Hormone-sensitive prostate cancer
De novo HSPC accounts for 50% of prostate cancer–related deaths
At initial diagnosis, localized prostate cancer has a 5-year relative survival rate of 100%; however, if a person is initially diagnosed with de novo metastatic prostate cancer, the 5-year relative survival rate is 37.9%. De novo metastatic hormone-sensitive prostate cancer (HSPC) makes up 5–10% of prostate cancer diagnoses. HSPC is characterized as androgen sensitive, meaning it is a stage of prostate cancer that still responds to androgen therapy.
Supporting better outcomes in HSPC
Healthcare professionals play a pivotal role in optimizing HSPC care. Key responsibilities include:
- Initial risk assessment for prostate cancer, including assessment of prostate-specific antigen (PSA), digital rectal examination (DRE) and life expectancy, family history, and ethnicity
- Risk stratification using Gleason score and/or International Society of Urological Pathology (ISUP) groups, PSA levels and kinetics, and genomic testing
- Tailored therapy based on disease burden, comorbidities, high-risk features, and patient preferences
- Monitoring for progression to castration-resistant prostate cancer (CRPC), which requires a shift in treatment strategy
- Managing side effects of hormone therapy, such as fatigue, sexual dysfunction, and loss of bone density
A multidisciplinary approach, engaging urologists, radiation and medical oncologists, pathologists, nurses, pharmacists, and more is essential to deliver personalized, evidence-based care.
Frequently asked questions
Why is it important to assess risk in HSPC?
Accurate risk assessment in HSPC is essential to minimize overdiagnosis and overtreatment, and to balance quality of life with the avoidance of disease progression. As progression to CRPC is expected in nearly all patients with HSPC, stratifying risk is key to identifying those at high risk and guiding appropriate treatment.
What treatment options are available for HSPC?
Treatment options for non-metastatic HSPC include androgen deprivation therapy (ADT), radiotherapy with or without ADT, radical prostatectomy, and androgen-receptor pathway inhibitors (ARPIs) with or without ADT for biochemical recurrence at high risk of metastasis.
For metastatic HSPC, treatment options have expanded beyond ADT alone to include doublet or triplet therapy using various combinations of ADT, CYP17 inhibitors, ARPIs, and/or chemotherapy.
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