Category: Treatment Information

The following was written by a prostate cancer survivor on the website “Prostatesnatchers” to which I highly suggest you subscribe.

“Back in 1990, when a suspicious lump was discovered on my prostate, my ignorance of the prostate gland and the possibility of prostate cancer was monumental. No one in my family or even among my close friends had ever had prostate cancer, and it never occurred to me that I might one day have the disease.

Now, 25 years later, I am still alive, the average man over 50 is more aware of prostate cancer, and also many less toxic and more effective treatment options are available. And yet one thing has not changed: just hearing the doctor say, “I’m afraid it’s cancer,” can leave even the most pragmatic man planning the music for his funeral.

Truth is there is still a lot of misinformation and misunderstanding out there about this disease. So here are some facts that I hope will alleviate some of your fears, and also clarify why I still contend that if you have to have cancer, prostate cancer is the best deal in town.

Prostate cancer is unique among cancers because the mortality rate is so low. According to the American Cancer Society, more than 2 million men who have been diagnosed at some point are living with the disease in the U.S. It’s difficult to determine actual prostate cancer survival rates because most men are around 70 years old when diagnosed, and many of them will die from medical problems unrelated to the disease. But if you check out the “relative” 5-year survival rate of all stages of prostate cancer, you will find it is almost 100%. And that almost 100% of men with low-risk or  intermediate-risk disease live more than 10 years after diagnosis.

Why is it that the statistics for prostate cancer are so much less frightening than for other cancers?

1)    The PSA test is an early warning system that other cancers don’t have.
2)    It can easily be diagnosed at an early stage.
3)    In most cases it has an exceptionally slow growth rate.
4)    Extremely effective monitoring and treatment is now available.
5)    It has a pattern of spread that spares critical organs like the brain, lungs and liver.
6)    There is a safety net like no other called “hormone blockade” that induces remissions lasting more than 10 years in men with relapsed disease after surgery or radiation.

So instead of thinking about your funeral, what you really want to be focusing on is not rushing into some form of radical treatment that will virtually guarantee  some degree of impotence or incontinence.

It appears that patients and doctors alike struggle with the idea of “watching” anything called cancer. But unless you have the less common high-risk form of the disease, my advice to you is to consider ‘Active Surveillance’ really carefully, especially if you are over 70. Because bottom line—and it bears repeating—out of over 200,000 men in the U.S. diagnosed annually with prostate cancer, the overwhelming majority will die with the disease, and not from it.”

In the January 23rd, 2015 issue [290(4):2024-33] of the Journal of Biological Chemistry, researchers published the finding of potential benefit for a combination of metformin and the gene inhibitor B12536 in late-stage prostate cancer.  Late-stage prostate cancer is commonly treated with androgen (hormone) deprivation therapy (ADT); however, the disease eventually becomes resistant to treatment.  Androgen deprivation can disturb the body’s metabolism, leading to insulin resistance that can stimulate unwanted androgen production.  Metformin, a drug commonly used to treat diabetes, helps reduce insulin resistance and has been associated with protection against specific cancers.  It is known that the gene poly-like kinase 1 (PLK1) can become over-expressed (overactive) during ADT and that its over-expression can also stimulate androgen synthesis, researchers tested the effects of administering the PLK1-inhibitor B12536 with low-dose metformin in prostate cancer cells.  The team found that the drugs worked synergistically to inhibit prostate cancer cell proliferation. The findings were confirmed in mice that received human prostate cell grafts. Further animal studies are underway with the eventual goal of initial human trials.

The Prostate Cancer Research Institute (PCRI) has listed four (4) Phase 2 or Phase 3 clinical trials which are currently recruiting patients.  These trials all involve immunotherapeutic agents. The first is a Phase 3 trial of ProstAtak® coupled with standard radiation therapy for localized prostate cancer.  Patients should be newly diagnosed with intermediate to high risk disease, having received less than 6 months of hormonal therapy, and with no metastases or no local treatment.  The trial is recruiting in several states and at institutions such as Johns Hopkins and Walter Reed in Maryland and Memorial Sloan Kettering in New York.  Second, a Phase 2 study involving Ipilimumab (Yervoy®) with abiraterone acetate (Zytiga®) plus prednisone in chemotherapy and immunotherapy-naïve patients with progressive metastatic hormone-resistant prostate cancer is recruiting patients at Memorial Sloan Kettering in New York.  Ipilimumab is a human monoclonal antibody currently approved for the treatment of melanoma.  Third, another Phase 2 study involving Provenge® (Sipuleucel-T) coupled with immediate or delayed CTLA-4 blockade is recruiting in San Francisco.  CTLA-4 (cytotoxic T-lymphocyte-associated protein 4) is a protein receptor found on the surface of T-cells that down-regulates the immune system.  The CTLA-4 receptor acts as an “off” switch for the attack of cancer cells by T-cells.  Hence blocking the CTLA-4 receptor would enhance T-cell anticancer activity.  Finally, a Phase 3 trial (Prospect) involving Prostvac in men with few or no symptoms of metastatic, hormone-resistant prostate cancer is recruiting patients.  This Prospect trial has been described in a previous blog posted on August 5th, 2014.

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.

Testosterone (androgen)-depleting therapies are usually the first line of defense for men with newly-diagnosed or recurrent prostate cancer. But resistance to these therapies develop over time which leaves the patient and physicians with a number of choices as to the next sequence of therapies to be administered. Recently, guidelines, issued jointly by the American Society of Clinical Oncology (ASCO) and Cancer Care Ontario (CCO) in Canada, highlight recent advances in treating this more advanced form of prostate cancer. Six new treatments have been approved in the last two years for the treatment of prostate cancer and its symptoms. However, opinions differ as to the sequence of using these therapies and their cost, their relationships to a man’s quality of life, the disease stage of the cancer, and prior therapies received by the patient. Combination studies are certainly needed and underway. The new guidelines for hormone therapy – resistant tumors that have metastasized are based on a review of 56 randomized clinical trials published since 1979 and include the following recommendations.

a) Continue hormone-deprivation therapy indefinitely.                                                              b) In addition to hormone deprivation, offer patients one of three treatment options including Zytiga® (abiraterone acetate and prednisone), Xtandi® (enzalutamide), or alpha-radin (radium-223 chloride if the cancer has spread to the bones). All three treatments are associated with improved survival, quality of life and a favorable balance of benefit and harms.                                                                                                                                c) When considering chemotherapy, taxotere (docetaxel®) with prednisone should be an option but side effects must be discussed. See also the September 20th, 2014 blog.             d) Offer cabazitaxel to men whose disease worsens even if taxotere has been tried,  but again discuss the side effects.                                                                                                             e) Offer Provenge® (sipuleucel-T) to men with no or minimal cancer symptoms. Some physicians maintain that it can be most effective to initially stimulate the immune system with agents like Provenge® before other agents are utilized.                                                      f) Offer mitoxantrone but include a discussion of the drug’s limited clinical benefit and side effect risk. Mitoxantrone is also used to treat leukemias and multiple sclerosis.           g) Offer ketoconazole or the anti-androgen therapies bicalutamide, flutamide or nilutamide but discuss the limited clinical benefits of these three medications.                    h) Do not offer other anti-cancer drugs such as bevacizumab (Avastin®), estramustine or sunitinib.                                                                                                                                                  i) Begin discussions of palliative care early on while discussing treatment options.

The experts on the panel formulating these guidelines said the optimum sequence in which various treatments should be given remains unclear, but “ongoing clinical trials are exploring this question, as well as potential benefits of combining various treatments.”