Dr Ashley Ross on the Changing Treatment Landscape of Prostate Cancer

Ashley Ross, MD, PhD, urologist and associate professor at the Northwestern University Feinberg School of Medicine, discusses the increasingly dynamic treatment landscape in prostate cancer.

Transcript

Therapy approvals for prostate cancer have lagged behind other cancers, even with treatments like PARP inhibitors, which were approved in breast and ovarian cancer long before gaining approval for prostate cancer. In what areas do you see prostate cancer treatment options catching up sooner than later?

There is an ever-expanding litany of treatment options for prostate cancer. As you mentioned, olaparib and rucaparib have been approved in in men with certain mutations in DNA damage repair. And it's important to note that as we go into the molecular field of medicine, you're also seeing blanket, tumor-agnostic approvals of drugs that are potentially relevant for prostate cancer. So, pembrolizumab had a blanket approval for all tumors with mismatch repair deficiencies. And certainly for metastatic castrate-resistant prostate cancer that's failing a line of therapy, if the man has any mismatch repair defects and has a higher tumor mutational burden or has microsatellite instability, that's in that tumor-agnostic group.

Other places where prostate cancer treatments are evolving are, I think, we've already seen some results and we're looking forward to more results of PSMA-targeted therapies. So, this is using molecular-targeted therapies. We've seen targeting PSMA by radiologic means—so things that are alpha or beta emitters like lutetium, for example—but we've also seen some early clinical trials looking at immunotherapeutics also targeting PSMA, bringing in T-cells to areas that are expressing PSMA, and so that's been kind of advancing.

It's important to remember that one reason why there’s been a little bit of a less of a push for some of these more targeted therapies for prostate cancer is that the vast majority of prostate cancers are addicted to androgen signaling and androgen receptor, and we’ve seen a lot of approvals of newer androgen receptor antagonists like darolutamide and apalutamide in the last several years, and there are still advances on new ways of either shutting down androgen synthesis or doing androgen receptor inhibition.

Finally, there's, again, a litany of clinical trials in development attacking other pathways that might be important for prostate cancer. We often will think about the PI3-kinase and PTEN pathway, but those are all works in development.