Individualizing Prostate Cancer Management: Employing Evidence-Based Strategies to Impact Community Care Across the Disease Continuum

Chair, Alicia K. Morgans, MD, MPH, FASCO, Matthew R. Smith, MD, PhD, and Sandy Srinivas, MD, prepared useful Practice Aids pertaining to prostate cancer for this CME/MOC/AAPA/IPCE activity titled “Individualizing Prostate Cancer Management: Employing Evidence-Based Strategies to Impact Community Care Across the Disease Continuum.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at https://bit.ly/3C26ESp. CME/MOC/AAPA/IPCE credit will be available until March 14, 2026.

1. Patient Resources for Prostate Cancer
Healthcare Professionals
1


Full abbreviations, accreditation, and disclosure information available at PeerView.com/WQG40 ZERO Prostate Cancer is committed to supporting prostate cancer healthcare professionals in
helping their patients and care partners learn about every aspect of prostate cancer.
ZERO Prostate Cancer provides a range of printable and online patient education resources free
of charge to help patients and care partners understand the diagnosis and treatment options.
ZERO provides access to lifesaving information and support as a means to connect with others
in the prostate cancer community.
• Printed educational materials
• Videos & webinars
• Podcasts
• Blogs
• Newly Diagnosed Guide
• Clinical trial information
• Patient Support Helpline
• Resources available in Spanish
• Peer support programs
Find resources designed specifcally
for Black men, Veterans, LGBTQIA+ persons,
and care partners
1. https://zerocancer.org/.

2. Patient-Centered Education:
Understanding Prostate Cancer Treatment Options

Full abbreviations, accreditation, and disclosure information available at PeerView.com/WQG40 Patient-centered education and support is key in prostate cancer care, as receiving
a cancer diagnosis can be overwhelming for patients and their care partners.

The printable resource on the following page is designed to help patients and their
care partners understand prostate cancer, navigate treatment options, and find
support through online groups and resources.
Printable Resource

3. Understanding Prostate Cancer Treatment Options:
A Quick Reference
If you or someone you love has been diagnosed with prostate cancer, you may
have a lot of questions about treatment options and where you can turn for help.
What Are the Diferent Types of Prostate Cancer?
Non-metastatic castration-resistant prostate cancer (nmCRPC) is found only in the prostate and 
no longer responds to hormonal therapy.
High-risk localized prostate cancer is characterized by rising PSA levels and is found only in the 
prostate but has an increased risk of spreading to other parts of the body.
Metastatic hormone-sensitive prostate cancer (mHSPC) has spread to other parts of the body 
such as bones, adrenal glands, liver, and lungs and still responds to testosterone-lowering treatments. 
Metastatic castration-resistant prostate cancer (mCRPC) has spread to other parts of the body, 
including bones and lymph nodes, and no longer responds to testosterone-lowering treatments. 
What Is the Role of Genetic Testing in Prostate Cancer?
Genetic testing helps to identify who is at risk for prostate cancer or more aggressive disease and 
to determine the most efective therapy options. 
It is important to test family members if certain gene mutations are found in a patient with 
prostate cancer.
Genetic and biomarker testing of the tumor and/or blood samples are recommended for all 
patients with metastatic prostate cancer and some with locally advanced or high-risk localized 
prostate cancer.
Where Can You Get More Support?
Patient advocacy organizations provide online and in-person services for patients and their care 
partners, including support groups; information on treatments, genetic testing, and clinical trials; 
and educational webinars and workshops.
Visit the links below or scan the QR codes to learn more about the resources each organization ofers.
ZERO Prostate Cancer
zerocancer.org
Online and printable information guides
Peer-to-peer support
Online support communities
Patient Support Helpline
Webinars and videos
Podcasts
Clinical trial information
What Are the Diferent Treatment Options for Prostate Cancer?
Androgen deprivation therapy (ADT)
Novel anti-androgens
PARP inhibitors
Chemotherapy
Radiation
Radioligands
Combination therapies
Active surveillance
Surgery/prostatectomy
Determining which treatment is right for you depends on your age 
and the type of prostate cancer you have. Your cancer care team will help you make 
a decision that takes into account your goals and preferences.
What Are the Diferent Side Efects Associated With 
Prostate Cancer Treatments?
Hot fashes
Loss of libido/erectile dysfunction
Fatigue
Hypertension
Loss of bone density
Falls and fractures
Urinary incontinence
Gastrointestinal efects
Cardiovascular/cardiometabolic efects
Anemia
Prostate cancer treatment can result in a number of side efects depending on the regimen chosen. 
Talk to your cancer care team about how your treatment may afect your quality of life.
Spotlight on Clinical Trials
Your cancer care team may ofer you the option of enrolling in a clinical trial. These studies provide 
important information on whether a treatment is safe and efective and give you access to new 
strategies that could be better than the options currently used. 
Clinical trial enrollment is voluntary. Each trial has specifc enrollment criteria, such as
age, type of cancer, stage, and prior treatments. Talk to your cancer care team
about whether clinical trial enrollment is right for you.
Prostate Cancer Foundation
pcf.org/patient-resources
CANCERcare
cancercare.org/diagnosis/prostate_cancer
PCEC: Prostate Conditions Education Council
prostateconditions.org

