It should be 100%,” he noted in an interview with CURE.

In the discussion, Petrylak highlighted advances in identifying genetic mutations and emerging strategies for early, intensive treatment for prostate cancer.

Transcript

What are some recent treatment advancements for prostate cancer that patients should be aware of?

There are a lot of areas of prostate cancer that have really come to the forefront. Firstly, the identification of genetic mutations, particularly the identification of BRCA and the related DNA repair enzymes and deficiencies in those. I think that's important from a therapeutic as well as a familial standpoint. From a familial standpoint, we know that the germline mutations can be passed down from generation to generation. Not only is the patient who has prostate cancer afflicted by that, but the family members can also potentially be afflicted. They need to be properly genetically counseled, including screening for breast cancer, ovarian cancer, and pancreatic cancer, among other cancers that may be involved in these hereditary syndromes.

From a therapeutic standpoint, we're now seeing that DNA repair does play a role as a target for those patients with metastatic prostate cancer. We know that the PARP inhibitors have activity in those BRCA-positive patients. There's a potential synergy between PARP inhibitors and next-generation antiandrogens, as we've seen recently. Moving these agents earlier in the hormone-sensitive state at least shows an improvement in radiographic progression-free survival, and perhaps we will see an overall survival benefit eventually. So, genetics is one theme.

The other theme that dovetails with that is using our agents in metastatic disease earlier. We know that androgen deprivation therapy is the backbone of treatment for metastatic prostate cancer, but adding antiandrogens does show a survival benefit. The question is whether that should be combined with chemotherapy or not, and there's a lot of controversy over which is the right patient to treat in that fashion.

Now, as I mentioned before, the PARP inhibitors are moving up, and the PSMA-targeted agents are moving up. So, intense initial treatment is something that needs to be considered for the appropriate patient in both of those different groups: for the genetic issue, as well as for the early treatment issue.

Currently, only about 40% of patients are being screened for mutations, and about 40 to 50% of patients are receiving intensification up front. It should be 100%—not those low percentage numbers.

Transcript has been edited for clarity and conciseness.

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