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INTRODUCTION

Prostate cancer (PC) is the leading cause of cancer among men in the United States (US), and the second-leading cause of cancer-related mortality.¹ PC accounted for an estimated 180 890 new cancer cases in 2016 (10.7% of all new cancers and 21% of cancers affecting men), and an estimated 26 120 deaths (4.4% of all cancer-related mortality and 8% of all cancer-related mortality in men).^1-2 Black men have a higher incidence of PC than white or Asian men and are also more likely to have advanced disease at the time of diagnosis.³ The risk of PC is also 2-fold to 3-fold higher for men with a first-degree relative with PC.⁴

Patients with prostate cancer are associated with a generally favorable prognosis when diagnosed and treated early in the course of the disease, with an estimated 5-year survival rate of more than 99% for patients with local or regional PC. However, 5-year survival decreases to only 28% for those with metastatic disease.¹ Approximately 10% to 20% of men with PC have metastatic disease at the time of diagnosis, while another 20% to 30% are initially diagnosed with localized disease but eventually progress to metastatic PC. ⁵ Thus, both PC screening and better approaches to the treatment of patients with metastatic disease are important to achieve the best possible outcomes for this patient population. Recommendations for PC screening are based on PC risk, including factors such as patient race, family history, and life expectancy. In recognition of the greater risk of PC and the likelihood of more severe disease at the time diagnosis, some experts have argued that black men should consider screening at an earlier age than white or Asian men.³ For example, the American Cancer Society recommends that black men, or those with a family history of PC, should begin discussions with a physician about PC screening at age 45, 5 years earlier than the recommended age for men at average risk.^3,6

Initial treatment of patients with PC depends largely on the stage at which the cancer is diagnosed. Prostatectomy is generally recommended for men in good health with PC that is confined to the prostate gland (Stage I to II).⁷ Radiation therapy may be used to treat patients with cancer that is confined to the prostate or surrounding tissues (Stages I to III). PC cell growth is stimulated by androgens, and the reduction of circulating androgen to castrate levels using androgen deprivation therapy (ADT) has long been a mainstay of PC therapy for men with locally advanced or metastatic disease. However, despite the effectiveness of ADT, nearly all men with advanced PC eventually progress to develop castrate-resistant (also referred to as hormone-refractory) PC and exhibit increasing prostate-specific antigen (PSA) levels, progression of disease on imaging, and/or worsening of symptoms.^5,8 Patients with metastatic castrate-resistant PC (mCRPC) are associated with an especially poor prognosis with a median survival of approximately 2 years, and considerable recent research has examined new approaches to provide better outcomes for these patients.¹

Pharmacists are central to the management of patients with PC and may work with other healthcare professionals to select treatment strategies, identify and manage adverse events (AEs), ensure appropriate monitoring and evaluation, and provide patient education. This activity provides and update and overview for pharmacists of the treatment of patients with mCRPC.