Dr Morgans on Considerations for Treating nmCRPC in the Community Setting

Alicia Morgans, MD, MPH, genitourinary medical oncologist, medical director, Survivorship Program, Dana-Farber Cancer Institute, and associate professor of medicine, Harvard Medical School, discusses considerations for oncologists treating patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) in the community setting.

Morgans presented findings at the 2024 ASCO Annual Meeting from a follow-up analysis of the phase 3 ARAMIS trial (NCT02200614) which evaluated androgen deprivation therapy (ADT) in combination with darolutamide (Nubeqa) or placebo for patients with nmCRPC.

Throughout the study, prostate-specific antigen (PSA) levels were routinely measured and imaging was conducted every 16 weeks in order to compare the cumulative incidence of time to radiologic progression with PSA levels. Time to radiologic progression was compared between patients with PSA levels of less than 0.2 ng/mL and those with higher PSA levels. Patients who had radiological progression also had PSA levels measured at the time of progression

Results demonstrated that patients treated with darolutamide achieved PSA levels less than 0.2 ng/mL at a higher rat compared with those who received ADT plus placebo. Additionally, results found that disease progression was detected by CT or bone scans before the patient developed PSA progression.

Morgans emphasizes the limitations of relying solely on PSA levels for monitoring disease progression in patients with nmCRPC, as these results may provide an incomplete picture of the disease. To gather a more comprehensive understanding of a patient’s disease state, Morgans advocates for community oncologists to request updated imaging every 6 to 12 months. This proactive approach allows for the early detection of disease progression that might not be reflected by PSA levels alone, she says.

Additionally, Morgans emphasizes the need for heightened vigilance in monitoring patients who do not achieve a deep PSA response—specifically, those who do not reach a PSA level of less than 0.2 ng/mL initially. These patients are at a higher risk of recurrence and thus require more intensive follow-up, which is crucial in ensuring timely intervention in the case of disease progression, she concludes.