Metastatic castration-sensitive prostate cancer
|
ADT 6-months formulations must be initiated. |
ADT is the current standard of care ( 1515. Mohler JL, Antonarakis ES, Armstrong AJ, D’Amico AV, Davis BJ, Dorff T, et al. Prostate Cancer, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2019; 17:479-505. , 1616. Mottet N, Cornford P, van den Bergh RCN, Briers E, De Santis M, Fanti F, et al. Prostate Cancer. EAU Guidelines Associates. [Internet]. Available at. <https://uroweb.org/guideline/prostate-cancer/>. https://uroweb.org/guideline/prostate-ca...
). |
Avoid intermittent ADT. |
Intermittent ADT requires a closer PSA and testosterone monitoring in addition to possible images. |
Consider combination castration therapy with the new hormonal treatments (abiraterone, apalutamide or enzalutamide). |
These drugs have demonstrated benefits in terms of survival compared to ADT alone ( 2424. Fizazi K, Tran N, Fein L, Matsubara N, Rodriguez-Antolin A, Alekseev BY, et al. Abiraterone plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer. N Engl J Med. 2017; 377:352-60.
25. Chi KN, Agarwal N, Bjartell A, Chung BH, Pereira de Santana Gomes AJ, Given R, Juárez Soto Á, et al. Apalutamide for Metastatic, Castration-Sensitive Prostate Cancer. N Engl J Med. 2019; 381:13-24. - 2626. Armstrong AJ, Szmulewitz RZ, Petrylak DP, Holzbeierlein J, Villers A, Azad A, et al. ARCHES: A Randomized, Phase III Study of Androgen Deprivation Therapy With Enzalutamide or Placebo in Men With Metastatic Hormone-Sensitive Prostate Cancer. J Clin Oncol. 2019; 37:2974-86. ). |
Prefer apalutamide or enzalutamide to abiraterone. |
Effect of corticosteroids in population infected with SARS-CoV-2 is not yet clear ( 55. [No authors]. British Association of Urological Surgeons. COVID-19 strategy for the Interim management of Prostate Cancer Prepared by the BAUS Section of Oncology. 2020. Available at. https://caunet.org/wp-content/uploads/2020/04/BAUS-OncologyCOVID-19-Prostate.pdf. Accessed May, 10, 2020 https://caunet.org/wp-content/uploads/20...
, 2828. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020; 395:473-5. ). |
Avoid CTx. |
CTx is associated with hematological toxicity and implies multiple visits to the hospital ( 66. Ribal MJ, Cornford P, Briganti A, Knoll T, Gravas S, Babjuk M, et al. European Association of Urology Guidelines Office Rapid Reaction Group: An Organisation-wide Collaborative Effort to Adapt the European Association of Urology Guidelines Recommendations to the Coronavirus Disease 2019 Era. Eur Urol. 2020: S0302-2838, 30324-9. Available at. <https://uroweb.org/wp-content/uploads/EAU-Guidelines-OfficeRapid-Reaction-Group-An-organisation-wide-collaborativeeffort-to-adapt-the-EAU-guidelines-recommendations-tothe-COVID-19-era.pdf>. Accessed May, 10, 2020 https://uroweb.org/wp-content/uploads/EA...
). |
Metastatic castration-resistant prostate cancer
|
ADT 6-months formulations must be maintained. |
ADT maintenance is the current standard of care ( 1515. Mohler JL, Antonarakis ES, Armstrong AJ, D’Amico AV, Davis BJ, Dorff T, et al. Prostate Cancer, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2019; 17:479-505. , 1616. Mottet N, Cornford P, van den Bergh RCN, Briers E, De Santis M, Fanti F, et al. Prostate Cancer. EAU Guidelines Associates. [Internet]. Available at. <https://uroweb.org/guideline/prostate-cancer/>. https://uroweb.org/guideline/prostate-ca...
