A 76-Year-Old Man With Recurrent Castrate-Sensitive Prostate Cancer - Episode 4
The importance of risk stratifying patients with hormone-sensitive prostate cancer, and recommendations for germline and somatic testing.
Nicholas Vogelzang, MD, FASCO, FACP: If we think about using a full androgen receptor-targeted therapy, in this case we are getting the leuprolide and apalutamide regimen, that gives us options for care. When he relapses, which is hopefully not for a long time, we still have docetaxel, we have radium, and we have sipuleucel-T. I should also mention that this patient should have at least some attempt made to obtain BRCA-targeting data. We should know whether he has PARP inhibition therapy options. I always tend to get germline testing and somatic testing done. I routinely get germline testing done, and I get somatic testing done on the tissue itself, so if he relapses down the road, then I have the opportunity for both olaparib and rucaparib therapies, depending upon which DNA repair deficiency enzyme the patient has. For example, I saw a patient the other day who has Bloom syndrome, and he has a rapid PSA [prostate-specific antigen] doubling time, so I am preparing to give him olaparib if his symptoms rapidly worsen. That is the treatment planning sequence, if you will.
Transcript edited for clarity.
Case: A 76-Year-Old Male With Recurrent Castrate-Sensitive Prostate Cancer
Treatment and Follow-Up