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Published in Advanced Prostate Cancer

Expert Opinion / Cases · April 16, 2021

Adenocarcinoma of Prostate Gleason 5+5

Written by
Pedro C. Barata MD

 

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  • Waleed Ragab

    Apr 23, 2021

    Enzalutamid

  • Kenneth Chen

    Apr 23, 2021

    The presence of a BRCA2 mutation tells us he would benefit from the PARPI, however indication is only in the mCRPC space. I would offer docetaxel for this patient based on the aggressive histology, high volume disease including viscera involvement and considering his good performance status.

  • Jose Luis Soto Rodriguez

    Apr 23, 2021

    docetaxel x6 cycles

  • Hadi Molana

    Apr 23, 2021

    Olaparib

  • Muho Ahmed

    Apr 23, 2021

    Olaparib

  • Rene Henriquez

    Apr 23, 2021

    Docetaxel 6cycles

  • Thomas Zahreddin

    Apr 23, 2021

    olaparib

  • Kazuyuki Sagiyama

    Apr 23, 2021

    Docetaxel 6cycles

  • Bahram Mofid

    Apr 23, 2021

    Docetaxel×6

  • Luis Barreras

    Apr 23, 2021

    Use docetaxel

  • Abdelhamid Sabaa

    Apr 23, 2021

    Both Enzalutamide and Arbiraterone + Prednisolone are suitable alternatives. I would suggest keeping the Docetaxel for relapses

  • Sava Micic

    Apr 23, 2021

    Docetaxel 6 cycles

  • Oscar Londono

    Apr 23, 2021

    Docetaxel

  • Charles Maack

    Apr 23, 2021

    Enzalutamide (Xtandi), but if not effective, olaparib (Lynparza) or rucaparib (Rubraca), and if still not effective, docetaxel plus carboplatin x6 cycles. If all not effective but patient still mobile, possibly pembrolizumab (Keytruda).

  • John Ochai

    Apr 23, 2021

    Docetaxel 6 cycles
The patient is young and with good performance status so should be offered upfront Docetaxel chemotherapy

  • Saad Benjelloun

    Apr 23, 2021

    Enzalutamide

  • emine sevil bavbek

    Apr 23, 2021

    Docetaxel 6 cycles. Tempted to add platinum with the BRCA mutation, but no data in the HAPC setting

  • Luis Felipe Lara Moscoloni

    Apr 23, 2021

    1 enzalutamide
2 olaparib
3 docetaxel

  • Charles Maack

    Apr 23, 2021

    Two research comments:
Germline BRCA2 carriers who received first-line abiraterone or enzalutamide (Xtandi, Astellas) vs. taxanes had longer cause-specific survival (24 months vs. 17 months) and PFS2 (18.9 months vs. 8.6 months).  
Patients with metastatic castration-resistant prostate cancer and harboring germline mutations in BRCA1/2 and ATM benefit from treatment with abiraterone and enzalutamide

  • Charles Maack

    Apr 23, 2021

    In any event, a prognosis for a patient with the status identified is, unfortunately, not good despite the good intentions of suggested therapies.

  • Syamsu Hudaya

    Apr 24, 2021

    Docetaxel 6x

  • farhood khaleghi mehr

    Apr 24, 2021

    docetaxel×6

  • Antonio Rosino-Sánchez

    Apr 24, 2021

    apalutamide or enzalutamide. Chemo after progression (docetaxel plus platin based).  Olaparib if progression after chemo

  • Manuel Ossa

    Apr 28, 2021

    doxetacel x 6 cycles

  • Khoury Elie

    Apr 29, 2021

    Olaparib

  • Rosanna Mirabelli

    Apr 29, 2021

    docetaxel  (alto rischio alto volume)

  • Oliver Sartor

    May 07, 2021

    More clinical trial clearly needed in this space....one day we may add a PARP inhibitor. The ADT + "novel hormones" gives a better PFS than ADT + docetaxel.....buying more time until progression allows to be more creative in the future. This patient may respond well to DNA damaging agents like Lu-177 tagged to PSA targeting agents. Would be great to get the trial open with ADT + novel hormone +/- PSMA Lu-177

  • Charles Maack

    May 07, 2021

    Dr. Sartor’s recommendation for Lutetium-177 PSMA is certainly one of the best approaches in this case once approved by the FDA.  Currently, this treatment is only approved for use in Germany, with a few other countries prescribing as a novel treatment option. So far with Phase III of the VISION trial, the intermediate results demonstrate that Lutetium-177 PSMA therapy leads to a significant improvement in biochemical and radiological parameters, improves the quality and general life expectancy of patients with metastatic prostate cancer. According to statistics obtained during the relevant international VISION and LuPSMA trials, the use of Lutetium-177 leads to a significant improvement in the results of laboratory tests and PET-CT (more than 57% of patients), and also improves quality (more than 70% of patients) and expectancy of life (more than 45% of patients).

  • selcuk seber

    Sep 27, 2021

    cabazitaxel carboplatin combination since this patient is very high risk and organ metastatic disease is a surrogate marker for relative anti hormonal therapy resistance . Although the pathology did not report the existence of neuroendocrine features further molecular diagnostics will probably reveal Rb and p53  Co existence. In any case at least carboplatin should have a place in the first line treatment of this patient.

  • Prasanta Kumar Pradhan

    Apr 03, 2022

    Lu-177 PSMA therapy seems to be a better therapeutic choice in this scenario.

  • Aug 17, 2022

    Pending Moderator approval.
    Delete

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