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CME: Advanced prostate cancer: Optimizing management strategies


Activity Description / Statement of Need:

In this online, self-learning activity:

Prostate cancer is the most common form of malignancy among men in the United States. There are over 164,600 new cases and over 29,000 deaths from PC in the U.S. annually. Probable risk factors include age 65 and older, African American ancestry, family history, and mutations in the BRCA1, -2, MSH2, and HOXB13 genes, with possible risk factors including occupational exposure to cadmium, dietary factors, and higher concentrations of serum testosterone. About 95% of cases are adenocarcinoma, with neuroendocrine tumors, sarcomas, and transitional cell carcinomas comprising the balance of tumor types. Symptoms of advanced prostate cancer (aPC) include back pain, cord compression, lower extremity edema, pathologic fractures, anemia, and weight loss.

Because tumor growth is primarily driven by androgen receptor activity, androgen-deprivation therapy (ADT) is the first-line approach to advanced disease and involves surgical or medical orchiectomy, the latter of which may include a luteinizing hormone-releasing hormone (LHRH) agonists, a gonadotropin-releasing hormone (GnRH) antagonist, and an antiandrogen agent (given concomitantly with a LHRH agonist), or an androgen synthesis inhibitor and may also include docetaxel.

Target Audience:

The following HCPs: oncologists and urologists; physician assistants, nurse practitioners, nurses, and pharmacists specializing in oncology; and any other HCPs with an interest in or who may clinically encounter patients with aPC.

Commercial Support Disclosure: This program is supported by educational grants from Sanofi / Genzyme and Bayer.

This activity is free of charge.

Release Date: March 13, 2020 -- Expiration Date: March 13, 2022

Faculty: Steven Freedland, MD


Faculty introduction, disclosures

  • Epidemiology: current trends
  • Causes and risk factors
  • Pathophysiology
    • Role of the androgen receptor and hormone sensitivity
    • Mechanisms leading to resistance
    • Clinical features, presentation, histopathology, genetics, and biomarkers’ roles in determining prognosis and treatment pathways
  • Symptomology and diagnosis of aPC

Treatment in patients with aPC

  • Treatment strategy overview for aPC and goals of therapy
  • The approach to castration-sensitive disease and the efficacy and safety data behind it
  • ADT ± abiraterone or docetaxel, combined androgen blockade
  • Androgen suppression with: GnRH ant/agonists,
  • Castration-resistant disease
    • Continued androgen inhibition plus
    • The place of non-pharmacotherapeutic treatment options: orchiectomy & radiotherapy
  • Mitigation of disease and therapy complications
  • Emerging treatments: Targeted therapy, immunotherapy, and novel anti-hormonal agents
  • Best practice: Putting it all together
  • Patient case(s)

Summary, conclusions, and best practice recap

Learning Objectives

By the end of the session the participant will be able to:

  • Recall the pathophysiology of aPC in a manner that informs treatment mechanisms.
  • Describe differences in approach between hormone-sensitive and castration-resistant aPC.
  • Identify the treatment modalities currently available for management of aPC and apply them to patient cases using evidence-based medicine.
  • Describe emerging treatment options presently available for aPC, their mechanisms of action and safety, and anticipated place in therapy.



Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review ScientiaCME.

Faculty Disclosure: Stephen J. Freedland, MD, Professor of Urology Director, Center for Integrated Research on Cancer and Lifestyle, Cedars-Sinai, has received financial compensation as a consultant from Janssen, Astellas, Pfizer, Bayer, Sanofi, Dendreon, Astra Zeneca, Merck, Clovis, and Myovant.

Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP, President of ScientiaCME, has no relevant financial discloses.

Commercial Support Disclosure: This program is supported by educational grants from Sanofi / Genzyme and Bayer.


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowledge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural/Linguistic Competence & Health Disparities

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.

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