Finding Small Amounts Of Prostate Cancer Using Imaging And Psma
NCI-supported researchers are developing new imaging techniques to improve the diagnosis of recurrent prostate cancer. A protein called prostate-specific membrane antigen is found in large amountsand almost exclusivelyon prostate cells. By fusing a molecule that binds to PSMA to a compound used in PET scan imaging, scientists have been able to see tiny deposits of prostate cancer that are too small to be detected by regular imaging. The Food and Drug Administration has approved two such compounds for use in PET imaging of men with prostate cancer.
This type of test is still experimental. But the ability to detect very small amounts of metastatic prostate cancer could help doctors and patients make better-informed treatment decisions. For example, if metastatic cancer is found when a man is first diagnosed, he may choose an alternative to surgery because the cancer has already spread. Or doctors may be able to treat cancer recurrenceeither in the prostate or metastatic diseaseearlier, which may lead to better survival.
As part of the Cancer Moonshot, NCI researchers are testing whether PSMA-PET imaging can also identify men who are at high risk of their cancer recurring. Such imaging may eventually be able to help predict who needs more aggressive treatmentsuch as radiation therapy in addition to surgeryafter diagnosis.
Side Effects Of Hormone Therapy
Whether through surgery or medication, hormone therapy can cause side effects that include hot flashes, low sexual desire, erectile dysfunction, fatigue, mood changes, muscle loss, weight gain and anemia.
Patients on long-term hormone therapy also have a risk of osteoporosis . To maintain bone health, ask your doctor about taking a calcium or vitamin D3 supplement. Your blood levels should be evaluated, as low vitamin D levels are common, and some individuals require a higher dose of this supplement. You should also participate in weight-bearing exercise regularly, as it helps to maintain bone health and muscle tone as well as reduce fatigue.
In addition, ADT’s effects on metabolism may increase your risk of diabetes and heart disease. We strongly recommend both aerobic and resistance exercise to maintain metabolic health, cardiovascular health, bone strength and quality of life. While treatment for advanced prostate cancer can disrupt your daily routine, it’s important not to abandon the healthy diet and exercise practices that are key to wellness and survival.
ADT’s impact on sex life is as important as the other side effects, and we hope to provide an open, supportive environment for you to discuss your condition and concerns. UCSF offers a program for treating erectile dysfunction.
Research Into Hormone Therapy
Prostate cancer depends on the male hormone testosterone for its growth. Hormone therapies block or lower the levels of testosterone. You might have it to lower the risk of your cancer coming back after treatment or to shrink or slow the growth of prostate cancer.
Researchers are looking into:
- the best time to have hormone therapy
- having hormone therapy in combination with other treatments
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New Treatment For Metastatic Hormone
A new drug, administered in combination with standard androgen-deprivation therapy and docetaxel chemotherapy, increased survival in patients with metastatic hormone-sensitive prostate cancer, according to a trial in The New England Journal of Medicine .
This represents a new strategy for managing metastatic hormone-sensitive prostate cancer , according to Maha Hussain, MD, the Genevieve E. Teuton Professor of Medicine in the Division of Hematology and Oncology, a co-author of the study and study steering committee member.
This is a combination therapy in the first-line for patients with metastatic prostate cancer, said Hussain, who is also deputy director of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.
This trial was presented at the 2022 American Society of Clinical Oncology Genitourinary Cancers Symposium, held in San Francisco, Calif., and simultaneously published in NEJM.
Prostate cancer is the most common cancer and the second-leading cause of cancer mortality among men in the United States. Androgen deprivation therapy , which reduces levels of androgen hormones upon which prostate cancer relies, has been the mainstay of care for more than 60 years.
Darolutamide essentially closes the window in the cell, preventing any circulating testosterone from entering the cell, Hussain said.
This study was supported by Bayer and Orion Pharma.
Targeted Radiation Therapy And Psma
Scientists are also developing targeted therapies based on PSMA, the same protein that is being tested for imaging prostate cancer. For treatment, the molecule that targets PSMA is chemically linked to a radioactive compound. This new compound can potentially find, bind to, and kill prostate cancer cells throughout the body.
