Men with metastatic castration-resistant prostate cancer should be treated primarily with second-generation hormone drugs, which offer better treatment response and longer life expectancy than chemotherapy. However, the effect depends on which mutations the patient's tumour carries. This is shown by results from the ProBio study, led by researchers at Karolinska Institutet in Sweden.
The findings are published in Nature Medicine . Every year, around 2,500 men in Sweden are diagnosed with metastatic prostate cancer. Initially, all are treated with testosterone blockade to prevent testosterone from activating the androgen receptor, the gene that mainly fuels the growth of cancer cells.
Over time, the cancer cells develop resistance and become so-called castration-resistant. This requires the use of new drugs - usually chemotherapy or second-generation hormone drugs (abiraterone/enzalutamide) that inhibit the androgen receptor. These are called Androgen Receptor Pathway inhibitors, or ARPi.
Although these drugs have been available for over a decade, there is no direct comparison from a randomised trial until now. For the first time, we have compared these treatments with each other and also analysed the DNA of the cancer cells to find out which drug that works best for different individuals." Johan Lindberg, senior researcher, Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet The bloodstream contains so-called cell-free DNA from cells that have di.