4. Combination Approaches Under Study
in Prostate Cancer
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Full abbreviations, accreditation, and disclosure information available at PeerView.com/WQG40
1. Kupelian PA et al. Cancer. 2002;95:2302-2307. 2. Kupelian PA et al. Urology. 2006;68:593-598. 3. Freedland SJ et al. JAMA. 2005;294:433-439. 4. Freedland SJ et al. J Clin Oncol. 2007;25:1765-1771. 5. Markowski MC et al. Clin Genitourin Cancer. 2019;17:470-471.
6. Scher HI et al. N Engl J Med. 2012;367:1187-1197. 7. Beer TM et al. N Engl J Med. 2014;371:424-433. 8. Hussain M et al. N Engl J Med. 2018;378:2465-2474. 9. Armstrong AJ et al. J Clin Oncol. 2019;37:2974-2986. 10. Davis ID et al. N Engl J Med. 2019;381:121-131. 11. https://clinicaltrials.gov.
12. Asim M et al. Nat Commun. 2017; 8: 374. Selected Trials in Prostate Cancer
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ARPI + ADT or Radioactive Isotopes
1-10
ARPI + PARP Inhibition
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0
10
20
30
40
50
60
70
80
90
Cancer Diagnoses, %
LocalizedRegional Distant
Patterns of Presentation
High risk
Intermediate risk
Low risk
Selected Trials in Prostate Cancer
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•  Based on the high degree of HRR mutations in prostate cancer, the use of PARP inhibitors 
  is efective 
•  Co-inhibition of AR and PARP promotes synthetic lethality with interdependency between  
  both pathways and enhanced activity, supporting the rationale for a co-targeting approach
•  Three combinations of ARPI + PARP inhibitors are FDA approved for mCRPC
 – BRCA-mutated mCRPC: niraparib + abiraterone (as a fxed-dose combination tablet)
    and olaparib + abiraterone
 – HRR-mutated mCRPC: talazoparib + enzalutamide
•  There is a critical unmet need for developing novel treatment options, supporting the    
  rationale for combining ARPIs with PARP inhibition for the treatment of patients with    
  advanced prostate cancer
  Phase 3 PROpel: abiraterone + prednisone ± olaparib in mCRPC
  Phase 3 MAGNITUDE: abiraterone + prednisone ± niraparib in mCRPC
  Phase 3 TALAPRO-2: enzalutamide ± talazoparib in mCRPC
 Phase 3 AMPLITUDE: abiraterone + prednisone ± niraparib in HRR-mutated mHSPC 
  Phase 3 TALAPRO-3: enzalutamide ± talazoparib in DDR-mutated mHSPC
•  Within 10 years following defnitive therapy, up to half of patients experience  
  disease recurrence characterized by rising PSA levels
•  Patients with high-risk BCR are at increased risk of prostate
  cancer–specifc mortality
•  20% to 40% of patients with high-risk localized disease who undergo RP  
  and/or RT develop BCR
• Evidence demonstrates that treatment intensifcation with ARPI    
  consistently improves patient outcomes across the prostate 
  cancer continuum
  Phase 3 ARASTEP: darolutamide + ADT in high-risk BCR prostate cancer
 Phase 2 ARAMON: darolutamide vs enzalutamide in BCR prostate cancer
  Phase 2 Apa-RP: apalutamide + ADT in high-risk BCR prostate cancer 
  Phase 2 ARASEC: darolutamide + ADT in mHSPC 
  Phase 3 PROTEUS: apalutamide + ADT prior to RP in
  high-risk localized or locally advanced prostate cancer
  Phase 3 DASL-HiCaP: darolutamide + ADT in very high-risk
  localized prostate cancer  
  Phase 3 EMBARK: enzalutamide ± leuprolide acetate in nmHSPC with BCR
  Phase 3 ARANOTE: darolutamide + ADT in mHSPC
 Phase 3 LBERTAS: apalutamide +  intermittent vs continuous ADT in mHSPC
  Phase 3 ARCHES: enzalutamide + ADT in mHSPC
  Phase 3 ARASENS: darolutamide + ADT + docetaxel in mHSPC
 Phase 3 PEACE-1: abiraterone + ADT + docetaxel
  Phase 3 PEACE-3: 
223
Radium + enzalutamide in mCRPC with 
  bone metastases

