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Adenocarcinoma of Prostate Gleason 5+5
- Written by
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Pedro
C.
Barata
MD
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Waleed Ragab
Enzalutamid
Kenneth Chen
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
docetaxel x6 cycles
Hadi Molana
Olaparib
Muho Ahmed
Olaparib
Rene Henriquez
Docetaxel 6cycles
Thomas Zahreddin
olaparib
Kazuyuki Sagiyama
Docetaxel 6cycles
Bahram Mofid
Docetaxel×6
Luis Barreras
Use docetaxel
Abdelhamid Sabaa
Both Enzalutamide and Arbiraterone + Prednisolone are suitable alternatives. I would suggest keeping the Docetaxel for relapses
Sava Micic
Docetaxel 6 cycles
Oscar Londono
Docetaxel
Charles Maack
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
Docetaxel 6 cycles The patient is young and with good performance status so should be offered upfront Docetaxel chemotherapy
Saad Benjelloun
Enzalutamide
emine sevil bavbek
Docetaxel 6 cycles. Tempted to add platinum with the BRCA mutation, but no data in the HAPC setting
Luis Felipe Lara Moscoloni
1 enzalutamide 2 olaparib 3 docetaxel
Charles Maack
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
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
Docetaxel 6x
farhood khaleghi mehr
docetaxel×6
Antonio Rosino-Sánchez
apalutamide or enzalutamide. Chemo after progression (docetaxel plus platin based). Olaparib if progression after chemo
Manuel Ossa
doxetacel x 6 cycles
Khoury Elie
Olaparib
Rosanna Mirabelli
docetaxel (alto rischio alto volume)
Oliver Sartor
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
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).