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.
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“When I started training 15 years ago we were doing very basic radiotherapy, where you’d treat big, square areas of the body.
“Of course, cancer is never square and that meant you would a lot of healthy tissue accidentally, because that was the best we could do.
“We are so much more precise that we don’t hit much of the healthy tissue now”, she told The Times.
It comes as another team of experts have developed a new cocktail of drugs to treat the cancer.
Could Immunotherapy Finally Break Through In Prostate Cancer
The first therapeutic cancer vaccine, approved more than a decade ago, targeted prostate tumours. The treatment involves extracting antigen-presenting cells a component of the immune system that tells other cells what to target from a persons blood, loading them with a marker found on prostate tumours, and then returning them to the patient. The idea is that other immune cells will then take note and attack the cancer.
The 2010 decision by the US Food and Drug Administration to approve this vaccine called sipuleucel-T raised hopes for a surge of cancer treatments that use the bodys natural capabilities to destroy the enemy within. Immunotherapies have at least partially delivered on that promise in many types of cancer. But not in the prostate.
Part of Nature Outlook: Prostate cancer
Prostate cancer has been a big challenge in terms of getting immunotherapies to work, says Lawrence Fong, a cancer immunotherapist at the University of California, San Francisco. Even sipuleucel-T was not an unqualified success. It delivered a slight survival benefit, but had no effect on tumour size or symptoms.
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Treating Advanced Prostate Cancer
If the cancer has reached an advanced stage, it’s no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.
Treatment options include:
- hormone treatment
If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.
The Right Way To Do It
For immunotherapies to deliver the greatest value, they will need to be targeted to the right people. Prostate is going to be an immunologically responsive disease, says Haas. We just need to better divide the patient populations. This sort of personalization is already common in treatment of breast, kidney and skin cancers, but is lagging in prostate cancer.
Drake, however, thinks that it shouldnt be necessary to limit treatments to small groups of people whose tumours fit a narrow set of criteria. We dont select patients for chemo for prostate cancer it just works, he says. If we had an effective combination regimen with immunotherapy, we could probably help the majority of patients.
There is growing consensus that the timing of an immunological intervention could be crucial. Most immunotherapy approaches have been taken in patients with quite advanced disease, says Haas. But the longer a cancer fights off a patients immune system, the more entrenched it can become. In advanced tumours, there arent a lot of T cells, says McNeel. Maybe weve been targeting the wrong stage of the disease. He suggests that it might be better to deploy immunotherapy immediately after surgery or radiation therapy, to prevent the disease coming back. There are also hints that radiotherapy might prime the immune system, perhaps by cracking open cancer cells and inducing an immune response.
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Access The Right Treatments At The Right Time
When it comes to treating prostate cancer, it is important to have access to the best expertise possible so you can receive the right treatments at the right time. The University of Maryland Cancer Network gives you the opportunity to connect with the best treatment options available.
Led by the University of Maryland Greenebaum Comprehensive Cancer Center , the UM Cancer Network provides you access to nationally renowned experts, the latest treatments, and promising clinical trials close to home. When you work with a UM Cancer Network cancer center, your community hospital will work in partnership with UMGCCC to help you beat cancer.
Find out more about prostate cancer treatments.
Find an UMMS cancer center near you.
What Is Focal Therapy
This novel approach to treating prostate cancer destroys the tumor within the prostate. Not all prostate cancers can be treated safely with focal therapy, and this is an ongoing area of research. We do know that high-quality imaging is critical. By visualizing the tumor with precision on MRI scans or other imaging tests, surgeons can use various sources of energy to get rid of the tumor. These include cryoablation , laser ablation, or high frequency ultrasound. High-intensity frequency ultrasound can also destroy the tumor without harming the prostate.
Focal therapy can successfully remove the prostate cancer without damaging the rest of the prostate gland, thus minimizing the risk of urinary or sexual side effects.
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Studying Early Detection For Men At High Risk
Men with certain inheritedgenetic traits are at increased risk for developing prostate cancer. Examples of such traits include inherited BRCA gene mutations and Lynch syndrome. No clear guidelines exist for when or howor ifto screen men at high genetic risk for prostate cancer.
