The drug therapies available for those with metastatic castrate-resistant prostate cancer have increased over the past few years. Abiraterone, a CYP17 inhibitor, has been proven effective in phase three trials, however those with poor performance status were largely under-represented in those trials. This multicentre retrospective study from a team in Canada aimed to evaluate the outcomes in those with good and poor performance status with metastatic castrate-resistant prostate cancer treated with abiraterone. Five hundred and nineteen patients were identified retrospectively using cancer registries. Various outcomes, including prostate specific antigen (PSA) decline, time to PSA progression, and overall survival, were compared between those with good and poor performance status. The study found that those in the poor performance status group had significantly inferior outcomes compared to those in the good performance status group. This was seen in both those who had and had not already received docetaxel. However, the study was limited in a lack of information on patient comorbidities, which may have impacted on the results seen. Despite this, considering the results of this study, in clinical practice it may be worth considering current patient performance status and possible future decline when deciding when to initiate therapy, as introducing abiraterone before a decline is seen may confer a survival benefit for the patient. 

Outcomes with abiraterone acetate in metastatic castration-resistant prostate cancer patients who have poor performance status.
Azad AA, Eigl BJ, Leibowitz-Amit R, et al.
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Sophia Cashman

Cambridge University Hospitals NHS Foundation Trust.

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