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In the last few years, several new therapeutic agents have been approved for treating various aspects of prostate cancer. Now research also needs to focus on the timely utilization of these agents either individually or in combination and at which stages of disease should they best be applied. Provenge® (sipuleucel-T) was approved by the Food and Drug Administration in 2010 for metastatic prostate cancer patients who were hormone-resistant (refractory) and who had little or no pain. Provenge® is an immunotherapy uniquely administered over several weeks and generally acts by “kick starting” the immune system while not attacking cancer cells directly. This website has described Provenge® in several posts over the past years. The question of when in the course of prostate cancer treatment should Provenge® optimally be administered is currently under much discussion. A recent series of video and e mail comments from four prominent prostate cancer physicians propose that Provenge® should be used at an early stage in the treatment of metastatic cancer. The videos and comments are linked in this post. The physicians cited are Dr. Charles Myers (himself a prostate cancer survivor), Dr. Charles Drake from Johns Hopkins, Dr. David Crawford from the University of Colorado, and Dr. Leonard Gomella from the Jefferson Kimmel Cancer Center. The reader is urged to share this information with one’s physician as much of it is medical in nature. But it raises some interesting points for discussion and possible incorporation into a treatment regimen as directed by one’s individual physician.
1) Researchers at the University of Texas Health Sciences Center in San Antonio have developed a “calculator” to predict probabilities of biopsy results based upon data such as PSA, age, race, results of digital examination and family history. To access the “calculator” online, go to http://deb.uthscsa.edu/URORiskCalc/Pages/calcs/jsp. The “calculator” is based on data from the prostate cancer trial that involved more than 5,800 patients to determine the risk of developing prostate cancer based upon PSA and digital rectal examinations. This information was recently cited in the October 19th Johns Hopkins Prostate Disorder Health Alerts.
2) When prostate cancer is first detected, the urologist will describe the extent of the tumor and the course of the disease using a system called the Whitmore-Jewett method or more commonly the TNM (tumor, nodes, metastasis) staging system. The “T” value describes the extent of the tumor; the “N” value indicates whether the cancer has spread to any lymph nodes; and, the “M” value indicates the presence or absence of metastasis to distant sites. This description will help in the choice of the most appropriate treatment option. The Johns Hopkins Health Alerts (September 13th, 2014) describes the TNM stages in more detail.
Androgen deprivation (hormonal) therapy is often administered to men with advanced prostate cancer. However, after a period of time genetic mutations can occur in the prostate cells which then promote tumor growth. A new way to monitor how a man’s cancer is changing during treatment and which could help identify the stage at which some drugs stop being effective would be very useful. A new blood test which measures DNA from these circulating prostate cells could reveal when existing treatment stops working and harmful, hormone-resistant tumor cells begin proliferating. At that point, existing treatment could be stopped and the next best treatment option could be administered. Measuring the circulating tumor cell’s DNA could conceivably personalize treatment for an individual based on the tumor cell mutations detected. According to a study published in the September 17th Science Translational Medicine and summarized in the September Prostate Cancer Foundation (PCF) Research NewsPulse, such a test could be a less invasive and less expensive way to monitor the emergence of treatment-resistant prostate cancer. This published preliminary study was small (16 men) and larger studies are in order.