New drugs, new thinking for prostate cancer

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Optimal treatment of older patients with recurrent prostate cancer now involves more of a decision process than in the past, say the authors of a review article in the journal Drugs & Aging (2012;29[11]:871-883).

Prostate cancer, the most common cancer in men, is most often diagnosed after age 65 years. Several new drugs have been approved for the treatment of this disease, but the unique characteristics of the elderly population must be considered when choosing a therapy, contend Elizabeth R. Kessler, MD, an oncology fellow at the University of Colorado Cancer Center (CU Cancer Center) in Aurora, Colorado, and CU Cancer Center colleague Thomas W. Flaig, MD. For example, new targeted therapies such as abiraterone and enzalutamide are able to selectively destroy cancer cells while sparing healthy tissue, yielding fewer side effects and resulting in greater tolerability by elderly patients.

Improved androgen blockade has increased overall survival in men with metastatic prostate cancer. However, clinicians should be aware that this therapy carries many of the same adverse effects as previous agents. Similarly, newer approaches with immunotherapy, radiopharmaceuticals, or second-generation androgen receptor blockers introduce a different adverse-effect profile for older patients.

“As data mature, these [agents] too may improve survival for patients with metastatic disease,” noted the researchers. “Throughout all stages of disease, one must keep in mind the unique needs of an older patient population.”

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