Ask the Expert: Taking a Multifaceted Approach to Castration-Resistant Prostate Cancer Management

Prostate cancer is the second leading cause of cancer-related death in men in the United States. Screening and earlier detection have led to an increase in the number of cases diagnosed at an earlier stage of disease, but there continue to be cases where patients present with later-stage prostate cancer or tumors that have recurred following initial treatment. Androgen-deprivation therapy, which is commonly used in such cases, ultimately loses its efficacy as the cancer becomes castration resistant. Several new and emerging agents are changing the therapeutic armamentarium and offering hope of improved survival. In this Ask the Expert series, Drs. Matthew Smith, Johann de Bono, and Charles J. Ryan respond to clinical questions on a range of topics relating to the clinical management of patients with prostate cancer.

Release date: November 2011
Expiration date: November 30, 2012
Estimated time to complete activity: 1 hour

Co-sponsored by

Support for this activity has been provided through educational grants from Janssen and Veridex.

This CME-certified Web-based enduring activity is based on information presented at an ancillary symposium held on June 5, 2011 in Chicago, Illinois.

Hardware/Software Requirements

Javascript-enabled browser
Active Internet connection

Target Audience
This activity has been designed to meet the educational needs of medical oncologists, urologic oncologists, and other clinicians who treat men with prostate cancer.

Learning Objectives
After completing this activity, participants should be able to:

Analyze the pathophysiologic pathways responsible for prostate cancer growth and the mechanism of action of agents designed to affect these pathways
Develop management plans that incorporate new and emerging therapies to improve prostate cancer outcomes
Properly manage treatment-related adverse events associated with current and emerging therapies used in prostate cancer

Activity Faculty

Matthew Smith, MD, PhD
Professor of Medicine
Harvard Medical School
Massachusetts General Hospital Cancer Center
Boston, Massachusetts

Johann de Bono, MD, PhD, MSc, FRCP
Professor of Experimental Cancer Medicine
The Institute of Cancer Research and Royal Marsden Hospital
London, England

Charles J. Ryan, MD
Associate Professor of Clinical Medicine
Urology Program Leader
Genitourinary Medical Oncology
UCSF Helen Diller Family Comprehensive Cancer
San Francisco, California

Accreditation Statement
USF Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation
USF Health designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Method of Participation
There are no fees for participating in this CME activity. To receive credit during the period November 2011 to November 30, 2012, participants must (1) read the learning objectives and disclosure statements, (2) study the educational activity, and (3) complete the posttest and activity evaluation form, including the certificate information section.

To obtain a certificate, participants must receive a score of 70% or better on the posttest. The posttest can be accessed at the end of the activity. Please e-mail any questions to cmeinfo@curatiocme.com or cpdsupport@health.usf.edu.

Medium
The Internet was selected as the medium to accommodate the learning preferences of a significant portion of the target audience.

Disclosure
USF Health and Curatio CME Institute endorse the standards of the ACCME and American Nurses Credentialing Center (ANCC) that require everyone in a position to control the content of a CME activity to disclose all financial relationships with commercial interests that are related to the content of the CME activity. CME activities must be balanced and independent of commercial bias and they must promote improvements or quality in health care. All recommendations involving clinical medicine must be based on evidence accepted within the medical profession.

A conflict of interest is created when individuals in a position to control the content of CME have a relevant financial relationship with a commercial interest that may bias his or her opinion and teaching. This may include receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, stocks, or other financial benefits.

USF Health and Curatio CME Institute will identify, review, and resolve all conflicts of interest that speakers, authors, or planners disclose prior to an educational activity being delivered to learners. Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of importance to their evaluation of a presentation. USF Health and Curatio CME Institute do not endorse any products or services. Relationship information appears below:

Johann de Bono, MD, PhD, MSc, FRCP, has disclosed the following relevant financial relationships:

Employee	The Institute of Cancer Research
Advisory Board	Centocor Ortho Biotech
Consultant	Johnson & Johnson

Dr. de Bono discusses the unlabeled or investigational use of a commercial product.

Charles J. Ryan, MD, has disclosed the following relevant financial relationships:

Advisory Board	ImClone
Grants/Research Support	Cougar Biotechnology, Millennium: The Takeda Oncology Company
Speakers Bureau	sanofi-aventis

Dr. Ryan discusses the unlabeled or investigational use of a commercial product.

Matthew Smith, MD, PhD, has disclosed the following relevant financial relationships:

Consultant, Grants/Research Support

Amgen, Exelixis

Dr. Smith discusses the unlabeled or investigational use of a commercial product.

USF Health
USF Health OCPD staff has disclosed no relevant financial relationships.

Curatio CME Institute
Shari J. Dermer, PhD, Director, Scientific Services, has disclosed no relevant financial relationships.
Jonathan S. Simmons, ELS, Senior Managing Editor, has disclosed no relevant financial relationships.

Disclaimer
The information presented in this activity is for continuing medical education purposes only and is not meant to substitute for the independent medical judgment of a physician regarding diagnosis and treatment of a specific patient’s medical condition.

Unapproved Product Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. USF Health, Curatio CME Institute, Janssen, and Veridex do not recommend the use of any agent outside the labeled indications.

The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of USF Health, Curatio CME Institute, Janssen, or Veridex. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Generic Name	Trade Name	Approved Use (if any)	Unapproved/Investigational Use
Abiraterone	Zytiga	Used in combination with prednisone for the treatment of patients with metastatic castration-resistant prostate cancer (CRPC) who have received prior chemotherapy containing docetaxel	Used in patients who are chemotherapy naive
Cabozantinib	N/A	N/A	Investigational agent: (inhibitor of vascular endothelial growth factor and MET) for treatment of metastatic bone lesions in CRPC
Docetaxel	Taxotere	Treatment of hormone-refractory prostate cancer with prednisone in androgen-independent (hormone-refractory) metastatic prostate cancer	Investigational use in combination with androgen-deprivation therapy
Dutasteride	Avodart	Treatment of symptomatic benign prostatic hyperplasia (BPH) in men with an enlarged prostate to improve symptoms, reduce the risk of acute urinary retention, and reduce the risk of the need for BPH-related surgery. In combination with the alpha-adrenergic antagonist tamsulosin, indicated for the treatment of symptomatic BPH in men with an enlarged prostate	Investigational use for treatment of CRPC

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