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62 yo w/ extensive bone mets, PSA 50 ng/mL, minimal complaints of pain (PS = 0)?62 yo w/ extensive bone mets, PSA 50 ng/mL, minimal complaints of pain (PS = 0)?A 62-year-old man with a good performance status (PS = 0) presents de novo with a PSA of 50 ng/mL and extensive bony metastases but has only minimal complaints of pain. What systemic treatment approach would you generally recommend, and what bone-targeted treatment, if any, would you recommend at this time? Hoskin P et al. Efficacy and safety of radium-223 dichloride in patients with castration-resistant prostate cancer and symptomatic bone metastases, with or without previous docetaxel use: A prespecified subgroup analysis from the randomised, double-blind, phase 3 ALSYMPCA trial. Lancet Oncol 2014;15(12):1397-406. Abstract Parker C et al; ALSYMPCA Investigators. Alpha emitter radium-223 and survival in metastatic prostate cancer. N Engl J Med 2013;369(3):213-23. Abstract Sartor O et al. Effect of radium-223 dichloride on symptomatic skeletal events in patients with castration-resistant prostate cancer and bone metastases: Results from a phase 3, double-blind, randomised trial. Lancet Oncol 2014;15(7):738-46. Abstract Smith MR et al. Denosumab and bone-metastasis-free survival in men with castration-resistant prostate cancer: Results of a phase 3, randomised, placebo-controlled trial. Lancet 2012;379(9810):39-46. Abstract Sweeney C et al. Impact on overall survival (OS) with chemohormonal therapy versus hormonal therapy for hormone-sensitive newly metastatic prostate cancer (mPrCa): An ECOG-led phase III randomized trial. Proc ASCO 2014;Abstract LBA2. |