Dr Zhang on Topics of Ongoing Debate Within Prostate Cancer

Tian Zhang, MD, MHS, associate professor, Department of Internal Medicine, Harold C. Simmons Comprehensive Cancer Center, University of Texas (UT) Southwestern Medical Center, discusses key topics of ongoing discussion within the realm of prostate cancer management.

At the United States Prostate Cancer Conference, oncologists discussed unanswered questions and key areas of debate within the field of prostate cancer, Zhang begins.

One topic of considerable discourse is biochemical recurrence, particularly with the introduction of PSMA-PET scans, Zhang says. This imaging modality has introduced a paradigm shift in the approach to early metastatic disease detection by providing enhanced visualization and localization of disease sites; this has prompted discussions on its optimal integration into clinical practice and its potential impact on treatment decision-making, she explains.

Another area of debate has surrounded the use of PARP inhibitors combined with androgen receptor (AR) inhibitors in prostate cancer, Zhang adds. Discussions have focused on determining the most effective sequencing and timing of these therapies, particularly in patients who have previously received AR-targeted therapy. Understanding the optimal utilization of these combination regimens is crucial for maximizing treatment efficacy and improving patient outcomes, Zhang states.

Additional discussions have centered around the role of primary tumor radiation in metastatic hormone-sensitive prostate cancer (mHSPC), Zhang continues. There has been debate surrounding the criteria for selecting patients who would benefit from this intervention, as well as its potential impact on disease progression and overall survival outcomes.

Lastly, the appropriate timing and intensification of therapy in the early stages of the disease, including the use of doublet or triplet therapies, is still being deliberated, Zhang notes, adding that the advent of PSMA-PET scans has also prompted discussions on defining high-volume vs low-volume mHSPC. These discussions aim to refine treatment approaches and optimize outcomes for patients with prostate cancer, taking into account factors such as disease volume, risk stratification, and individual patient characteristics.

Overall, these discussions underscore the dynamic nature of prostate cancer management, driven by advancements in imaging technologies, therapeutic options, and evolving clinical evidence.