Duke Cancer Center Offers New Treatment For Metastatic Prostate Cancer
Terence Wong, MD, PhD, and Stacy Wood, a Duke Health nuclear medicine technologist, provides treatment to a patient.
Men with advanced metastatic prostate cancer that has not responded to other treatments may now benefit from a new radiopharmaceutical treatment called PLUVICTOTM . Duke is one of the first cancer centers in the Southeastern region to offer PLUVICTOTM following its FDA approval in March 2022. Studies show it can extend the lives of people with this aggressive form of prostate cancer, even in the late stages, said Terence Wong MD, PhD, a nuclear radiologist at Duke Health.
Risks Of Prostate Surgery
The risks with any type of radical prostatectomy are much like those of any major surgery. Problems during or shortly after the operation can include:
- Reactions to anesthesia
- Blood clots in the legs or lungs
- Damage to nearby organs
- Infections at the surgery site.
Rarely, part of the intestine might be injured during surgery, which could lead to infections in the abdomen and might require more surgery to fix. Injuries to the intestines are more common with laparoscopic and robotic surgeries than with the open approach.
If lymph nodes are removed, a collection of lymph fluid can form and may need to be drained.
In extremely rare cases, a man can die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team.
Allowing Cells To ‘let Their Freak Flags Fly’
According to Lee, immunotherapies like checkpoint inhibitors have achieved response rates of around 20% to 30% in many different solid tumor types, but they have not worked as well in prostate cancers.
One reason, he believes, is because prostate cancers donât have a lot of DNA mutations, or as he puts it, they have a âlow mutational burden.â
âThe importance of that is that the immune system has to figure out what is âself’ and what is ânon-self’ or foreign,â he said. âCancer develops in our body, so itâs part of us. If there are mutations, the proteins that are presented or flagged on the surface appear abnormal to the immune system.â
But with a low mutational burden, there arenât many abnormal flags flying.
âThat makes it difficult for the immune system to even act,â Lee said. âAnd on top of that, prostate cancers have an environment that is very inhospitable to the activity of immune cells.â
Lee and his team have come up with a potential workaround, though. Since the immune system usually recognizes cancer cells by their abnormal flags â or antigens â and prostate cancer has few mutations , the researchers devised a plan to force cancerâs hand.
âThe hope is that, by inhibiting ERAP1, youâre raising the flag of these antigens that the immune system can recognize to slow down or decrease the growth of these tumors,â he said.
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New Ways To Detect And Destroy Prostate Cancer
Of course, before prostate cancer can be treated, it must first be detected, and the earlier the better. New imaging technology is making a difference here as well.
When prostate cancer is suspected, a biopsy is required to confirm it. A needle guided by an ultrasound machine extracts the tissue sample.
Lau is excited about the magnetic resonance imaging -fusion system using a parametric magnetic resonance imaging machine , and grafting those images onto the picture generated by the ultrasound. This method does a much better job pinpointing spots where a biopsy should be taken.
It gives us a roadmap, said Lau, and it decreases the chance of repeated biopsies.
And what if you could detect AND destroy prostate cancer with the same system?
Thats the promise of a new field called theranostics.
Theranostics is simply a mashup of the words therapeutics and diagnostics, explained nuclear pharmacist Kofi Poku, Pharm.D. In other words, You see it you treat it.
Research Shows A Promising New Option For Men Who Experience Rising Psa After A Radical Prostatectomy
Many men who undergo surgical treatment for prostate cancer live out their lives without a recurrence of their disease. But 20% to 40% of them will experience a rise in prostate-specific antigen levels within 10 years of the operation. PSA should be undetectable in blood if the prostate has been removed, so elevated levels signify that the cancer may have returned. Doctors call this a biochemical relapse, and ordinarily they treat it by giving radiation to the prostate bed, which is where the prostate resided before it was taken out. Referred to as pelvic bed radiation therapy, or PBRT, this sort of treatment often succeeds in bringing PSA back down to zero for years.
Now, a large study shows that PBRT is even more effective when combined with other treatments. The findings are a potential game-changer for men experiencing a biochemical relapse after radical prostatectomy.
Funded by the National Cancer Institute, the SPPORT phase 3 clinical trial was conducted at nearly 300 medical centers across the United States, Canada, and Israel. A total of 1,797 men were enrolled between 2008 and 2015, all with post-surgical PSA levels ranging between 1 and 2 nanograms per milliliter .
