In a patient with M0CRPC with PSA doubling time < 6 months, will you wait
until the absolute PSA value is >2, or is PSADT alone sufficient to start an AR targeted agent?
In the SPARTAN trial, median PSA at study entry was ~ 7. Does the MFS benefit extend to patients with low PSA(< 2 or < 1)?
Answer from: Medical Oncologist at Academic Institution
The SPARTAN trial required patients to have evidence of PSA progression per Prostate Cancer Working Group 2 (PCWG2) criteria at the time of enrollment. Per PCWG2 criteria, the PSA must be ≥25% and ≥2 ng/ml above the nadir, and it must be confirmed to be rising ≥3 weeks later. Similar eligib...
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Answer from: Medical Oncologist at Community Practice
Yes, it is reasonable to treat a patient with M0 CRPC with one of the new antiandrogen agents even if his most recent PSA is only 1 ng/mL or 2 ng/mL. However, the accuracy of calculating PSADT decreases when PSA levels are less than 1 ng/mL. Also, the majority of patients with M0 CRPC and PSA levels...
Answer from: Medical Oncologist at Academic Institution
I would agree with @Michael T. Schweizer and @Emmanuel S. Antonarakis, but simply add a caveat of considering the patient's initial Gleason score and PSA at diagnosis. Those with high grade disease and low PSAs are at higher risk for prostate cancer specific mortality (with more neuroendocrine featu...