New Treatments And Clinical Trials
Research has increased our overall understanding of prostate cancer and new treatments are being tested in patients. Clinical trials primarily involve patients who have rising PSAs after treatment or who have more advanced, metastatic cancers. A number of new agents may eventually provide more treatment options for new and recurring cancers. But at this time, none of them are regarded as cures, or even as replacements for surgery, radiation or hormone therapy.
Generally, patients being treated with these new approaches have experienced fewer side effects than patients receiving more traditional treatments.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
In Five Years A Major Treatment Shift
In men diagnosed with metastatic hormone-sensitive prostate cancer, the cancer is typically driven to grow and spread by androgens that are produced largely in the testes. For many years, treatments that block androgen production have been a mainstay for men initially diagnosed with metastatic prostate cancer.
Starting in 2014, that began to change after a large clinical trial showed that adding the chemotherapy drug docetaxel to ADT improved how long men with hormone-responsive disease lived. Shortly after, another clinical trial showed that adding abiraterone to ADT also improved survival in these men, although primarily in men with many metastatic tumors, known as high-volume disease.
However, docetaxel, which works by directly killing cancer cells, can have substantial side effects, and some patients arent healthy enough to tolerate it. And abirateronewhich blocks androgen production throughout the bodycan also cause side effects, including those that affect the liver. It also has to be given in combination with the steroid prednisone, which carries its own toxicity.
Doing so, Dr. Chi said during a presentation of the TITAN data at the ASCO meeting, might help stave off the typically inevitable development of hormone-resistant cancer, which is more difficult to treat and a key driver of prostate cancer deaths.
Staging Of Prostate Cancer
Doctors will use the results of your prostate examination, biopsy and scans to identify the “stage” of your prostate cancer .
The stage of the cancer will determine which types of treatments will be necessary.
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.
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Thinking About Taking Part In A Clinical Trial
Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they’re not right for everyone.
If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.
Getting Help With Treatment Decisions
Making such a complex decision is often hard to do by yourself. You might find it helps to talk with your family and friends before making a decision. You might also find it helpful to speak with other men who have faced or are currently facing the same issues. The American Cancer Society and other organizations offer support programs where you can meet and discuss these and other cancer-related issues. For more information about our programs, call us toll-free at 1-800-227-2345 or see Find Support Programs and Services.
Itâs important to know that each manâs experience with prostate cancer is different. Just because someone you know had a good experience with a certain type of treatment doesnât mean the same will be true for you.
You might also want to consider getting more than one medical opinion, perhaps even from different types of doctors. For early-stage cancers, it is natural for surgical specialists, such as urologists, to favor surgery and for radiation oncologists to lean more toward radiation therapy. Doctors specializing in newer types of treatment may be more likely to recommend their therapies. Talking to each of them might give you a better perspective on your options. Your primary care doctor may also be helpful in sorting out which treatment might be right for you.
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Diagnostic Advances In Prostate Cancer
Prostate cancer diagnosis is followed by staging of the cancer. If theres no evidence of metastasis of the original prostate tumor, meaning the cancer hasnt spread to other parts of the body, your cancer will also be assigned to a risk stratification group, also known as a risk group. The risk group attempts to predict the likelihood that the disease has spread microscopically outside the prostate. We informally refer to three risk groups: low risk, intermediate risk and high risk, although as many as six different groups exist.
The specific stage and/or risk stratification of your cancer may determine your treatment options. In general:
Depending on your specific diagnosis, you may have two or more good treatment choices that have similar outcomes, and you probably have time to investigate those options.
Recent areas of advancement in oncology may provide a more accurate picture of your specific diagnosis, directing you and your doctor to more appropriate treatment options. Two specific developments include prostate-specific PET scan agents that may allow us to get more accurate imaging than we could before and the results of advanced genomic testing, which may help identify more aggressive cancers that are less suitable for active surveillance.
Future Directions In Care
Coupled with advances in imaging and genomic testing, the emergence of new therapeutic options for mCRPC suggests the potential for optimizing outcomes and survival. However, increasing patient access to these therapies remains a challenge, Gomella observed. Cost is one potential barrier, as he noted, Men are living longer, and many of these newer regimens can run $8000 to $10,000 or more a month, a financial burden for most. We are going to have to deal with these practical challenges. Also, it can be difficult to provide patients with appropriate treatment when also navigating challenges associated with insurance coverage and prior authorization. Insurance coverage is one of those unforeseen problems with these advances made over the last 10 years, Gomella said. The costs of developing novel agents are very significant, as well.
References
1. Lowrance WT, Breau RH, Chou R, et al. Advanced prostate cancer: AUA/ASTRO/SUO guideline part I. J Urol. 2021 205:14- 21. doi:10.1097/JU.0000000000001375
2. Cancer stat facts: prostate cancer. National Cancer Institute/ Surveillance, Epidemiology, and End Results Program. Accessed June 22, 2021. https://seer.cancer.gov/statfacts/html/prost.html
3. Rice MA, Malhotra SV, Stoyanova T. Second-generation antiandrogens: from discovery to standard of care in castration resistant prostate cancer. Front Oncol. 2019 9:801. doi:10.3389/ fonc.2019.00801
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Family History And Genetics
Until recently, doctors assumed that the key risk factors for prostate cancer were age, a family history of prostate cancer and being of African-American ancestry. Today, however, researchers like Dr. Heather Cheng are looking at family history more broadly.
