Men with prostate cancer often survive 15 years or longer after learning they have the disease, but prostate cancer remains one of the five most common cancers and the second most frequent cause of cancer-related death among men.¹'² Today, fewer people are being screened for the disease, and many are unaware of new treatment approaches that can extend life.
In 2012, the U.S. Preventive Services Task Force (USPSTF) made a controversial recommendation to abandon routine screening for all men using a blood test that measures levels of a protein called prostate specific antigen, or PSA. Despite a reversal of this recommendation in 2018, a disturbing trend has emerged – more men are being diagnosed with prostate cancer after the disease has progressed into the more dangerous advanced stage, and the once-declining prostate cancer death rate has stalled.³
As the standard of care for prostate cancer has evolved in the past decade, a number of new treatment options have become available for men with advanced prostate cancer – those whose cancer recurs after radiation or surgery.⁴
The first line of treatments aims to suppress production of the hormone testosterone, which contributes to prostate cancer growth.⁵ However, hormone therapy's effectiveness diminishes over time, and the treatment eventually fails in more than 60 percent of men,⁶ indicating the disease may be progressing. It is at this transition point where the newest treatments can make a difference.
One of the newest categories, immunotherapy, changes the dynamic for both patients and physicians, says Dr. Ben Lowentritt, director of the comprehensive prostate cancer program at Chesapeake Urology Associates, a 85-physician group with practice locations in Maryland and Delaware. Says Lowentritt, "Immunotherapy extends life, which is the most important outcome we can see."
Newer Treatment Options for Advanced Prostate Cancer Offer Hope
The introduction of advanced treatment options for prostate cancer required a shift in thinking for physicians. In the past, doctors rarely ordered bone scans or other tests to pinpoint the cancer when it became more serious, because there were few options besides pain management and chemotherapy to offer. Some physicians chose to not even tell patients that their cancer had progressed.
Things are very different today. In the past three decades, physicians have had an array of new therapies available to treat men in the advanced stages of the disease, including anti-androgen therapy, radiopharmaceuticals, chemotherapy and immunotherapy.⁷
Among these, immunotherapy is one of the most exciting categories of cancer treatments to emerge in the past decade and works differently than other cancer treatments. This is truly "personalized" medicine using a patient's own cells to stimulate the body's immune system to target and attack the prostate cancer cells.
The availability of such new, more effective treatment options is a good thing for patients, but it demands careful disease management. There are important questions about when to give each of these therapies and what sequence provides the greatest positive impact on survival.
However, if men don't know their options or don't have access to prostate cancer specialists who can best guide them, they may miss the opportunity for these newer treatments.⁸ The right treatments at the right times may help patients live better and longer.
Close Monitoring Takes on New Importance
Diligent monitoring is crucial, especially for immunotherapy. Studies show that treatment with immunotherapy may extend life.⁹ However, to have the best chance of successfully boosting the patient's own immune system, immunotherapy treatment should be administered before the cancer has done too much damage to the immune system. This is because treatment works best when the immune system is not overly damaged.¹⁰ This typically is before a patient has any pain or other symptoms, so a combination of blood tests and bone scans are essential.
Regular blood tests to measure PSA help spot when the prostate cancer becomes more aggressive. High or steady increases in PSA levels are signs of active prostate cancer. However, catching the disease when it spreads requires additional methods such as imaging with CT-scans or other advanced imaging technologies, which help doctors spot prostate cancer that may have spread to the bones or other organs.¹¹
Now, urologists want men with prostate cancer to understand if they get their PSA tests and bone scans on the schedule their doctor recommends, there may be treatments that can boost the body's own cancer-fighting power and help them live longer.
"We tend to watch those patients a lot more closely and make sure that we are following them closely, because that's when they're most vulnerable," says Lowentritt.
Specialized Clinics Optimize Treatment
To support the changing treatment landscape, a growing number of specialized urology care clinics have emerged, where patients can get a full range of services provided by nurses, doctors and other professionals who focus only on advanced prostate cancer.
With an emphasis on improved quality of life, Lowentritt and many other urologists at these clinics have expert staff who help patients navigate the treatment journey. Just helping sort out the treatment options or financial issues can make a difference.
"It's really about engaging the patients early and educating them about what they can expect, so that things don't come as a shock and they can be an active participant," says Lowentritt.
For patient John Webster of Edgewood, Md., finding his way to a specialist has been important. When his regular doctor saw some unusual test results, Webster was referred to a urologist, who found the prostate cancer and began both treatment and check-ups every three months.
"Things seemed to be going well until about a year ago, when my PSA levels started going back up," says Webster, 61, a retired home improvement contractor. CT-scans to study his bones and other organs found that his cancer had spread. This summer, he was treated with immunotherapy and subsequent treatment.
Information keeps people living
"It was kind of scary at first, but (the medical team) talked me through everything and made me feel very special. It gives me hope knowing that my own body is working against the cancer itself."
Webster echoes what Lowentritt says about the importance of being an active participant in health care.
"Don't be afraid to be tested. (Prostate cancer) is nothing to be ashamed of. Get tested, it's something that could save your life," says Webster, who was first diagnosed in 2013. "There are a lot more options now – things that can prolong your life, so get tested."
The contents and information in this Dendreon-provided and sponsored article are for informational purposes only and not intended as a substitute for professional medical advice. If you think you may have a medical emergency, dial 9-1-1 or contact your doctor immediately.
- National Cancer Institute. Common Cancer Sites - Cancer Stat Facts. seer.cancer.gov. https://seer.cancer.gov/statfacts/html/common.html. Published 2018. Accessed July 31, 2018.
- Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7-30. doi:10.3322/caac.21442
- Negoita S, Feuer EJ, Mariotto A, et al. Annual Report to the Nation on the Status of Cancer, part II: Recent changes in prostate cancer trends and disease characteristics. Cancer. 2018;124(13):2801-2814. doi:10.1002/cncr.31549
- Prostate Cancer Foundation. Choosing a Treatment Option - PCF. https://www.pcf.org/about-prostate-cancer/prostate-cancer-treatment/choosing-treatment-option/. Accessed July 31, 2018.
- Prostate Cancer Foundation. Hormone Therapy for Prostate Cancer - PCF. https://www.pcf.org/about-prostate-cancer/prostate-cancer-treatment/hormone-therapy-prostate-cancer/. Accessed July 31, 2018.
- Dendreon. Data on File (2016).
- Denmeade SR, Isaacs JT. A history of prostate cancer treatment. Nat Rev Cancer. 2002;2(5):389-396. doi:10.1038/nrc801
- Bowers E. How to Pick Your Advanced Prostate Cancer Medical Team. Everyday Health. https://www.everydayhealth.com/hs/conditions/how-pick-advanced-prostate-cancer-medical-team/. Published 2014. Accessed July 31, 2018.
- Prostate Cancer Foundation. Immunotherapy for Prostate Cancer - PCF. https://www.pcf.org/about-prostate-cancer/prostate-cancer-treatment/immunotherapy-prostate-cancer/. Accessed July 31, 2018.
- Crawford ED, Petrylak DP, Higano CS, et al. Optimal timing of sipuleucel-T treatment in metastatic castration-resistant prostate cancer. Can J Urol. 2015;22(6):8048-8055. http://www.ncbi.nlm.nih.gov/pubmed/26688132. Accessed July 20, 2018.
- Hricak H, Choyke PL, Eberhardt SC, Leibel SA, Scardino PT. Imaging Prostate Cancer: A Multidisciplinary Perspective. Radiology. 2007;243(1):28-53. doi:10.1148/radiol.2431030580
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