URO FORUM

The Lebanese Urology Society Forum

By Walid Alame
#43
What is your preferred first line mCRPC treatment option in the majority of symptomatic men who did receive Docetaxel in the castration - sensitive setting ?
1- Abiraterone or Enzalutamide
2-Cabazitaxel
3-Observe
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By Nehme Raad
#44
Walid Alame wrote:
Fri Jan 12, 2018 10:00 pm
What is your preferred first line mCRPC treatment option in the majority of symptomatic men who did receive Docetaxel in the castration - sensitive setting ?
1- Abiraterone or Enzalutamide
2-Cabazitaxel
3-Observe
This is a very interesting question indeed that needs to be the subject of a study.
So for a patient who previously received Docetaxel in the setting of a metastatic hormone-naive prostate cancer, and who became now castrate resistant while being symptomatic, what would I choose?
- Surely not observation because the patient is symptomatic
- I think that the choice between chemotherapy and hormonal therapy would rely on the same criteria for a patient who didn't receive prior Docetaxel (visceral metastasis, time to resistant, fatigue, volume overload ...).
The only problem would be: how much will the hormones be sensitive after a prior chemo? As we know, in CRPC, hormones are not very efficient after chemo. But here, there is a time gap between chemo and hormones (and this is not usually the case in CRPC).
- I would probably add another choice here: Use of Docetaxel again before shifting to Cabazitaxel.
We don't want to forget that we have previously stopped Docetaxel because we have completed the 6 cycles of chemo (and not because of resistant - and this is another argument why hormones might be sensitive in this case). So using Docetaxel would be a valid choice as well.

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