An associate professor of medical oncology at the University of Washington School of Medicine, Cheng says there are proven genetic links between prostate cancer in men and breast, ovarian and pancreatic cancer in their female relatives.
If there is an inherited cancer risk, that risk may manifest itself in female relatives differently than in male relatives, Cheng says.
The genetic links work both ways. When sharing their family history with their doctors, men should include information about female relatives on both sides of the family who have had cancer. And men who are diagnosed with metastatic prostate cancer should undergo genetic testing, as should their siblings and children if a mutation is discovered.
That doesnt mean a person will definitely get cancer, but it may increase their risk, Cheng says. It also provides information for them to use that risk knowledge to be proactive.
Family history can also help inform a patients decision about whether to have a PSA test. That test is no longer routinely recommended due to the potential for overtreatment, but Cheng says it becomes more important if a man has a known mutation or if theres a family history of early breast and ovarian cancer.
Emerging Treatment Options For The Management Of Metastatic Castration
Prostate cancer is the most common solid organ malignancy diagnosed in men in the United States, accounting for 13% of new cancer cases annually.1,2 Although localized disease is associated with high survival rates, advanced or metastatic disease has proven more challenging to treat, with 5-year survival rates found to be approximately 30%.2
Metastatic castration-resistant prostate cancer is responsible for the majority of prostate cancerrelated deaths. In recent years, newer imaging technologies have yielded additional insights about mortality risks, including the number and location of metastatic sites, whereas novel therapeutic agents have provided more options for patients.1,3
Newer imaging technologies may impact some men with nonmetastatic CRPC based on standard imaging, according to Gomella. A big unknown right now is in the setting of stage M0 CRPC disease and the impact of the PSMA scan, Gomella observed. Will the PSMA scans widespread use suddenly reduce the number of men considered to be M0 and reclassify them as stage M1? That remains to be seen and is something well be watching.
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Prostate Cancer Survival Rates
Answering the question of how curable is prostate cancer? first requires understanding what doctors mean when they refer to curability. Regardless of the type of cancer, doctors consider cancer cured when a patient remains cancer-free for a specified period after treatment. The higher the number of patients who stay cancer-free for five years or longer, the higher the curability of that particular disease.
Prostate cancer, therefore, has one of the highest curability rates of all types of cancer, thanks in large part to early detection standards and advances in treatment, such as the stereotactic body radiation therapy offered by Pasadena CyberKnife. When the cancer is detected in the early local or regional stages that is, before the cancer has spread or when it has only spread to limited areas in the pelvic regions the five-year survival rate is nearly 100 percent.
Survival rates decline significantly when cancer is detected at later stages however, the good news is that only about five percent of men are diagnosed after the cancer has become widespread throughout the body. In short, more than 90 percent of men who are diagnosed with prostate cancer live for five years or longer after treatment, making it one of the most curable forms of cancer.
Patients On Active Surveillance
A critical need exists to develop effective nontoxic compounds that slow prostate cancer growth. One promising agent is curcumin, which is a widely reviewed nutraceutical that has previously been considered safe to consume.
Evidence from early phase clinical trials suggests curcumin might prolong survival among prostate cancer patients. The agent has shown early promising activity in preclinical prostate cancer cell lines.
UT Southwestern is the sponsor of the phase three Randomized, Double-Blinded, Placebo-Controlled Trial of Curcumin to Prevent Progression of Biopsy Proven, Low-Risk Localized Prostate Cancer in Patients Undergoing Active Surveillance. The primary outcome of the study is the number of patients who have progressed at 24 months of follow-up, defined using standard criteria for progression.
The reason we were attracted to curcumin is because of the interesting data in cell lines, but animal models have also shown it has potential to slow the growth rate of prostate cancer, says Dr. Lotan, who treats patients with bladder, prostate, kidney, ureteral, and testicular cancer. His nationally recognized research on urine and molecular markers helps to identify patients who are at higher risk for recurrent cancer.
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New Breakthroughs And Treatment Options For Metastatic Castrate
In recent years, scientists have made some landmark discoveries in how to treat mCRPC. New treatments for this form of cancer are being found. Also, changes are being made to existing treatments so they work better. If you are diagnosed with mCRPC, your doctor may prescribe one of these treatments:
Vaccines or Immunotherapy. Usually, vaccines prevent infections. Lately, researchers have been looking into using vaccines to treat mCPRC. If your prostate cancer returns despite hormone therapy and is metastatic, your doctor may offer the cancer vaccine sipuleucel-T . Sipuleucel-T works by boosting the bodys immune system so it attacks cancer cells. This is the first vaccine that has been shown to help men with prostate cancer live longer. Other prostate cancer vaccines are also being studied.
