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.³READ MORE: Fruit Stand Worker Injured In East Side Crash Still In Pain, But Grateful To Be Alive: 'I Thank God Morning And Night'
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.
“This is an exciting time to be in the field of urology,” says Deepak A. Kapoor, MD, Clinical Associate Professor of Urology at the Icahn School of Medicine at Mount Sinai and President of Advanced Urology Centers of New York in Melville, N.Y., one of the largest urology practices in the United States. “We have a far more robust armamentarium of surgical and medical techniques. We can offer the possibility to extend survival far beyond the 18 to 24 months the patients could historically expect.”
For Ralph Monterosso of Massapequa, N.Y., these new treatment options give him hope, despite having prostate cancer since 2000 and a powerful family history of prostate cancer. “My father died from it. My uncle had it. And two of my cousins had it,” says Monterosso, 74, a retired sales manager. “It’s dramatically different now.”
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 ImportanceREAD MORE: Queens Neighbor Holds Rally In Solidarity With Asian-American Community
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.
“You’ve got a lot of things you can do now that you couldn’t do 10 or 15 years ago,” says Monterosso. “Get your (bone) scans and stay on top of it.”
Monterosso was treated with a combination of treatments, including immunotherapy in 2015, and says he has been healthy ever since. He keeps a busy schedule: he delivers meals for his church once a week, plays in a band several days a week, recruits basketball players for his college, and raises money for charities. “I help people. I don’t get help,” he says. “All things considered, I feel great.”
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.
Managing advanced prostate cancer requires a holistic process to both prolong duration and enhance quality of life, says Dr. Kapoor. Patients frequently need help sorting out the logistics of carefully timed medical appointments or getting insurance or other benefits coverage. “Integrating the team is the optimal way to care for people with advanced prostate cancer,” says Dr. Kapoor whose team includes nurse navigators, benefits experts and a team of specialized physicians who review and optimize every patient’s therapeutic plan.
Information Keeps People Living
“The biggest challenge is patient education; while we have opportunities for novel treatments for patients with a diagnosis of advanced prostate cancer, many patients remain unaware that such options exist,” says Dr. Kapoor. “If we get patients early on, their response to immunotherapy is much, much greater. It’s critically important for patients to be active participants in their care.”
Monterosso encourages conversations about cancer. “I don’t go around announcing what I’m dealing with, but if it comes up, I’ll talk about it. Sometimes it’s hard, but there’s no reason to be afraid.”MORE NEWS: Child Hit By Fire Truck, Seriously Injured On Staten Island
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- 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