Prostate cancer is the most common tumor type in men in the United States. Nonmetastatic castration-resistant prostate cancer (CRPC) is a highly heterogeneous disease process that lacks effective treatment options. Metastatic CRPC is the primary cause of prostate-related mortality, with a median overall survival that remains less than two years.
In this interview with i3 Health, Alicia K. Morgans, MD, MPH, Associate Professor of Medicine at Northwestern University Feinberg School of Medicine, discusses the challenges of treating CRPC and the latest research developments in the field.
What led you to pursue research in prostate cancer? How has the field sustained your interest?
Alicia Morgans, MD, MPH: I initially became interested in prostate cancer because of the exciting opportunity to work with long-term patients and to build those connections that allow us to engage in a patient's treatment over time. This has allowed me to see the development of multiple new treatments and approaches to care over a number of years, and it has enabled me to get to know my patients and their families on a deeper level. It's been incredibly rewarding to be a part of the prostate cancer field because I get to see men living longer and feeling better with the success that we've had in clinical research over the last few years.
What are some of the most challenging aspects of treating patients with castration-resistant prostate cancer (CRPC)?
Dr. Morgans: In CRPC, one of our biggest challenges is understanding how to best tailor the sequencing of all of the agents that we have to meet the specific needs of each individual patient. As clinicians, this really involves us asking a lot of questions to determine an individual's unique needs before just choosing the next drug on the shelf. One of the other more challenging aspects of CRPC treatment is making sure that we stay on top of all of the advances that are constantly rolling in; we need to be aware of clinical trial outcomes and the next trial opportunities so that we can give new options to our patients as new trials become available.
What are the most important new developments in the treatment of CRPC?
Dr. Morgans: The establishment of the metastasis-free survival end point in nonmetastatic CRPC has been a really important development. This is not an end point that we've had for patients with solid tumors before, and it allows us to delay the time before men experience consequences like pain from their disease. This novel end point has enabled us to see multiple therapies approved in a short period of time.
Besides that, I've also been really happy with the emphasis on investigating and understanding how the treatments that we use impact our patients' quality of life: we're really focused not only on how long we can help them live but also on how well we can make them feel during that time.
How do you believe that the treatment of CRPC will evolve in the future?
Dr. Morgans: The future of CRPC will involve combinations of medications that will hopefully synergize and augment the power of each other. In addition, it will involve treatment with medications that are targeted in a way that allows us to minimize side effects and complications from therapy. Recent trials and recent mishaps in clinical trials have shed light on our need not only to make sure that we're pushing the envelope in terms of therapeutic success, but also to recognize the importance of supportive measures so that we reduce complications and ensure that patients are well enough to get the treatments that we've developed.
What advice would you give to community oncologists and urologists treating patients with CRPC?
Dr. Morgans: I would advise them to think carefully about the treatment options that they have and talk about these options with their patients in order to make sure that the treatments they choose are the best ones for the individual in front of them. In addition, it's important for us not combine therapies without having data from clinical trials demonstrating that the therapeutic combinations that we put together are beneficial and don't have unforeseen harms associated with them.
For More Information
For additional expert perspectives from Dr. Morgans and Dr. Tanya Dorff on the management of CRPC, complete i3 Health's complimentary Online Strategy Session for CME/CE credit and ILNA points: Current Trends in the Management of Castration-Resistant Prostate Cancer.
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily represent the views of i3 Health.