NCI researchers are using magnetic resonance imaging of the prostate in men at high risk to learn more about how often and how early these cancers occur. Theyre also testing whether regular scans in such men can detect cancers early, before they spread elsewhere in the body .
What Are The Warning Signs Of Prostate Cancer
Warning signs of prostate cancer often dont appear until the cancer is advanced. Thats why we stress screening, which involves a simple rectal exam and a PSA blood test that measures the amount of PSA, an enzyme secreted by the prostate gland. You should start annual screening at age 50 or, if you have risk factors, at 45.
Know The Signs: The Symtoms Of Prostate Cancer You Should Look Out For
In most cases, prostate cancer doesn’t have any symptoms until the growth is big enough to put pressure on the urethra – that tube you pee through.
- Straining and taking a long time while peeing
- Feeling that your bladder hasn’t emptied fully
Many men’s prostates get larger as they age because of the non-cancerous conditions, prostate enlargement and benign prostatic hyperplasia.
In fact, these two conditions are more common than prostate cancer – but that doesn’t mean the symptoms should be ignored.
The signs that the cancer has SPREAD include bone, back or testicular pain, loss of appetite and unexplained weight loss.
Dr Matthew Hobbs, director of research at Prostate Cancer UK said the study shows that combining the drugs could give men up to 18 months of additional life.
“This will make a huge difference for these men, and if the full results confirm these findings, we want to see this combination approved on the NHS as quickly as possible, he said.
The second trial, the Stampede trial, focussed on high-risk prostate cancer.
It found that at the six-year point, men who had received standard treatment as well as AAP for two years had an improvement in metastasis-free survival from 69 per cent to 82 per cent.
They also had an improvement in overall survival from 77 per cent to 86 per cent, and an improvement in prostate cancer specific survival from 85 per cent to 93 per cent – compared to standard treatment alone.
Creating Novel Cellular Therapies
The third aim of the study is to use the information gleaned from ERAP1 inhibition to eventually create new cellular immunotherapies for patients with treatment-resistant metastatic prostate cancer.
âIf we can figure out what freak flags the cancer is showing and then figure out the other side â what T cells and receptors are identifying cancer in this way â we can generate an army of these T cells that we can infuse into patients to treat them,â Lee said, explaining that the team will use single-cell sequencing to identify the T-cell receptors.
Marty Chakoian, chair of the Patient Advocacy Committee for the Pacific Northwest Prostate Cancer SPORE to which Lee presented his proposal, said the new research could be a game changer for men with this disease.
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Could It Work In Other Cancers
Even better, thereâs a possibility that this innovative approach may lead to immunotherapies for other solid tumors.
âOver 30,000 men pass away every year in the U.S. from metastatic prostate cancer,â Lee said. âWeâre hoping that these two strategies can be leveraged to develop new treatment combinations for that disease and expand the powerful reach of immunotherapies for advanced prostate cancer. And weâre also hoping that if successful, this concept can be broadly applied in the future to other cancer types.â
Chakoian said the potential to expand into additional cancers is whatâs most exciting for him.
âIf he can break through that conundrum and develop new therapies for prostate cancer, some of the principles that heâs come up with may be applicable to other solid tumor cancers,â Chakoian said. âThatâs the part of this project that Iâm excited about, finding new ways for the T cells to find the cancer cells and kill them. Thatâs brilliant.â
Lee, who has been at Fred Hutch for nearly five years, admits his project is âambitious,â and he said much credit goes to the Kleberg Foundation for their financial support.
What Special Treatments Are Offered At Cbmc
We offer minimally invasive robotic surgery to remove the prostate, using a pen-sized instrument inserted through several small incisions in the abdomen. Robotic surgery provides significant magnification of the prostate and the nerves and blood vessels surrounding it, which allows the surgeon to do a better job of taking care of the cancer while avoiding injury to the adjacent tissue .
Im one of the few surgeons using a new technique that involves placing an amniotic membrane around the nerves that have been spared at the time we remove the prostate. It speeds healing and allows most men to return to normal sexual function more quickly.
