The survival of patients with advanced prostate cancer in the last 15 years has been tripled thanks to the development of new hormonal agents, chemotherapy or radiopharmaceuticals, going from 12-18 months in 2005, when only chemotherapy was available, more than 36 current months.
Cancer prostate is the second most diagnosed cancer in our environment (first in men), with an estimate of 35,764 new cases in Spain in 2021, according to the SEOM report “Cancer figures in Spain” from 2021.
In addition, it is the tumor with the highest prevalence in men, 24.3% of the global incidence, which by 2020 was 259,788 affected patients, according to the latest available data collected in the aforementioned SEOM report. However, it ranks third as responsible for the number of cancer deaths in men in Spain, but the mortality rate is progressively reducing. The five-year net survival of patients diagnosed in the 2008-2013 period was 89.8%, the highest among common tumors.
Today, the vast majority of prostate cancer cases are diagnosed in initial stages, while only 10% correspond to advanced cases (metastatic) at diagnosis. In the initial stages, prostate cancer is curable in the vast majority of cases using current surgical techniques, radiotherapy / brachytherapy with or without the addition of hormonal therapy.
In a proportion of cases, however, the disease develops resistance to hormonal treatment (resistance to castration) with the eventual development of metastasis, a situation called metastatic castration-resistant prostate cancer. On other occasions, however, patients present metastasis at the time of diagnosis, a situation called metastatic hormone-sensitive prostate cancer, no longer subsidiary to curative options such as surgery and radiotherapy. In these cases, the goals of treatment are to prolong survival, preserve quality of life, and prevent bone events.
It is in these advanced cases (resistance to castration and metastatic hormone-sensitive disease) where the most advances in the treatment of the disease.
Between 2011 and 2014, the development of new agents hormonal (abiraterone, enzalutamide), chemotherapy (cabazitaxel) or radiopharmaceuticals (Ra-223) have increased survival from 12-18 months in 2005, when only chemotherapy with docetaxel was available, to the current 32-36 months.
On the other hand, the combinations of new drugs with immunotherapeutic agents represent another promising therapeutic strategy in advanced prostate cancer, currently under evaluation in clinical trials to identify which patients are the best candidates for this treatment.
In addition, new studies have confirmed the value of both chemotherapy and these new hormonal agents, such as abiraterone, apalutamide or enzalutamide, in combination with androgen deprivation (hormone therapy), in patients with metastatic disease at diagnosis. Through different clinical trials, these agents have shown a reduction in the risk of death of up to 38%, even in high-risk patients, and an increase in the median survival from 32 to 50 months.