Radiographic Progression With and Without Prostate-Specific Antigen Rise in Patients With Advanced Prostate Cancer Treated With Enzalutamide
An important post-hoc analysis from ARCHES and PROSPER that quantifies something we've suspected clinically, roughly 1 in 4 enzalutamide-treated patients who progress radiographically have no prostate-specific antigen (PSA) rise, and the majority won't meet PCWG2/3 PSA progression criteria. Liver metastases were 5-fold more common at radiographic progression on enzalutamide versus control, suggesting lineage plasticity and AR-independent clones are the culprit. Bottom line for practice: don't wait for PSA to rise before imaging your metastatic hormone-sensitive prostate cancer (mHSPC) and nonmetastatic castration-resistant prostate cancer (nmCRPC) patients on ARPIs, periodic cross-sectional imaging, especially in the first two years, is warranted regardless of PSA trend.
1 thought on “Low Risk of Cardiovascular Events With ADT for Prostate Cancer; Higher Risk in Older Men”
A large retrospective VA study presented at ASCO 2020 reported increased MACE and more so with Agonists than antagonists. So I am skeptical about this EMR review data and it dose not differentiate Agonist vs antagonist; For patients with pre-existing or high risk I choose direct antagonists than agonists. Also to be noted there are increasing data that Abiratarone is associated with increase cardiovascular events.