Dr Dreicer on the Complexities of Prostate Cancer

Robert Dreicer, MD, deputy director, director, solid tumor oncology, Division of Hematology/Oncology, professor, medicine and urology, the University of Virginia Cancer Center, discusses the overall goal of his presentations, “From PSA Failure to Hormone Sensitive Metastatic Prostate Cancer?” and “CRPC: Start of the Art,” given at 17th Annual Interdisciplinary Prostate Cancer Congress® and Other Genitourinary Malignancies, highlighting a case study in prostate cancer.

The goal of the presentations was to provide an overview of the complexities of prostate cancer, Dreicer begins, adding that he highlighted the disease’s heterogeneity and the diversity among the oncologists who manage it. By discussing cases that reflect the broad spectrum of prostate cancer, Dreicer states that he set the stage for more detailed conversations and case-based discussions during the meeting.

In the metastatic castration-resistant prostate cancer setting, Dreicer focused on the factors that make advanced prostate cancer unique compared with other solid tumors, particularly in terms of treatment sequencing. Treating oncologists have limited data guiding appropriate treatment sequences, and treatment approaches can vary significantly depending on whether a patient is managed by a urologist, a medical oncologist, or a genitourinary medical oncologist, he explains. Although this variability may be acceptable in the absence of strong evidence, it’s not ideal for patient care, Dreicer adds.

One case study that Dreicer highlighted in the presentations involved a patient with locally advanced disease, which typically requires multimodality therapy for the best chance of cure. The challenge here lies in integrating next-generation imaging, like prostate–specific membrane antigen [PSMA] PET CT, into treatment decisions, he says. These imaging results may suggest more distant disease, raising questions about whether to pursue curative-intent strategies based on historical imaging approaches or adapt based on the new imaging findings, despite the lack of evidence from current trials that include PSMA PET imaging, according to Dreicer. This represents a real-world challenge in managing prostate cancer today, Dreicer concludes.