Pt on LHRH agonist for PSAonly recurrence dvlps pain and bone, lung mets after 2y. Tx?


Pt on LHRH agonist for PSA-only recurrence dvlps pain and bone, lung mets after 2y. Tx?

An otherwise healthy 62-year-old man receiving an LHRH agonist for PSA-only recurrent prostate cancer develops pain, recent weight loss and extensive bony and pulmonary metastases 2 years later. What treatment would you likely recommend (with or without bone-targeted treatment)?

How would you care for the same patient if he were 80 years old?

 

Bracarda S et al. Clinical implications for a treatment algorithm and differential indication to hormone therapy and chemotherapy options in metastatic castrate-resistant prostate cancer: A personal view. Expert Rev Anticancer Ther 2014;14(11):1283-94. Abstract

Fizazi K et al. Denosumab versus zoledronic acid for treatment of bone metastases in men with castration-resistant prostate cancer: A randomised, double-blind study. Lancet 2011;377(9768):813-22. Abstract

Graff JN et al. Pharmacotherapeutic management of metastatic, castration-resistant prostate cancer in the elderly: Focus on non-chemotherapy agents. Drugs Aging 2014;[Epub ahead of print]. Abstract

Gravis G et al. Androgen-deprivation therapy alone or with docetaxel in non-castrate metastatic prostate cancer (GETUG-AFU 15): A randomised, open-label, phase 3 trial. Lancet Oncol 2013;14(2):149-58. Abstract

James ND et al. Survival with newly diagnosed metastatic prostate cancer in the “docetaxel era”: Data from 917 patients in the control arm of the STAMPEDE trial (MRC PR08, CRUK/06/019). Eur Urol 2014;[Epub ahead of print]. Abstract

Lipton A et al. Superiority of denosumab to zoledronic acid for prevention of skeletal-related events: A combined analysis of 3 pivotal, randomised, phase 3 trials. Eur J Cancer 2012;48(16):3082-92. 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.

van Soest RJ et al. Cross-resistance between taxanes and new hormonal agents abiraterone and enzalutamide may affect drug sequence choices in metastatic castration-resistant prostate cancer. Eur J Cancer 2013;49(18):3821-30. Abstract