In a recent clinical trial, men with a type of advanced prostate cancer who received a PSMA-targeting drug lived longer than those who received standard therapies. Ongoing and planned clinical trials are testing PSMA-targeting drugs in patients with earlier stages of prostate cancer, and in combination with other treatments, including targeted therapies like PARP inhibitors and immunotherapy.
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Standards Of Care In Hormone Therapy
Most doctors agree that hormone therapy is the most effective treatment available for patients with advanced prostate cancer. However, there is disagreement on exactly how and when hormone therapy should be used. Here are a few issues regarding standards of care:
Timing of Cancer Treatment
The disagreement is due to conflicting beliefs. One is that hormone therapy should begin only after symptoms from the metastases, like bone pain, occur. The counter belief is that hormone therapy should start before symptoms occur. Earlier treatment of prostate cancer is associated with a lower incidence of spinal cord compression, obstructive urinary problems, and skeletal fractures. However, survival is not different whether treatment is started early, or deferred.
The only exception to the above, is in lymph node-positive, post-prostatectomy patients, given androgen deprivation as an adjuvant immediately after surgery. In this situation, immediate therapy resulted in a significant improvement in progression free survival, prostate cancer specific survival, and overall survival.
Length of Cancer Treatment
The disagreement in this situation is between continuous androgen deprivation and intermittent androgen deprivation.
Combination vs. Single-Drug Therapy
Progress In Prostate Cancer Care: Highlights From A Decade Of Innovation
Targeted Therapies in Oncology
Targeted Therapies in Oncology asked some experts in prostate cancer diagnostics and therapeutics for their thoughts on the milestone improvements in treating patients with prostate cancer over the past decade.
There have been numerous changes to the standard of prostate cancer care in the past 10 years, with novel agents moving into earlier and different disease settings for prostate cancer and the introduction of radiopharmaceuticals into both the diagnostic and treatment spaces. Targeted Therapies in Oncology asked some experts in prostate cancer diagnostics and therapeutics for their thoughts on the milestone improvements in treating patients with prostate cancer over the past decade.
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At The Recent Prostate Cancer Foundation Scientific Retreat You Gave A Presentation Titled Lupsma: The Newest Treatment Class For Advanced Prostate Cancer Can You Provide A Brief Summary Of This Presentation As Well As The Psma
The setting where this was studied was men with metastatic castration-resistant disease, who had progressed after docetaxel chemotherapy and also after an anti-androgen targeted therapy, like enzalutamide or abiraterone . So, this is a third-line treatment option. In the TheraP study, it was vs cabazitaxel. In the VISION trial, some patients had progressed after cabazitaxel, some patients weren’t suitable for cabazitaxel. So, this is now providing a strong evidence base for lutetium PSMA 617. The treatment recently received FDA breakthrough status, which means it will be more rapidly reviewed. We expect an outcome from the FDA next year and if that’s positive, we expect global, widespread availability of this as a new option for men with metastatic castration resistant prostate cancer.
Biomarkers For Prognosis And Treatment Selection
Biomarkers, characteristics that are objectively measured and evaluated as indicators of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention , can be disease- or host-related. Many biomarkers have been proposed for prognostication or direct therapy, but few have been rigorously verified or validated. With advances in next-generation sequencing and its falling costs, much has been learned about the genomic basis of advanced prostate cancer and its response to therapy. In fact, many ongoing studies are developed based on our genomic understanding of the disease .
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Prostate Cancer Detection Reviewed In Gulf Regions
It is important to point out cancer in an early stage for the health of the patient and research society. Early detection of cancer makes treatment tremendously coherent. It can cause death because of poor diagnosis. Although tissue biopsy is the standard for diagnosis, the classification and recognition have improved via imaging and indicators or biomarkers . In this review, we have only explained in detail the detection of PC via machine learning as the conventional diagnostics have been explained previously in other research articles in detail.
