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Non-metastatic castrate-resistant prostate cancer: a call for improved guidance on clinical management

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Abstract

Background

Guidelines on the clinical management of non-metastatic castrate-resistant prostate cancer (nmCRPC) generally focus on the need to continue androgen deprivation therapy and enrol patients into clinical trials of investigational agents. This guidance reflects the lack of clinical trial data with established agents in the nmCRPC patient population and the need for trials of new agents.

Aim

To review the evidence base and consider ways of improving the management of nmCRPC.

Conclusion

Upon the development of castrate resistance, it is essential to rule out the presence of metastases or micrometastases by optimising the use of bone scans and possibly newer procedures and techniques. When nmCRPC is established, management decisions should be individualised according to risk, but risk stratification in this diverse population is poorly defined. Currently, prostate-specific antigen (PSA) levels and PSA doubling time remain the best method of assessing the risk of progression and response to treatment in nmCRPC. However, optimising imaging protocols can also help assess the changing metastatic burden in patients with CRPC. Clinical trials of novel agents in nmCRPC are limited and have problems with enrolment, and therefore, improved risk stratification and imaging may be crucial to the improved management. The statements presented in this paper, reflecting the views of the authors, provide a discussion of the most recent evidence in nmCRPC and provide some advice on how to ensure these patients receive the best management available. However, there is an urgent need for more data on the management of nmCRPC.

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Authors’ contributions

F. Rozet, T. Roumeguère, M. Spahn, D. Beyersdorff and P. Hammerer were involved in project development, data collection, data analysis, manuscript writing/editing, and other (approval of final draft for submission).

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Authors and Affiliations

  1. Department of Urology, L’Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France

    Francois Rozet

  2. Department of Urology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium

    Thierry Roumeguère

  3. Department of Urology, Bern University Hospital, Bern, Switzerland

    Martin Spahn

  4. Clinic for Diagnostic and Interventional Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Dirk Beyersdorff

  5. Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany

    Peter Hammerer

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  1. Francois Rozet
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  2. Thierry Roumeguère
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Correspondence to Francois Rozet.

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Conflict of interest

Francois Rozet, Thierry Roumeguère, Martin Spahn and Dirk Beyersdorff have no conflict of interest to declare. Peter Hammerer has been an advisor for Janssen, Takeda and Ipsen.

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This manuscript was funded by Ipsen. The authors take full responsibility for the content of the paper. Martin Gilmour of ESP Bioscience, Crowthorne, UK (supported by Ipsen) provided editorial assistance in the preparation of the manuscript.

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Rozet, F., Roumeguère, T., Spahn, M. et al. Non-metastatic castrate-resistant prostate cancer: a call for improved guidance on clinical management. World J Urol 34, 1505–1513 (2016). https://doi.org/10.1007/s00345-016-1803-9

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