Integrating CHAARTED Findings Into Prostate Cancer Care

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The phase III randomized CHAARTED trial demonstrated a high-level of response with the addition of chemotherapy to androgen deprivation therapy (ADT) as a treatment for patients with hormone-sensitive metastatic prostate cancer. In the study, the combination resulted in a median overall survival (OS) of 57.6 months compared with 44 months in the ADT-alone arm (HR = 0.61; P = .0003). Additionally, in patients with high-volume disease, the median OS was 49.2 months with the combination versus 32.2 months with ADT alone.

Although findings from the CHAARTED trial are practice changing, the patient population studied comprises only a small subset of those being treated for prostate cancer, Kenneth Kernen, MD, explains. In the United States, this subset constitutes approximately 5% of patients with prostate cancer, Neal D. Shore, MD, states. Despite the small size of this population, patients who develop hormone-sensitive metastatic prostate cancer make up approximately 20% to 40% of the roughly 30,000 men who die annually from prostate cancer.

The detection of patients for the combination of ADT and chemotherapy is reliant on the detection of metastatic disease using proper imaging. Many urologists wait until their patient has a PSA level above 20 before utilizing scans, Christopher Pieczonka, MD, suggests. However, this strategy does not take advantage of the opportunity to use treatment earlier. Patients with a PSA above 2 should have some form of imaging conducted, Pieczonka believes. PSA velocity and doubling time should be utilized for future scans, rather than a single reading.