One of the approaches is by using a deep learning model for the detection of prostate cancer using a microarray gene expression dataset . This approach used a feature selection technique chaotic invasive weed optimization after preprocessing data samples. Furthermore, a deep neural network model with the RMSProp optimizer can be involved in prostate cancer detection. The output classification, as well as the analytical complicacy, is improved to a greater extent .
Deep learning methods such as long short-term memory and Residual Net .
Model using the correlation feature selection method and random committee model .
Age-standardized rate of patients with prostate cancer worldwide.
Emerging Therapies For Prostate Cancer
Researchers are pursuing several new ways to treat advanced prostate cancer. Vaccines that alter the body’s immune system and use genetically modified viruses show the most promise. One vaccine technique works by manipulating blood cells from the patient’s immune system and causing them to attack the prostate cancer.
Blood is drawn from the patient. From the blood sample, cells that are part of the immune system are exposed to cells that make up prostate cancer. Then the blood cells are placed back in the body, with the hope that they will cause other immune system cells to attack the prostate cancer. In a more traditional type of vaccine, the patient is injected with a virus that contains PSA. When the body is exposed to the virus, it becomes sensitized to cells in the body that contain PSA and their immune system attacks them.
Immune or genetic therapy have the potential to deliver more targeted, less invasive treatments for advanced prostate cancer. This would result in fewer side effects and better control of the prostate cancer.
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Improved Survival At 4 Years
In the ARASENS trial, nearly 1,300 participants were randomly assigned to receive darolutamide or a placebo . All participants received ADT within 12 weeks before randomization and six cycles of docetaxel starting within 6 weeks after randomization.
After 4 years, about 63% of patients who received darolutamide were still alive compared with about 50% of patients who received placebo. The group that received darolutamide lived longer even though most participants in the placebo group received other commonly used treatments, including abiraterone and enzalutamide, during follow-up.
Darolutamide resulted in other improvements as well. For example, among those treated with darolutamide, the time for their cancers to become resistant to hormone-suppressing therapies was longer, as was the time until the pain caused by their cancer got worse.
The frequency of serious side effectswhich included fatigue, falls, fractures, and cardiac issueswas similar in the two groups. Roughly two-thirds of the patients in both groups experienced serious side effects, most of which occurred when darolutamide were given at the same time as docetaxel.
Is There Anything Else You Feel Urologists Should Know About This Topic
It’s probably also worth mentioning that all the clinical trials that I was describing use lutetium PSMA 617, which is the Novartis product. There is another product in active development called lutetium PSMA INT, which is very, very similar, has some minor differences, and there are a few companies around the world commercializing lutetium PSMA INT. There other groups working on next-generation targeting molecules. So, they’re the 2 first cabs off the rank, and now we’ll have a newer generation. Can we improve targeting by modifying the PSMA targeting molecule further?
Another way we’re trying to improve this treatment is by using different radioactive substances other than lutetium 177. There’s a lot of interest in actinium 225, which is an alpha emitter, a different type of radioactive substance. And there’s a whole myriad of different radioactive substances that can be used that are going to be evaluated over the next few years. I think this is going to be an area of really explosive growth and interest, but most importantly, a new treatment option to both improve survival and improve quality of life for men with prostate cancer.
References
1. Hofman. PSMA Theranostics: The New Age of Prostate Cancer Imaging and Treatment. Lecture presented at: 2021 Prostate Cancer Foundation Scientific Retreat October 28-29 and November 4-5, 2021 Virtual.
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Antiandrogens For Prostate Cancer
These prostate cancer drugs work by blocking the effect of testosterone in the body. Antiandrogens are sometimes used in addition to orchiectomy or LHRH analogs.This is due to the fact that the other forms of hormone therapy remove about 90% of testosterone circulating in the body. Antiandrogens may help block the remaining 10% of circulating testosterone. Using antiandrogens with another form of hormone therapy is called combined androgen blockade , or total androgen ablation. Antiandrogens may also be used to combat the symptoms of flare . Some doctors prescribe antiandrogens alone rather than with orchiectomy or LHRH analogs.
