Prostate cancer - Emerging treatments

Androgen replacement

Despite the widely held belief that testosterone replacement is contraindicated in men with known or suspected prostate cancer, there is no convincing evidence that the normalization of testosterone serum levels in men with low but not castrate levels is deleterious. Testosterone therapy may be a viable option for selected men with prostate cancer suffering from testosterone deficiency.[382][383]

Vascular-targeted photodynamic (VTP) therapy

In one phase 3 trial of 413 men with low-risk prostate cancer, the incidence of negative prostate cancer biopsy was higher among those receiving VTP therapy with the photosensitizer padeliporfin compared with active surveillance (49% vs. 14%) at 24 months.[384] VTP therapy with padeliporfin also delayed time to progression. The most common adverse effects include dysuria, hematuria, and erectile dysfunction. At 4-year follow-up, patients receiving VTP were significantly less likely to report higher-grade cancer (on biopsy) than the active surveillance cohort.[385] VTP with padeliporfin is approved in Europe for men with previously untreated, unilateral, low-risk prostate cancer with a life expectancy of at least 10 years.[386]

5-alpha reductase inhibitors

In a randomized trial of men with low-risk prostate cancer who were undergoing active surveillance, use of dutasteride reduced the risk of prostate cancer progression compared with placebo.[387] Continued use of a 5-alpha reductase inhibitor during active surveillance does not appear to be associated with risk of reclassification.[388]

Poly (ADP-ribose) polymerase (PARP) inhibitors plus abiraterone for patients with metastatic castration-resistant disease regardless of mutation status

Olaparib plus abiraterone is approved for patients with BRCA-mutated metastatic castration-resistant prostate cancer, but may also be of benefit in patients without a homologous recombination repair (HRR) gene mutation.[389][390] The Food and Drug Administration has granted priority review for olaparib in combination with abiraterone for patients with metastatic castration-resistant prostate cancer, regardless of HRR mutation status.[345]

Docetaxel plus EBRT plus ADT for high-risk disease

Addition of docetaxel to external beam radiation therapy (EBRT) plus androgen deprivation therapy (ADT) has been shown to improve relapse-free survival and overall survival in patients with high-risk disease.[391][392][393][394] However, many high-risk patients are older patients and would not be suitable for docetaxel due to its toxicity profile.