). |
Consider combination castration therapy with the new hormonal treatments (abiraterone, enzalutamide). |
These drugs have demonstrated benefits in terms of survival compared to ADT alone ( 2929. de Bono JS, Logothetis CJ, Molina A, Fizazi K, North S, Chu L, et al. Abiraterone and increased survival in metastatic prostate cancer. N Engl J Med. 2011; 364:1995-2005. , 3030. Ryan CJ, Smith MR, Fizazi K, Saad F, Mulders PF, Sternberg CN, et al. Abiraterone acetate plus prednisone versus placebo plus prednisone in chemotherapy-naive men with metastatic castration-resistant prostate cancer (COU-AA-302): final overall survival analysis of a randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol. 2015; 16:152-60.
31. Scher HI, Fizazi K, Saad F, Taplin ME, Sternberg CN, Miller K, et al. Increased survival with enzalutamide in prostate cancer after chemotherapy. N Engl J Med. 2012; 367:1187-97. - 3232. Beer TM, Armstrong AJ, Rathkopf DE, Loriot Y, Sternberg CN, Higano CS, et al. Enzalutamide in metastatic prostate cancer before chemotherapy. N Engl J Med. 2014; 371:424-33. ). |
Prefer enzalutamide to abiraterone. |
Effect of corticosteroids in population infected with SARS-CoV-2 is not yet clear ( 55. [No authors]. British Association of Urological Surgeons. COVID-19 strategy for the Interim management of Prostate Cancer Prepared by the BAUS Section of Oncology. 2020. Available at. https://caunet.org/wp-content/uploads/2020/04/BAUS-OncologyCOVID-19-Prostate.pdf. Accessed May, 10, 2020 https://caunet.org/wp-content/uploads/20...
, 2727. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020; 323:1061-9. ). |
Avoid CTx. |
CTx is associated with hematological toxicity and implies multiple visits to the hospital ( 66. Ribal MJ, Cornford P, Briganti A, Knoll T, Gravas S, Babjuk M, et al. European Association of Urology Guidelines Office Rapid Reaction Group: An Organisation-wide Collaborative Effort to Adapt the European Association of Urology Guidelines Recommendations to the Coronavirus Disease 2019 Era. Eur Urol. 2020: S0302-2838, 30324-9. Available at. <https://uroweb.org/wp-content/uploads/EAU-Guidelines-OfficeRapid-Reaction-Group-An-organisation-wide-collaborativeeffort-to-adapt-the-EAU-guidelines-recommendations-tothe-COVID-19-era.pdf>. Accessed May, 10, 2020 https://uroweb.org/wp-content/uploads/EA...
). |
Avoid Immunotherapy (Sipuleucel-T). |
Sipuleucel-T might cause cytokine release while cytokines as IL-6 have been directly related to the most aggressive forms of COVID-19 (4, 3434. Mulders PF, De Santis M, Powles T, Fizazi K. Targeted treatment of metastatic castration-resistant prostate cancer with sipuleucel-T immunotherapy. Cancer Immunol Immunother. 2015; 64:655-63. ). |
Avoid Radium-223. |
Radium-223 is associated with overall survival benefit by 3,6 (in the absence of visceral metastases) compared to ADT alone, but it is also associated to hematologic toxicity ( 3535. Parker C, Nilsson S, Heinrich D, Helle SI, O’Sullivan JM, Fosså SD, et al. Alpha emitter radium-223 and survival in metastatic prostate cancer. N Engl J Med. 2013; 369:213-23. ). |
Avoid starting denosumab or zoledronic acid. |
Denosumab or zoledronic acid have no impact on overall survival but could generate osteonecrosis of the jaw or hypocalcaemia ( 3636. Smith MR, Saad F, Coleman R, Shore N, Fizazi K, Tombal B, et al. Denosumab and bone-metastasis-free survival in men with castration-resistant prostate cancer: results of a phase 3, randomised, placebo-controlled trial. Lancet. 2012; 379:39-46. , 3737. Saad F, Gleason DM, Murray R, Tchekmedyian S, Venner P, Lacombe L, et al. A randomized, placebo-controlled trial of zoledronic acid in patients with hormone-refractory metastatic prostate carcinoma. J Natl Cancer Inst. 2002; 94:1458-68. ). |
In those patients under treatment, denosumab may be maintained while zoledronic acid should be delayed. |
Denosumab can be administrated in its monthly subcutaneous formulation while zoledronic acid requires monthly hospital intravenous administration. |