Fast Five Quiz: Castration-Resistant Metastatic and Advanced Prostate Cancer Management

Evelyn S. Marienberg, MD


November 08, 2022

Factors mainly associated with a poor hormonal response to first-line novel hormone therapy in the metastatic CRPC setting include high Gleason, visceral involvement, and slightly elevated PSA level with large tumor volumes. In these cases, chemotherapy can be considered.

The optimal treatment sequence for patients with metastatic CRPC has not been identified, per Henríquez and colleagues. Treatment selection should consider patient characteristics, like performance status, comorbidities, and degree of frailty, as well as treatment efficacy and toxicity profiles.

Up to 23% of metastatic CRPC tumors have somatic mutations, which are mostly found in BRAC2 and ATM, and 42% of patients with BRAC2 somatic mutations had germline mutations as well. Germline genetic testing is recommended for patients with high-risk node-positive or metastatic disease, very high-risk localized disease, positive family history, and intraductal/cribriform histology. Risk group-based somatic genetic testing is recommended for patients with regional and metastatic prostate cancer.

Learn more about the management of metastatic CRPC.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.