Prostate Cancer Series: Systemic Therapy for Non-Metastatic Prostate Cancer

This podcast episode focuses on the medical oncology portion of the prostate cancer series, specifically discussing systemic therapy for non-metastatic prostate cancer. It highlights the importance of understanding risk stratification and staging, considering PSA levels, disease extent, and Gleason pattern. The use of PSMA PET CT for imaging is discussed, which has higher sensitivity and specificity for detecting bone and soft tissue lesions. The significance of PSA doubling time is emphasized, indicating high-risk features and the need for staging imaging. Treatment options for biochemical recurrence after surgery or radiation therapy are explored, including salvage radiation therapy and the role of androgen deprivation therapy (ADT). For castration-sensitive disease, ADT monotherapy is recommended, while for castration-resistant disease with a PSA doubling time of less than 10 months, Anderson receptor antagonists (Abiraterone and Enzalutamide) are suggested. The podcast also delves into adjuvant therapy for very high-risk prostate cancer, highlighting the Stampede trials that showed improved metastasis-free survival with the addition of Abiraterone and Prednisone to ADT. Important limitations of the trials and the need for appropriate post-protocol care are noted. Overall, the episode provides valuable insights for understanding and managing non-metastatic prostate cancer.