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A Biopsy Is Done To Diagnose Prostate Cancer And Find Out The Grade Of The Cancer
A transrectal biopsy is used to diagnose prostate cancer. A transrectal biopsy is the removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure may be done using transrectal ultrasound or transrectal MRI to help guide where samples of tissue are taken from. A pathologist views the tissue under a microscope to look for cancer cells.
Sometimes a biopsy is done using a sample of tissue that was removed during a transurethral resection of the prostate to treat benign prostatic hyperplasia.
If cancer is found, the pathologist will give the cancer a grade. The grade of the cancer describes how abnormal the cancer cells look under a microscope and how quickly the cancer is likely to grow and spread. The grade of the cancer is called the Gleason score.
To give the cancer a grade, the pathologist checks the prostate tissue samples to see how much the tumor tissue is like the normal prostate tissue and to find the two main cell patterns. The primary pattern describes the most common tissue pattern, and the secondary pattern describes the next most common pattern. Each pattern is given a grade from 3 to 5, with grade 3 looking the most like normal prostate tissue and grade 5 looking the most abnormal. The two grades are then added to get a Gleason score.
The Nyulmc/sperling Prostate Cancer Center
Between April 2013 and April 2014, 21 men underwent focal laser ablation as part of a collaboration between the NYULMC Smilow Comprehensive Prostate Cancer Center and the Sperling Prostate Cancer Center. All candidates for this collaborative focal laser ablation of the prostate study signed informed consent to participate in a longitudinal outcomes study.
The selection criteria for focal laser ablation included a 10-year life expectancy, between one to two focal abnormalities on mpMRI consistent with prostate cancer, no Gleason pattern 4 disease on random TRUS-guided biopsies of the normal appearing prostate on mpMRI, focal abnormality on MRI < 15 mm, and no Gleason score over 7. In most cases, preservation of potency was a very high priority. Candidates are extensively counseled regarding the very limited short-term and lack of long-term oncologic outcomes data with focal prostate cancer laser ablation.
Fiber placement T2-weighted axial sequence.
Temperature-sensitive fast spoiled gradient-recalled echo images.
Postablation gadolinium-enhanced T1-weighted axial sequence.
To date, there has been no significant change in the mean AUASS, IPSS, or SHIM between 3 to 6 months and baseline . Incontinence has not been reported by any patient in the perioperative or postoperative setting. The mean preoperative PSA value was 5.40 . Among the 12 patients in whom the 6-month PSA was available, the mean PSA value decreased from 5.10 at baseline to 3.69 at 6-month follow-up .
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Car T Therapy For Solid Tumors
The idea of training the bodys own immune system to fight cancer has percolated throughout the cancer landscape for years now. Dorff is especially excited about the promise of CAR T treatment: taking a patients immune, or T cells, reengineering them to recognize specific tumor-associated antigens and then reintroducing them as supercharged cancer killers.
Dorff calls the progress in CAR T therapy profound and revolutionary. The Food and Drug Administration has approved two CAR T products for blood cancers.
But solid tumors, including prostate cancer, present special challenges.
Unlike say, leukemia cells, which are fairly uniform, solid tumors are packed with a wide variety of different cells, which means a one-size-fits-all CAR T cell targeting one specific protein cant mount much of an attack. Also, tumors often display an immunosuppressant microenvironment which can counter the punch of a CAR T onslaught. Finally, theres the problem of toxicity. Some of the proteins targeted by CAR T cells also exist in healthy tissue.
Dorff is heavily immersed in research and clinical trials to address all these concerns.
We need to find a way to get the CAR T cells into the tumor with the right amount and find a way to kill tumor cells with different expressions, she said. And we need to reduce toxicity and the immunosuppressant response.
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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How To Decide Between Radiation Or Surgery For Prostate Cancer
If you want to know how to decide between radiation or surgery for prostate cancer, youve come to the right place.
Prostate cancer is the second most common cancer in men, with more than 1 million cases diagnosed in 2018. It often grows slowly so that most men die of other causes before it becomes clinically advanced and hard to treat.
As most prostate cancers are diagnosed in slow-growing stages, they usually do not require immediate treatment decisions.
For localized and locally advanced prostate cancers, surgery and radiation therapy are the main treatment options.
Both options have risks, including erectile dysfunction, urinary problems, and bowel complications.
Your doctor will use the results of your diagnostic tests to balance the treatment benefits against those side effects.
