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Oncology

Non-metastatic castration-resistant prostate cancer: the evolving treatment landscape and role of nurse specialists

26 May 2022

Product Focus

02 May 2022

Volume 31 · Issue 10

ISSN (print): 0966-0461

ISSN (online): 2052-2819

Abstract

Prostate cancer is the most common type of cancer in men in the UK. Within 2 years of diagnosis, one-third of patients with non-metastatic castration-resistant prostate cancer (nmCRPC) will develop metastatic disease, which is associated with significantly greater morbidity and mortality compared to disease without metastases. The approval of second-generation androgen receptor inhibitors such as darolutamide has transformed the nmCRPC treatment landscape because they lead to prolonged metastasis-free survival and better maintenance of quality of life compared with placebo. Early identification of patients with nmCRPC who are suitable for treatment is imperative because most of these patients are asymptomatic. Clinical nurse specialists (CNSs) play a critical, supportive role in the management of disease and treatment follow-up. This product-focused article discusses the use of darolutamide in nmCRPC and the vital role that CNSs play in the management and care of patients with prostate cancer.

Prostate cancer is the most common cancer among men in the UK, with more than 52 000 new cases diagnosed and nearly 12 000 deaths each year (Cancer Research UK, 2022). The development and progression of the disease is considered to be dynamic, with key milestones of disease states (Anantharaman and Small, 2017).

Recurrence of localised or locally advanced prostate cancer is initially managed by androgen deprivation therapy (ADT), by either surgical or pharmacological means post radical therapy (Anantharaman and Small, 2017; Drudge-Coates et al, 2018). Ultimately, most patients (~77%) develop resistance to ADT, despite having castration levels of testosterone, and the disease progresses to non-metastatic, castration-resistant prostate cancer (nmCRPC) (Liede et al, 2016) or ‘hormone-relapsed non-metastatic prostate cancer’ (National Institute for Health and Care Excellence (NICE), 2019a), evidenced by rising levels of prostate-specific antigen (PSA) (Anantharaman and Small, 2017; Drudge-Coates et al, 2018; El-Amm and Aragon-Ching, 2019).

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Non-metastatic castration-resistant prostate cancer

Darolutamide

Anti-androgen therapy

Clinical nurse specialist

Nurse-led care