Two Onc Docs Metastatic Prostate Cancer x Dr. Charles Ryan 2025 UPDATE
8 snips
Mar 24, 2025 Dr. Charles Ryan, a leading GU oncologist from MSK in NYC, returns to share vital updates on metastatic prostate cancer. He discusses the differences between castrate-sensitive and castrate-resistant prostate cancer, crucial for treatment strategies. Advancements like PARP inhibitors and immunotherapy take center stage, alongside the necessity for genomic testing. Ryan emphasizes learning from clinical trials, whether outcomes are positive or negative. He also inspires future oncologists by showcasing the stunning progress in cancer treatment, blending research with heartfelt encouragement.
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Castrate Sensitive Vs Castrate Resistant
- Castrate sensitive disease grows with normal testosterone while castrate resistant grows with low testosterone levels.
- FDA defines castrate testosterone as below 50 ng/dL, though clinicians often see levels <30 ng/dL.
Use Upfront Intensification For De Novo Disease
- Intensify upfront ADT for de novo metastatic disease by adding a second agent like an ARPI or docetaxel.
- Triplet therapy (ADT+docetaxel+darolutamide/abiraterone) is also a defensible option for qualifying patients.
Treatment Landscape For CRPC
- CRPC options depend on prior therapies and include chemo, second ARPIs (often ineffective if prior ARPI used), radium-223, Lutetium-177 PSMA, and sipuleucel-T.
- Genomic testing is essential before CRPC because ~10–15% have HRR mutations that predict PARP inhibitor benefit.
