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 .
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 .
The first line of treatments aims to suppress production of the hormone testosterone, which contributes to prostate cancer growth . However, hormone therapy’s effectiveness diminishes over time, and the treatment eventually fails in more than 60 percent of men, indicating the disease may be progressing. It is at this transition point where the newest treatments can make a difference.
“Once that diagnosis of advanced disease is made, we let men know that there are many effective therapies available, and more therapies are coming online all the time,” says Paul Dato, urologist at Genesis Healthcare Partners in San Diego. “There’s been an explosion of therapies that we can offer to help them live longer and live better, despite a situation that is not curable.”
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 .
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 . The right treatments at the right times may help patients live better and longer.
Close Monitoring Takes On New Importance
Diligent monitoring is crucial, especially for immunotherapy. Studies show that treatment with immunotherapy may extend life . 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 . 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 .
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.
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.
With an emphasis on improved quality of life, [doctor name] and many other urologists at these clinics have other physicians, nurses and expert staff who help patients navigate the treatment journey. Just helping sort out the treatment options or financial issues can make a difference.
Dick Miller of Julian, Calif., credits Dato and his team for guiding him towards immunotherapy and helping him understand not only how it works, but what he needed to do to maximize his chances for improvement.
“I was in denial a bit, but my PSA went up to 10 and alarm bells went off. That’s when we got started” with immunotherapy, says Miller, 82, who follows doctor’s orders, goes to the gym three times a week and “eats his broccoli.”
Since immunotherapy treatment two years ago, Williams has kept a full schedule of volunteer work at the San Diego Model Railroad Museum in Balboa Park and social outings with friends and nearby children and grandchildren.
Information Keeps People Living
Dato says that patients who have family or friends involved in their overall care can help a lot, especially since immunotherapy requires carefully timed appointments to have blood cells removed and then for the supercharged cells to be infused back in. Besides, the goal of treatment is to enable patients to live well for as long as they can, which includes social and other activities.
“Family members can be involved and help men share their concerns, fears and anxieties and also get encouragement,” says Dato, whose treatment plans include exercise regimens and healthy eating recommendations.
For Williams, immunotherapy has given him more time to volunteer at the railroad museum and enjoy friends, family and travel. During his career as an aeronautical engineer, Miller worked on components that helped land man on the moon, and he still has a sense of adventure.
“A week ago, I ran away to Arizona for five days and drove old Highway 66. I bought a brand-new roadster, got a lady friend, and off we went.”
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