Dr. Hwang on Treatment Selection in Metastatic Castration-Sensitive Prostate Cancer

Clara Hwang, MD, a medical oncologist with Henry Ford Health System, discusses treatment selection in newly diagnosed metastatic castration-sensitive prostate cancer (mCSPC).

In addition to volume of disease, toxicity should be taken into account when deciding between hormonal therapy and chemotherapy, as chemotherapy and hormonal therapies have different safety profiles, says Hwang. With docetaxel, some patients need to be monitored for infections, which can potentially be fatal. Additionally, patients who receive docetaxel should be healthier than those who are given one of the hormonal therapies.

Among the hormonal therapies, enzalutamide (Xtandi) can result in seizures. Patients on apalutamide (Erleada) or enzalutamide should be monitored for potential central nervous system toxicity, adds Hwang. Patients on abiraterone acetate (Zytiga) should also be monitored for cardiac toxicity and liver function, as this treatment can lead to elevated liver enzymes. Darolutamide (Nubeqa), one of the newer antiandrogens, may not have that toxicity; however, more mature data are needed to confirm the agent’s safety profile.

The patient’s comorbidities and overall health are also factored into the treatment decision. If financial toxicity is also a concern, the length of therapy can weigh into the decision as well, concludes Hwang.