Transcript: Emerging evidence in HSPC
Axel Merseburger, MD, PhD
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There is a lot of evidence and a lot of late developments in hormone-sensitive prostate cancer. So, we have a lot of publications in this field, and I think the standard nowadays is not only ADT anymore in non-metastatic hormone-sensitive prostate cancer, high-risk and biochemical recurrence situation. We have an RP, enzalutamide approved to treat this potentially deadly disease.
When it comes to metastatic hormone-sensitive prostate cancer, we have several options divided into doublet therapy or triplet therapy in combination with chemotherapy docetaxel where we have to decide and discuss with the patient what they want, patient preferences, and also with regards to the disease volume and stage, what is best for the patient.
Doublet therapy or triplet has definitely replaced the ADT monotherapy in metastatic hormone-sensitive prostate cancer, which is not a standard anymore since more than 10 years, ever since Chris Sweeney has published the CHAARTED trial. Since then, we have two hands of publications really setting the scene in this situation of advanced prostate cancer. Recently also, quality of life data have been published. That's why I avoid to talk about treatment intensification because it sounds like intense treatment with deterioration of quality of life, which is not true. We have seen published evidence on RP treatment, doublet treatment that the quality of life is better when treatment, not intensification, but let's call it optimization, is done.
Because it has an effect on the PSA, we've seen good data on ultra low PSA. The faster, the deeper the PSA drops, the better the response, the better the overall and longtime prognosis for this man treated with doublet treatment, ADT and an RP. Or even with triplet treatment, we've seen also low PSA data. The future is definitely PSMA PET or it's already there. PSMA PET for detecting metastasis or metastatic disease and to accurately stage the patient. And then, we have developments in PSMA-targeted radioligand therapy. We have approval in some countries for the radioligand therapy in mCRPC. It's not approved yet in hormone-sensitive prostate cancer.
So, we will have to await further trials in this situation. And we have also ongoing studies looking at the use of PARP inhibitors and PARP inhibitor combinations in metastatic hormone-sensitive prostate cancer. And this is also, especially for the man with an HRR mutation. For example, a BRCA alteration, BRCA1 or BRCA2. Some promising approach that has to be further investigated because we have approval in mCRPC. And now, a lot of the substances are moving earlier, but we have to await the evidence, approval status. But a very exciting field in non-metastatic hormone-sensitive prostate cancer. In the biochemical recurrence situation, there's a lot going on. And especially in metastatic hormone-sensitive prostate cancer, we have gold standards like doublet and triplet.
We should avoid ADT monotherapy and low volume oligometastatic disease radiation to the primary, to the prostate. Still, it's recommended prostatectomy and metastatic disease does not play a role only in clinical trials. So as said, a lot of evidence already there and some exciting developments in hormone-sensitive advanced prostate cancer. I thank you very much for your attention. I'm looking forward to meet you in person at the next conference.
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MA-MM-16217, August 2025.