In addition, we also offer CyberKnife® Robotic Radiosurgery, which is a safe, noninvasive alternative to surgery that delivers beams of high-dose radiation to tumors with extreme precision, sparing healthy tissue. Treatment for prostate cancer usually requires five sessions and is an effective option for many patients.
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Active Surveillance And Watchful Waiting
If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.
Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.
ASCO encourages the following testing schedule for active surveillance:
A PSA test every 3 to 6 months
A DRE at least once every year
Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years
Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.
Prostate Cancer Uk Highlights Latest Treatment Innovations
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Hormone Therapy For Prostate Cancer
Over the last few years, several new approaches to hormone therapy for advanced or metastatic prostate cancer have been approved for clinical use.
Many prostate cancers that originally respond to treatment with standard hormone therapy become resistant over time, resulting in castrate-resistant prostate cancer . Three new drugs have been shown to extend survival in men with CRPC. All three block the action of hormones that drive CRPC:
The survival benefit for these drugs has been seen regardless of whether men have previously received chemotherapy.
In addition, both enzalutamide and the drug apalutamide have all been shown to in men with CRPC that has not yet spread to other parts of the body. Darolutamide has been shown to increase the amount of time men live without their cancer metastasizing.
Abiraterone, apalutamide, and enzalutamide have been shown to improve the survival of men with metastatic castrate-sensitive prostate cancer when added to standard hormone therapy.
Scientists are continuing to study novel treatments and drugs, along with new combinations of existing treatments, in men with metastatic CRPC.
Radical Prostatectomy Survival Rates
Men who undergo radical prostatectomy have a high survival rate and low rates of cancer recurrence, cancer spread and death, according to a study of 10,332 men who had surgery between 1987 and 2004. The research showed that between 5 and 20 years after having the surgery, only 3% of the patients died of prostate cancer, 5% saw their cancer spread to other organs, and 6% had a localised recurrence.
Another large Scandinavian study compared men who chose active surveillance with those treated by radical prostatectomy. The results suggest that in the long term, younger men with higher-risk tumours who have a radical prostatectomy, have a definite survival advantage.
Results from another study at Johns Hopkins Hospital in Baltimore confirmed that 82% of men undergoing radical prostatectomy were free of recurrence at 15 years. The data from the research also indicated that in those men whose PSA level starts to rise again after surgery, the recurrent prostate cancer spreads in only around one-third of the men. In addition, unless a man had an aggressive grade of prostate cancer, the spreading of the disease would not become life-threatening for several years and would be amenable to treatment.
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This newPSMA PET scan can detect prostate cancer metastases much earlier, when they are much smaller, which may help to improve treatment of patients with prostate cancer. PSMA, short for Prostate Specific Membrane. The actor and comedian previously received treatment for. Apr 12, 2022· Imaging Techniques To Detect Bladder Cancer.
Hinova Pharmaceuticals Inc., a clinical-stage biopharmaceutical company focused on developing novel therapeutics for cancers and metabolic diseases through targeted protein degradation.
Researchers continue to look for foods that can help lower prostate cancer risk. Scientists have found some substances in tomatoes and soybeans.
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Queens researcher awarded £280,000 to develop newprostatecancertreatment 31 August, 2022. A researcher at Queens University Belfast has been awarded over £280,000 from ProstateCancer UK to develop the first-ever personalised radiotherapy treatment for advanced prostatecancer based on mens genes.
Basel, March 23, 2022 Novartis announced today that the US Food and Drug Administration approved Pluvicto TM for the treatment of adult patients with a certain type of advanced cancer called prostate-specific membrane antigen-positive metastatic.
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The Stages Of Treatment
Because the stage of your cancer is the most influential factor in how your treatment will progress, weve divided the rest of this article into segments based on the stage of your cancer:
Stage 1 prostate cancer is the least advanced stage. This means your cancer is small and hasnt advanced past your prostate.
In this stage, PSA and Grade Group levels are low. Over 99% of people with prostate cancer caught in this stage survive the effects of cancer for at least 5 years. This means that you can still die of other causes, but you have a less than 1% chance of dying of prostate cancer complications.
for stage 1 prostate cancer usually consists of some combination of active surveillance, surgery, or radiation therapy. You may also be eligible for clinical trials that offer newer treatment techniques.
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