HOLLYWOOD, Florida — For men with castration-resistant prostate cancer (CRPC), treatment options are still far from ideal; however, a handful of new and emerging therapies might help stave off disease progression and improve overall survival, according to those involved in updating National Comprehensive Cancer Network (NCCN) prostate cancer guidelines.
"The time period is often measured in decades from the time a man is diagnosed, and the good news is that many men are still living longer than their physicians," said Andrew J. Armstrong, MD, ScM, from the Duke Cancer Institute in Durham, North Carolina.
The most significant changes reflected in the NCCN guidelines are in recommendations for systemic therapies in men with metastatic CRPC, Dr Armstrong said here at the here at the NCCN 20th Annual Conference.
"This term 'castration-resistant disease' really evolved over the past several decades — from 'endocrine refractory' to 'androgen independent' to 'hormone-refractory disease' — based on new information around disease biology. This biology has indicated that the androgen receptor remains a key target in this disease," he explained.
In a 2010 study, Dr Armstrong and his colleagues found that four major prognostic markers can be used to stratify men with CRPC into risk categories predictive of overall survival: pain requiring opiates for control, visceral metastases, the presence of new bone lesions on bone scan, and anemia (Eur J Cancer. 2010;46:517-525).
Table. Association Between Risk Factors and Overall Survival
|Number of Risk Factors||Risk Category||Overall Survival, Months|
|0 or 1||good||25.7|
|3 or 4||poor||12.8|