From the Research
Continuing triptorelin maintenance alone is generally not sufficient for a patient with metastatic prostate cancer who has completed 6 cycles of docetaxel plus triptorelin without disease progression. The recommended approach is to continue androgen deprivation therapy (ADT) with triptorelin indefinitely, but additional therapy should be considered based on the patient's disease characteristics. For patients with metastatic hormone-sensitive prostate cancer, adding a second-generation androgen receptor pathway inhibitor such as abiraterone (1000mg daily with prednisone 5mg daily), enzalutamide (160mg daily), apalutamide (240mg daily), or darolutamide (600mg twice daily) to ongoing ADT has shown significant survival benefits, as seen in recent studies 1. This combination approach targets androgen signaling more completely than ADT alone, as triptorelin only suppresses testicular androgen production while these additional agents block androgen receptors or inhibit extragonadal androgen synthesis. The choice between these agents should be individualized based on the patient's comorbidities, potential drug interactions, and side effect profiles. Regular monitoring with PSA testing every 3 months, periodic imaging, and assessment for treatment-related adverse effects is essential for optimal management of these patients, as supported by the most recent evidence on triptorelin's efficacy and safety in prostate cancer treatment 2. Key considerations in the management of metastatic prostate cancer include:
- Continuing ADT with triptorelin indefinitely
- Adding a second-generation androgen receptor pathway inhibitor to ongoing ADT for patients with metastatic hormone-sensitive prostate cancer
- Individualizing treatment based on patient characteristics and disease progression
- Regular monitoring and assessment for treatment-related adverse effects.