Journal de la science et de la recherche sur le cancer
Libre accès
ISSN: 2576-1447
ISSN: 2576-1447
Wafaa Kaikani
PROSTATE cancer (PC) is the second most frequent cancer in males. Based on GLOBOCAN 2018 estimates, 1,356,176 new cases of prostate cancer and a mortality of 378,553 are expected in 20201. Despite an overall 5-year survival rate of 98.2%, mHSPC has a dismal 30% 5-year survival rate2. Metastatic hormone-sensitive prostate cancer (mHSPC) is the disease space whereby men have metastatic prostate cancer and have never received (ie. are sensitive to) androgen deprivation therapy (ADT). mHSPC previously constituted ~30% of prostate cancer cases , however, from 2004-2012 secondary to PSA testing, the estimate was ~5% of cases in USA3. Many experts in the field suggest that with decreased PSA screening over the last few years, as a result of the United States Preventative Services Task Force (USPSTF) Grade D recommendation for PSA screening (subsequently upgraded to C 4), that these estimates are likely to once again increase 5. At diagnosis, 77% of prostate cancer cases are localized; in 13%, the cancer has spread to regional lymph nodes, and 6% have distant metastasis. The 5-year relative survival rate for localized and regional prostate cancer is 100%, compared with 30.5% for metastatic cases. 2Conventional treatment of mHSPC has been ADT since the land- mark discovery by Huggins and Hodges in 1941 demonstrating the hormonal sensitivity of PC. Since 2015; we have seen several landmark trials published that have added therapies to ADT for these men, favorably impacting overall survival (OS). Men are now faced with decisions of androgen-deprivation therapy alone or combinations with either docetaxel, abiraterone, enzalutamide, or apalutamide, and there are now additional complex decisions around triple combination or sequential therapy with induction androgen-deprivation therapy/docetaxel plus a potent androgen-re- ceptor inhibitor or whether single-agent chemotherapy or androgen-receptor inhibitor use with androgen-deprivation therapy is sufficient. These decisions are presently based on costs, availability and approvals, disease risk/volume, patient age and comorbidity, and of course shared decision-making. This article will discuss the effect of docetaxel and inhibitors of androgen signaling developed in the past 5 years among men with mHSPC and review the subsequent literature following reporting of these trials.