New Hormone Therapies. Two new kinds of hormone therapies have helped men with mCRPC delay symptoms and live longer.
Androgen synthesis inhibitors. The oral drug abiraterone acetate stops your body and the cancer from making steroids . Because of the way it works, this drug must be taken with an oral steroid known as prednisone. Abiraterone is approved by the FDA for use before or after chemotherapy in men with mCRPC
Prostate Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Prostate
The prostate is agland in the malereproductive system. It lies just below the bladder and in front of the rectum . It is about the size of a walnut and surrounds part of the urethra . The prostate gland makes fluid that is part of the semen.
Prostate cancer is most common in older men. In the U.S., about 1 out of 5 men will be diagnosed with prostate cancer.
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How Is Prostate Cancer Diagnosed
Screenings are the most effective way to catch prostate cancer early. If you are at average cancer risk, youll probably have your first prostate screening at age 55. Your healthcare provider may start testing earlier if you have a family history of the disease or are Black. Screening is generally stopped after age 70, but may be continued in certain circumstances.
Screening tests for prostate cancer include:
- Digital rectal exam: Your provider inserts a gloved, lubricated finger into the rectum and feels the prostate gland, which sits in front of the rectum. Bumps or hard areas could indicate cancer.
- Prostate-specific antigen blood test: The prostate gland makes a protein called protein-specific antigen . Elevated PSA levels may indicate cancer. Levels also rise if you have BPH or prostatitis.
- Biopsy: A needle biopsy to sample tissue for cancer cells is the only sure way to diagnose prostate cancer. During an MRI-guided prostate biopsy, magnetic resonance imaging technology provides detailed images of the prostate.
How Can I Choose From Among The Options
In addition to talking with family and friends, you will need a team of physicians to help advise you. It is advisable that you meet with all of the specialists involved in your cancer treatment planning prior to making a decision regarding treatment, including:
- your primary care physician as well as a urologist to discuss surgery
- a radiation oncologist to discuss radiation therapy.
Once you have met with these doctors, you will be able to make a more informed decision regarding your treatment options. If you have an early-stage cancer or moderately advanced cancer and there is no evidence of spread to other organs , the two major options for treatment are surgery or radiation therapy .
If your cancer is advanced and you require hormonal suppression therapy or chemotherapy, then you will also need a medical oncologist, who administers these drugs. Hormone-ablation therapy, which is often used to treat more advanced prostate cancer by suppressing your androgen hormones since most prostate cancer growth is stimulated by androgen or testosterone. The androgen suppression treatment can be administered by your internist, urologist, radiation oncologist or medical oncologist. Depending on the stage of the cancer, hormone suppression therapy may be used in addition to radiation therapy to help control the cancer. Hormone suppression therapy may be administered for as little as four to six months, or for as long as two to three years.
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Prostate Cancer Treatment Approved In England
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Prostate cancer cell. Credit: LRI EM Unit.
Following its approval in Scotland 2 weeks ago, a new treatment will now be available on the NHS in England for some people with prostate cancer.
Currently, androgen deprivation therapy is a cornerstone of prostate cancer treatment as it reduces the level of testosterone . However, in cases where this treatment doesnt work, there are no alternatives other than to continue.
But the latest decision changes that. The National Institute for Health and Care Excellence approved darolutamide with standard hormone therapies for adults whose prostate cancer hasnt spread outside the prostate, has stopped responding to ADT and are at high risk of developing metastatic disease in the future.
Kruti Shrotri, head of policy development at Cancer Research UK.
Darolutamide works by blocking the activation of testosterone receptors on cancer cells, thereby limiting the growth of the cancer.
Clinical trial data has shown that individuals taking darolutamide alongside ADT have more time before their cancer spreads outside of the prostate compared to those taking ADT on its own. The data also suggest that this combination increases the length of time people live , but the long-term benefits are unclear.
Prostate Cancer: A New Treatment Option
Ochsner Health is excited to announce that we now offer an innovative new treatment for prostate cancer at the Center for Urologic Oncology in the Gayle and Tom Benson Cancer Center.
Men with localized prostate cancer have had these options: active surveillance for low-risk tumors to radical therapy with surgery or radiation for patients with intermediate or high-risk tumors. Patients now have a new option: Focal One HIFU , which fills an important niche between the other available options.
What is HIFU and how does it work?
To treat localized prostate cancer, the Focal One HIFU device uses high-frequency sound waves precisely directed at the cancerous tissue through an ultrasound probe inserted into the rectum. No incisions are made. The high-intensity sound waves heat up and destroy the targeted cancer tissue, causing cell death.
With HIFU, the urologist is able to focus and destroy the cancerous tissue without damaging other surrounding structures, which include nerves, blood vessels and muscle tissue. This reduces the risks of long-term erectile dysfunction and incontinence.
What does the new Focal One Robotic HIFU system make possible?
Who qualifies for HIFU?
Learn more about this new prostate cancer procedure by calling 504-842-4083.
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