Dr Louise Kostos on the rapidly evolving prostate cancer treatment landscape

In recent video interview with Urology Times®, Dr Louise Kostos was asked for take-home points regarding a recent European Urology paper in which investigators evaluated combination therapies for the treatment of locally advanced and metastatic hormone-sensitive prostate cancer.¹

“I think we now have really robust data showing that earlier treatment intensification with combination regimens does lead to improved survival for patients with metastatic hormone-sensitive prostate cancer, and really all patients now should be considered for at least an ADT [androgen deprivation therapy] plus ARPI [androgen receptor pathway inhibitor] doublet. I think select patients who are fit could be considered for a triplet with docetaxel. But the data really are mostly supportive in that synchronous, high volume cohort of patients. I also think moving forwards, as patients are living longer and on treatment for longer, optimizing patient selection for treatment with better biomarkers will become more important, and we will start to see that integrate into practice in the coming years and also, there's more of an emphasis now on trying to mitigate those long-term toxicities as patients start combination treatments much earlier than they would have if we just use conventional scans,” said Kostos, a medical oncologist and PhD candidate at Peter MacCallum Cancer Centre in Victoria, Australia.

In the interview, Kostos also commented on the number of trials taking place that are evaluating combination treatments in prostate cancer.

“Some of those are looking at oligometastatic prostate cancer with stereotactic radiotherapy, and some include radioligand therapy and also ADT-sparing approaches as well. I think more and more, we will see a very personalized or bespoke approach to how we treat [patients with] prostate cancer based on current and emerging biomarkers that are being established. It's a rapidly moving field. In another year or 2, it will probably be a totally different treatment paradigm,” Kostos said.

REFERENCE

1. Azad AA, Kostos L, Agarwal N, et al. Combination therapies in locally advanced and metastatic hormone-sensitive prostate cancer. Eur Urol. 2025 Feb 12:S0302-2838(25)00023-5. doi:10.1016/j.eururo.2025.01.010