Prostate Cancer: Treatment Options and New Medicine
Prostate Cancer by the Numbers
Prostate cancer is the number one cause of cancer in men, representing about 21% of all cancer diagnoses in men. An estimated 192,000 new prostate cancer cases will be diagnosed nationally in 2020, and about 3,000 of these cases will be in Louisiana. Prostate cancer is the number two cause of cancer-related deaths in men (lung cancer is number one). An estimated 33,000 men in the United States will die from prostate cancer this year, and 450 of these deaths will be in Louisiana.
Prostate cancer has a widely variable biology and clinical course. Many patients will have an indolent disease that can be managed either with surveillance or localized therapies such as surgery or radiation therapy. Some patients will have a more aggressive disease that may require a multidisciplinary approach, including surgery, radiation therapy, hormonal therapy and even chemotherapy.
Most cases of prostate cancer are diagnosed after a prostate biopsy is performed in response to an elevated PSA (prostate specific antigen) test. The PSA test is somewhat controversial because it can lead to over-diagnosis and over-treatment of prostate cancers that perhaps never would have caused any clinical problems. Also, there can be other non-cancerous reasons for an elevated PSA level. For these reasons, it is important to discuss the pros/cons of PSA screening with your physician.
The Gleason score is a grading scale used to classify how the prostate cancer looks under the microscope. A higher Gleason score is reflective of a more aggressive cancer.
For prostate cancers that are confined to the prostate gland, management options include surgery (a prostatectomy), radiation therapy, or, in some cases, active surveillance. Active surveillance includes frequent measurement of PSA levels and intermittent prostate biopsies; it is only an option for very low-risk disease. Sometimes radiation is given following surgery.
Sometimes, following surgery or radiation, androgen-deprivation therapy is given to decrease the risk of prostate cancer recurrence. We know that male sex hormones, specifically testosterone, are a driving factor for development and progression of prostate cancer. Androgen-deprivation therapy (ADT) essentially decreases the effect of testosterone on the cancer by decreasing the production of testosterone or by blocking the binding of testosterone to receptors on the cancer. The major side effects of ADT include impotence, fatigue, and mood changes.
New Medicine Emerges
For advanced prostate cancers, including metastatic disease when prostate cancer has spread to other organs, treatment includes androgen-deprivation therapy, chemotherapy, and sometimes radiation/radioactive therapy. Several new medications have been approved by the FDA over the past three to five years, and they have transformed the therapy for castration-resistant prostate cancer, a term used to describe prostate cancer that continues to grow despite androgen-deprivation therapy.
Patients with prostate cancer are living longer than ever before. Because prostate cancer can be widely different in terms of aggressiveness, it is important that patients be managed in a multidisciplinary setting, in which urologists, radiation oncologists, and medical oncologists collaborate together to determine a treatment strategy that is specific to your unique cancer.