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Clinical and Translational Oncology
Published in: Clinical and Translational Oncology 5/2021

Open Access 01-05-2021 | Prostate Cancer | Clinical Guides in Oncology

SEOM clinical guidelines for the treatment of advanced prostate cancer (2020)

Authors: A. González del Alba, M. J. Méndez-Vidal, S. Vazquez, E. Castro, M. A. Climent, E. Gallardo, E. Gonzalez-Billalabeitia, D. Lorente, J. P. Maroto, J. A. Arranz

Published in: Clinical and Translational Oncology | Issue 5/2021

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Abstract

The treatment of advanced prostate cancer has evolved due to recent advances in molecular research and new drug development. Dynamic aberrations in the androgen receptor, DNA repair genes, PTEN-PI3K, and other pathways drive the behavior of advanced prostate cancer allowing a better selection of therapies in each patient. Tumor testing for BRCA1 and BRCA2 is recommended for patients with metastatic prostate cancer, also considering a broad panel to guide decisions and genetic counseling. In symptomatic metastatic patients, castration should be stared to palliate symptoms and prolong survival. In high-risk or high-volume metastatic hormone-naïve patients, castration should be combined with docetaxel, abiraterone, enzalutamide or apalutamide. Radiotherapy to the primary tumor combined with systemic therapy is recommended in low-volume mHNPC patients. In patients with non-metastatic castration-resistant tumors, risk stratification can define the frequency of imaging. Adding enzalutamide, darolutamide or apalutamide to these patients prolongs metastasis-free and overall survival, but potential adverse events need to be taken into consideration. The choice of docetaxel, abiraterone or enzalutamide for treating metastatic castration-resistant patients depends on previous therapies, with cabazitaxel being also recommended after docetaxel. Olaparib is recommended in BRCA1/BRCA2 mutated castration-resistant patients after progression on at least one new hormonal therapy. Aggressive variants of prostate cancer respond to platinum-based chemotherapy. To optimize treatment efficiency, oncologists should incorporate all of these advances into an overall therapeutic strategy.
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Metadata
Title
SEOM clinical guidelines for the treatment of advanced prostate cancer (2020)
Authors
A. González del Alba
M. J. Méndez-Vidal
S. Vazquez
E. Castro
M. A. Climent
E. Gallardo
E. Gonzalez-Billalabeitia
D. Lorente
J. P. Maroto
J. A. Arranz
Publication date
01-05-2021
Publisher
Springer International Publishing
Published in
Clinical and Translational Oncology / Issue 5/2021
Print ISSN: 1699-048X
Electronic ISSN: 1699-3055
DOI
https://doi.org/10.1007/s12094-021-02561-5

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