Exploring Genetics and Advanced Therapies in Prostate Cancer

In recognition of September as Prostate Cancer Awareness Month, Daniel Petrylak, MD, Yale School of Medicine, discusses some of the important advancements in the field.

According to Petrylak, many areas of prostate cancer have come into the forefront. Firstly, the identification of genetic mutations, particularly the identification of BRCA and the related DNA repair enzymes and deficiency. Petrylak believes this is important from a therapeutic as well as a family standpoint.

From the familial standpoint, germline mutations can be passed down from generation to generation. Not only is the patient who has prostate cancer afflicted, but the family members potentially can be afflicted. Petrylak emphasizes that family members need to be properly genetically counseled, including screening for breast cancer, ovarian cancer, and pancreatic cancer.

From a therapeutic standpoint, Petrylak notes that we now see DNA repair plays a role as a target for patients with metastatic prostate cancer. PARP inhibitors have also shown activity in BRCA mutation-positive patients. There is a potential synergy between PARP inhibitors and next-generation antiandrogens.

Petrylak notes that moving these agents earlier in the hormone-sensitive state shows an improvement in radiographic progression-free survival, and perhaps there will be an overall survival benefit eventually.

Another theme Petrylak highlights is moving agents in metastatic disease earlier. While androgen deprivation therapy is the backbone of treatment for metastatic prostate cancer, adding antiandrogens upfront does show survival benefit. The question is whether that should be combined with chemotherapy or not. Petrylak notes that there a lot of controversy over that as to who the right patient to treat in that fashion. However, Petrylak believes that intense treatment initially is something for the appropriate patient that needs to be considered.

Read the full interview with Dr Petrylak here.