beyond lhrh analogues in hormone refractory prostate cancer amman - 2016

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Beyond LHRH Analogues in Hormone Refractory Prostate Cancer.

Beyond LHRH Analogues in Hormone Refractory Prostate Cancer.

Mohamed Abdulla M.D.Prof. of Clinical Oncology Cairo UniversityJOS Meeting GI. GU ConferenceLe Royal Hotel Amman Jordan Friday, 01/04/2016

Member of Advisory Board, Consultant, and Speaker for:Amgen, Astellas, AstraZeneca, Hoffman la Roche, Janssen Cilag, Merck Serono, Novartis, Pfizer, MundipharmaThe content of this presentation does not relate to any product of a commercial interest

Speaker Disclosures:

Basic Facts:2nd most common cancer in men (27%).1/6 men prostate cancer.2nd leading cause of cancer related death in men (10%).World Wide: > 1000000 new case annually.> 300000 death/year.Closely related to age & AndrogensWide geographic and ethnic variations.Pre- and post-PSA era. MJA 2008; 189: 315318

Prostate Cancer: The Story:

Dr. Huggins(1941): Orchiectomy and DES Effective Disease Control Noble Price 1966.Dr. Shcally et al: (1977): LHRH Analogue Effective disease Noble Price

Prostate Cancer: Best Identity: Natural HistoryAndrogen BiosynthesisAndrogen Receptor ActivityAggressiveness


HypothalamusLHRHPituitaryTestesSupra-renalTestosteroneLHACTHProstate Cancer is an Androgenic Disease:

LHRH AnalogueBilateral Orchiectomy

Prostate Cancer:Natural History:Locoregional DiseaseBiochemical FailureMetastatic SensitiveMetastatic RefractoryDeathTIMETumor BurdenRisk StratificationA.S.Local Therapy+/- HormonalLocal Therapy+/- Hormonal Hormonal+/- Others2nd HormonalOthers

Maintaining testosterone 32 ng/dLSurvival free of CRPC in 73 patients with non-metastatic prostate cancer receiving ADT.*Patients with three serum testosterone determinations 32 ng/dL.Serum testosterone was measured every 6 months. ADT=androgen-deprivation therapy; CRPC=castration-resistant prostate cancer.Figure adapted from Morote J, et al. J Urol 2007;178:12905.

100806040200Cumulate survival free of CRPC (%)050100150200250Follow up (months)>32 ng/dL30 ng/dLVariableTestosteroneContinuous variable*Testosterone