Prostate cancer treatment is rapidly evolving, with new therapies offering more targeted and personalized approaches. Dr. Andrew Hahn discusses advances in treating advanced and metastatic prostate cancer, including combination therapies, targeted radiation, and treatment options guided by specific genetic and molecular features of a tumor.
Dr. Andrew Hahn is a Genitourinary Medical Oncologist and an Assistant Professor of Genitourinary Medical Oncology at The University of Texas MD Anderson Cancer Center. Learn more about Dr. Hahn.
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Transcript
Katherine Banwell:
Thank you. Dr. Hahn, what are recent advances in prostate cancer research? And how could they change how patients are treated?
Dr. Andrew Hahn:
It’s very exciting times for research in prostate cancer; therefore, I think for patients living with prostate cancer as well. There are many things I could touch upon. I’m going to focus upon two of them. The first is that we’re really starting to intensify treatment for metastatic APMS or hormone-sensitive prostate cancer. There are two different terminologies that are now used. I’ll stick with the more contemporary one, which is APMS prostate cancer. It’s just that new diagnosis of prostate cancer. We’re further intensifying the treatments. We previously were working with a backbone of ADP to lower testosterone levels and an AR pathway inhibitor to further inhibit testosterone levels, and occasionally using chemotherapy for select patients.
Now, and I can go over this in more detail in coming questions, we’re moving more and more therapies into, as that first group of treatments, as a third agent. There are three different groups of treatments that we’re using there. So, that’s the first really big advance. I think in 2026 we’ve seen new approvals, and we’re starting to see shifts in the way all of us are treating metastatic prostate cancer.
The second one I’ll just be biased towards because of my enthusiasm here is that for the first time in almost a decade now, we have new approaches to targeting the androgen receptor or AR, which is the backbone of how we treat prostate cancer, but also what drives cancer worsening on our therapies. And we have totally new therapies that are targeting the androgen receptor that are working, that are exciting, that are well-tolerated for patients. I think that’s another space of enthusiasm.
Katherine Banwell:
Dr. Hahn, what progress is being made in treating advanced or metastatic prostate cancer?
Dr. Andrew Hahn:
For this one, I’m going to take it from the metastatic APMS, formerly known as hormone-sensitive prostate cancer, perspective. I’ll get more specific on this. As I was mentioning, the backbone for treatment of advanced or metastatic prostate cancer is ADT and an AR pathway inhibitor. I think all of us are pretty comfortable with that in community or academic settings.
But what’s happened in the past year or so is we’ve started to add a new third agent. Before, it was only consider chemo if you wanted to. Now, it’s consider adding Lutetium PSMA-617 if a patient has PSMA expression. If their PET scan lights up bright, we can think of adding a targeted radiation for those patients. So, that’s an exciting option. That was just approved by the FDA within the past month or so. If patients have very specific mutations in their cancer when they’re initially diagnosed, specifically a BRCA2 mutation, we can use a PARP inhibitor.
The one that’s approved by the FDA currently is ADT abiraterone (Zytiga) for AR pathway inhibitor and then niraparib (Zejula) for the PARP inhibitor. So, now you have three drugs, PARP inhibitor, the niraparib, a new addition that may have a BRCA2 mutation.
Then finally, this was again new approval by the FDA in June of 2026, so you can see a lot of new approvals, a lot of things happening. But for that one, this is for patients whose tumors have lost a protein called PTEN. Either oncologists will test and see if the expression of PTEN. If it’s lost 90 percent of PTEN or more, they can qualify to add capivasertib (Truqap), which is targeting a specific protein called AKT. It’s a pill that you take. So, then it would be ADT plus abiraterone plus capivasertib for those patients. We still have docetaxel (Taxotere) chemotherapy.
So, you can see how up-front treatment is really evolving. It’s getting more intense, but I think more intense in a way that hopefully will be helping men feel better and live longer with advanced prostate cancer.
Katherine Banwell:
Dr. Hahn, how is research improving the ability to personalize prostate cancer treatment based on a person’s counts or diagnosis, their genetics, and their individual needs?
Dr. Andrew Hahn:
That’s a great question. It’s an increasingly complicated one. A lot of the things that I recently mentioned, whether that’s BRCA2, P10, PSMA expression, these are all molecular characterization of prostate cancer. In my mind, when someone’s initially diagnosed with advanced or metastatic prostate cancer, they should have germline DNA testing done to see if a patient has inherited a mutation in a gene such as BRCA2, or you can have an approval for a PARP inhibitor that really changes the outlook for those patients.
They should have somatic DNA testing completed as well. What the difference there is germline is what you inherited from mom and dad. Somatic DNA testing is the mutations that are present specifically in the cancer itself, which differs from our whole bodies. Again, looking for BRCA2. Then we can take that tumor tissue, and we can do PTEN expression on it. PTEN expression will determine whether or not someone will qualify for a medication called capivasertib. If your cancer has lost 90 percent or more of PTEN you qualify for capivasertib. So, now I’ve already listed off three different tests that we’re ordering on that first visit.
You should have a PSMA PET scan done early on to understand if your cancer is bright on a PET scan. That can inform what we’re going to be doing. And then if you want to make it even slightly more complicated, but this is I think really helpful for patients and for all of us, is that there’s a gene expression score that we send with the same biopsy called Decipher that can inform on the utility of up-front docetaxel chemotherapy or hold it for later.
So, one of the challenges that we’re all living through right now is these new targeted therapies have not been compared head-to-head to date. So, we don’t know which is better if a patient has two of these things present. We have inclinations, but we don’t have clear evidence. It is complicated. There are a lot of components happening. But from a patient perspective, I think the question you should be asking whoever your cancer doctor is should there be genomic and other molecular characterization done on my cancer. Because the answer is yes, and there should be a lot done early.