Dr. Stadler on Sequencing Therapies in Prostate Cancer

Walter M. Stadler, MD, Fred C. Buffett Professor of Medicine and Surgery, chief of the Section of Hematology/Oncology, and director of the Genitourinary Program at the University of Chicago Medicine, discusses sequencing therapies in prostate cancer.

Prostate cancer is becoming quite complicated in terms of sequencing therapy, notes Stadler. The main question that often surfaces is regarding patients who have early castration-resistant prostate cancer (CRPC), and those who have disease progression after standard androgen ablation. In that setting, physicians are beginning to see the entrance of sipuleucel-T (Provenge). Physicians also have access to second-line androgen receptor targeted therapies, hormone therapies, and chemotherapies. Other targeted therapies for specific subsets such as PARP inhibitors in patients with DNA repair mutations are emerging, adds Stadler.

It is not always clear what to use first, explains Stadler, though there is a tendency to use second-line hormonal therapies in early CRPC. Another emerging marker is the androgen receptor splice variant AR-V7, which may help guide treatment choices in the future.