Search

In recent years, the armamentarium of life-prolonging systemic agents for metastatic castration-resistant prostaste cancer (mCRPC) has been expanded with radium-223 (Ra-223), abirateron, enzalutamide and cabazitaxel. Since 2013, Ra-223 is approved in the European Union as a Targeted alpha Therapy (TaT) for the treatment of patients with mCRPC and symptomatic bone metastases. Recently issued recommendations by a European expert group for the optimal usage of all life-prolonging treatment options for mCRPC position Ra-223 as a relevant option for second- and third-line treatment after androgen receptor inhibitors and/or docetaxel. This review paper summarizes these recommendations. It also describes real-world experience with Ra-223 accumulated in recent years and provides outlines of the most important recently completed or ongoing clinical trials of Ra-223 in combination with docetaxel, androgen receptor inhibitors, immunomodulatory anticancer agents or PARP inhibitors. The possible future application of PSMA-directed radioligand therapy in prostate cancer is briefly outlined. [ABSTRACT FROM AUTHOR]

At this moment, germline genetic testing is rarely requested in patients with prostate cancer. However, a breast cancer gene mutation is frequently detected in men with metastasized prostate cancer (mainly in BRCA2). In this paper we propose criteria for genetic testing in prostate cancer. Genetic test results may have major implications for relatives who may take appropriate measures to prevent cancer or diagnose it at an early stage. It may also have direct relevance for the treatment of the patient. It is time to set up a new workflow enabling treating physicians to order a DNA test (mainstreaming of genetic testing). It calls for close collaboration between clinical geneticists and treating physicians, and adequate education of urologists, oncologists and specialized nurses. [ABSTRACT FROM AUTHOR]