Available antiandrogens include abiraterone acetate , apalutamide , biclutamide , darolutamide , enzalutamide , flutamide , and nilutamide . Patients take antiandrogens as pills. Diarrhea is the primary side effect when antiandrogens are used as part of combination therapy. Less likely side effects include nausea, liver problems, and fatigue. When antiandrogens are used alone they may cause a reduction in sex drive and impotence.
The New Therapeutic Locks On To The Psma Protein In The Cancer Cell Membrane Delivering Radiation And Destroying Cancer Cells
Northwell Health Cancer Institutes radiation and nuclear medicine clinicians are offering a new radiopharmaceutical therapy to treat men with metastatic prostate cancer, which is cancer that has spread beyond the prostate gland. The FDA-approved therapy offers hope for prolonged survival and reduced complications from cancer for those who have limited treatment options. Known as prostate specific membrane antigen therapy, it targets cancer cells throughout the body and destroys them. Developed by Novartis, the new drug, Pluvicto, also known as lutetium-177 or Lu-PSMA, is a type of radiopharmaceutical therapy. The drug zeroes in on the protein, PSMA, which is found in higher amounts in most prostate cancer cells. Acting like a magnet, the drug locks on to the PSMA protein in the cancer cell membrane, delivering radiation that damages DNA, destroying cancer cells. It is administered via injection into a vein in the arm. Patients could expect to receive one injection every 6 weeks, up to six injections.
PSMA therapy is offered at the Cancer Institutes Radiation Medicine Department at the Center for Advanced Medicine , but there are plans to expand the program to other sites, in addition to related therapeutic clinical trials in development.
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How Lupsma Is Changing The Prostate Cancer Space
At the recent 2021 Prostate Cancer Foundation Scientific Retreat, Michael S. Hofman, MBBS , FRACP, FAANMS, FICIS, presented the latest research on LuPSMA for the treatment of advanced prostate cancer.1 He gives an overview on current LuPSMA clinical trials and what these trials hope to accomplish in the prostate cancer space. Hofman is a nuclear medicine physician and director of the Prostate Cancer Theranostics and Imaging Center of Excellence , Melbourne, Australia.
More Options Lead To More Questions
Elisabeth Heath, M.D., director of prostate cancer research at Karmanos Cancer Institute in Detroit, agreed that the ARASENS results should have an immediate impact on how this form of the disease is treated.
Speaking at the ASCO symposium, Dr. Heath, who was not involved in the study, highlighted an important difference between ARASENS and other trials that tested androgen receptorblocking drugs in men with this form of prostate cancer. In those other trials, she explained, some participants received docetaxel prior to treatment with the androgen receptorblocking drugs rather than at the same time.
Based on the ARASENS results, Dr. Heath said, giving all three treatments simultaneously looks to be the preferred option for some patients.
Dr. Karzai noted that despite there being multiple options to treat metastatic hormone-sensitive prostate cancer, many questions remain. We don’t have guidelines on who should start with what drug and whether one drug is better than another for a patient, she said.
She also pointed out that more research is needed on how the order in which the drugs are given impact their effectiveness and the frequency of side effects.
Additionally, she said, the survival improvement in the ARASENS trial was seen in patients whose cancer had spread in multiple areas beyond the prostate .
We dont know if people with lower-volume benefit from as much as the patients with higher-volume disease do, she said.
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Biggest Breakthroughs In Advanced Prostate Cancer Treatment
by Health Writer
Prostate cancer is most often diagnosed at an early and highly treatable stagebut if youre one of the men with advanced-stage prostate cancer at diagnosis, youre in a club whose numbers have risen in the last decade, according to the Centers for Disease Control and Prevention . Thankfully, advancements in prostate cancer research have led to promising improvements in treatment possibilities for this club. We spoke to the experts to learn more about breakthroughs that are changing the treatment game in prostate cancer.