Urology Future Directions • The treatment landscape is changing. We are moving away from cytotoxic chemotherapy to more targeted agents. The goal is to have treatments available that are easily tolerated and work well. • Orteronel is a drug which works similarly to Zytiga. It may inhibit CYP17 more precisely. It is, however, only available in clinical trials. • Yervoy (Ipilimumab) is a monoclonal antibody which is approved to treat advanced melanoma. It is being actively studied in patients with metastatic prostate cancer. It works by controlling the body’s immune system to help fight against the cancer. • Cabozantinib is a new molecule which targets the c met protein. It also helps block VGEF. There is some exciting data about this drug in patients with metastatic prostate cancer. It is currently approved for patients with metastatic medullary carcinoma of the thyroid. • Another vaccine (PROSTVAC-VF) uses a genetically modified virus, which contains PSA. Early trials have shown some promising results.
Conclusion Metastatic prostate cancer is a spectrum ranging from indolent to highly virulent disease. The goal of treatment is to balance the risk versus the benefit. Depending on the patient’s performance status, age and patient decision, choices can vary from active surveillance to cytotoxic chemotherapy. There have been quite a few new drugs approved to treat such patients. Many more drugs and therapies are in the pipeline. It is important to use the right drug at the right time for the right patient. v
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