Here, we explore the suitability of different treatment options. Well help you understand how to decide between radiation or surgery for prostate cancer. We offer information to help you consider the best treatment for your specific disease.
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How To Decide If You Want Radiation Or Surgery For Prostate Cancer
There is still a debate on selecting the best options to go by. Research that has been conducted on the outcomes of both procedures shows that both of them are effective in the treatment of prostate cancer and the choice of either of these depends on your underlying health conditions and is different from person to person.
To better decide on the treatment option to follow, it is important to first understand the disease itself. You can also gather as much information about the recovery experiences on either of these methods. Having a deep understanding of what it takes during and after the surgery or radiation therapy will help you to make a solid decision on which path to follow.
Making the right decision comes down to understanding the options that you have and how each of them can affect the outcomes you get. That is the main reason why it is always important first to undergo intensive diagnosis and pre-screening. This helps you to make the right decisions based on the results from the tests.
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Developing Therapies For Treatment
by Cedars-Sinai Medical Center
Molecular Therapy
Investigators from Cedars-Sinai Cancer have identified an investigational therapeutic approach that could be effective against treatment-resistant prostate cancer. Results of their Phase II clinical trial, published in Molecular Therapy, have led to a larger, multicenter trial that will soon be underway.
Cancer of the prostate, a small gland just below the bladder, is the second-leading cause of cancer-related death in men. Many prostate tumors are not aggressive and may require no or minimal treatment. Aggressive tumors are initially treated with surgery or radiation therapy.
In about one-third of patients, the cancer comes back after initial treatment, said Neil Bhowmick, Ph.D., research scientist at Cedars-Sinai Cancer, professor of Medicine and Biomedical Sciences and senior author of the study. Those patients are usually treated with medications that suppress the actions of testosterone and other androgensmale hormones that help prostate tumors grow.
“Patients do really well until the tumor figures a way around the androgen-suppressing therapy,” Bhowmick said. “One way that it can do this is to cause cells to make only part of the protein that the drug binds to, rendering the drug useless. The partial proteins are called splice variants.”
More information:Molecular TherapyJournal information:
Yale Professors Create New Drug That Could Combat Prostate Cancer
A Yale chemist and oncologist collaborated to create a new treatment for prostate cancer that tags specific proteins within the cancerous cells, making it easier for the bodys natural mechanisms to identify and destroy them.
11:30 pm, Sep 27, 2022
Staff Reporter
Courtesy of Karissa Van Tassel and Yale Office of Communications
Two Yale researchers have developed a new way to harness the bodys protein degradation system to target prostate cancer.
Professors Craig Crews and Daniel Petrylak at the Yale School of Medicine, have collaborated to develop a new drug that treats cancer by tagging specific problem cells for destruction. Proteolysis-targeting chimaera, or PROTACs, are now showing promise in clinical trials.
Every cell in your body has a system, a machinery that recycles proteins, Crews said. It takes old proteins damaged proteins and tags them for destruction.
Crews is the John C. Malone Professor of molecular, cellular and developmental biology and a professor of chemistry, and Petrylak is a professor of medical oncology and urology.
PROTACs were born out of a cross-department collaboration initiative. According to Petrylak, he met Crews at a Chemistry Department conference. There oncologists were invited to present the most important clinical issues related to their type of tumor expertise with the goal of harnessing the knowledge of both the chemistry and oncology departments to develop a new drug.
Selin Nalbantoglu | selin.nalbantoglu@yale.edu
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What Are Some New Diagnostic Methods For Prostate Cancer
Diagnosing prostate cancer isnt easy. Thats because the major tools the prostate-specific antigen test and prostate biopsy arent perfect. PSA levels can be high for reasons other than cancer, and they can be low even when someone has cancer. This makes it hard to know when someone needs a prostate biopsy. Some people end up getting prostate biopsies they dont need, while others can get biopsies too late. Even when done perfectly, the biopsy can miss the cancer cells and delay a diagnosis.
Once someone has a diagnosis of prostate cancer, theyll get a risk class. This risk class tries to predict how the cancer will behave over time. Teams usually pick treatments based on these risk classes. But the tools that help to assign a risk class arent perfect either.
Scientists are working to improve methods for diagnosis to overcome these limitations. The FDA hasnt approved some of these methods yet, and your insurance may not cover them. But even so, they might be right for you:
Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.
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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 .
Prostate cancer is most common in older men. In the U.S., about 1 out of 8 men will be diagnosed with prostate cancer.