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 tumor carries. These findings are a result of the ProBio study, led by researchers at Karolinska Institutet in Sweden.
The is published in . Every year, about 2,500 men in Sweden are diagnosed with . Initially, all are treated with testosterone blockade to prevent testosterone from activating the , 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 randomized trial until now. Personalized treatment "For the first time, we have compared these treatments with each other and also analyzed the DNA of the cancer cells to find out which drug that works best for different individuals," says Johan Lindberg, senior researcher at the Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet. The bloodstream contains so-called cell-free DNA from cells that have died, something that happens all the.