5. Management Strategies for PARP Inhibitors  
in Prostate Cancer
1-4
 
Full abbreviations, accreditation, and disclosure information available at PeerView.com/WQG40 • Warnings and precautions: MDS/AML and embryo-fetal toxicity
• Most common AEs (≥20%) in clinical trials
 – Fatigue (including asthenia), nausea, anemia, increased ALT/AST, decreased appetite, rash, constipation, thrombocytopenia, vomiting, diarrhea
Niraparib
Rucaparib
Talazoparib
Olaparib
Safety and Monitoring in Patients With Prostate Cancer Receiving PARP Inhibitors
• Warnings and precautions: MDS/AML, myelosuppression, hypertension, CV efects, PRES, embryo-fetal toxicity, hypokalemia, hepatotoxicity,    
  adrenocortical insufciency, hypoglycemia, and increased fractures 
• Most common AEs (≥10%) in clinical trials
 – In a combination tablet with abiraterone acetate: nausea, thrombocytopenia, anemia, fatigue, constipation, musculoskeletal pain,      
    abdominal pain, vomiting, neutropenia, decreased appetite, leukopenia, insomnia, headache, dyspnea, hypertension, cough, dizziness,      
    acute kidney injury, and UTI
• Warnings and precautions: MDS/AML (~1.2%), pneumonitis, VTE, and embryo-fetal toxicity 
• Most common AEs (≥10%) in clinical trials
 – As a single agent: nausea, fatigue (including asthenia), anemia, vomiting, diarrhea, decreased appetite, headache, dysgeusia, cough,      
    neutropenia, dyspnea, dizziness, dyspepsia, leukopenia, and thrombocytopenia
 – In combination with abiraterone and prednisone or prednisolone: anemia, fatigue, nausea, diarrhea, decreased appetite, lymphopenia,      
    dizziness, and abdominal pain
• Warnings and precautions: MDS/AML, myelosuppression, and embryo-fetal toxicity
• Most common AEs (≥10%) in clinical trials 
 – In combination with enzalutamide: anemia, neutropenia, lymphocytopenia, fatigue, thrombocytopenia, hypocalcemia, nausea, decreased    
    appetite, hyponatremia, hypophosphatemia fractures, hypomagnesemia, dizziness, elevated bilirubin, hypokalemia, and dysgeusia

6. Management Strategies for PARP Inhibitors
in Prostate Cancer
1-4

Full abbreviations, accreditation, and disclosure information available at PeerView.com/WQG40 Approaches to Manage Hematologic AEs
Approaches to Manage Hypertension and Cardiovascular AEs
Approaches to Manage Nonhematologic AEs
Hematologic Nonhematologic Rare
Anemia
Thrombocytopenia
Neutropenia
Nausea/vomiting
Asthenia/fatigue
Diarrhea/constipation
AML
MDS
Pneumonitis
• Interrupt PARP inhibitor and monitor blood counts weekly until grade 1 is reached or AE is resolved
• If hematologic profile recovers, consider restarting drug at a reduced dose
• Monitor CBC
‒Month 1: weekly
‒Months 2-12: monthly
‒After month 12: periodically
• If hematologic profile has not recovered to grade ≤1 after 4 weeks, refer to hematologist for bone marrow analysis and cytogenetics
• Monitor BP and heart rate
‒Months 1-2: weekly
‒Months 3-12: monthly
‒After month 12: periodically
• Closely monitor patients with cardiovascular conditions
• Medically manage hypertension with antihypertensive medications and dose adjustment, if necessary
If fatigue is severe
• Administer prophylactic antiemetics 30 minutes prior to dosing
• Lifestyle modifications—promote small meals
• Nausea: Taking the PARP inhibitor before bedtime can help reduce the impact of nausea by allowing the patient to sleep through it
• Insomnia: If nausea is not a concern, taking the PARP inhibitor in the morning may reduce the impact of insomnia
• Consider dose interruption or dose reduction if severe fatigue
1. Akeega (niraparib and abiraterone acetate) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/216793s000lbl.pdf. 2. Lynparza (olaparib) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/208558s028lbl.pdf.
3. Rubraca (rucaparib) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/209115s013lbl.pdf. 4. Talzenna (talazoparib) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/217439s000lbl.pdf.