Typically, when prostate cancer spreads beyond the prostate gland, the metastases show up in the skeleton system. However, with improved imaging, such as with PSMA diagnostic scans, oncologists are increasingly finding prostate cancer in the viscera as well.
In patients with metastatic disease, the standard treatment is not just ADT, but ADT combined with either abiraterone and prednisone or one of the newer anti-androgens, such as enzalutamide.
A group of researchers asked a simple question: Does the presence of visceral mets make a difference in terms of what is the best treatment for the patient? To find the answer, the authors reviewed data from six, relatively recent, phase III trials that included almost 5400 patients. Out of that sample, just over 15% of the patients had visceral metastasis. Based on the study the authors reviewed, some patients were treated with a newer anti-androgen while others received abiraterone acetate and prednisone.
The winner here was the abiraterone and prednisone. For patients with visceral mets, abiraterone and prednisone combined with ADT improved overall survival better than anti-androgens and ADT.
This confirms how important it is to have good imaging when dealing with a rising PSA after treatment for localized disease. Knowing where the disease is in the body helps physicians to come up with the best personalized treatment.
Reference:
Yekedüz, E., McKay, R. R., Gillessen, S., Choueiri, T. K., & Ürün, Y. (2023). Visceral Metastasis Predicts Response to New Hormonal Agents in Metastatic Castration-Sensitive Prostate Cancer. The oncologist, oyad102. Advance online publication. https://doi.org/10.1093/oncolo/oyad102