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.³
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
“When I first started practicing, a man diagnosed with advanced prostate cancer would have a life expectancy measured in months,” says Dr. Christopher Stewart, director of the Advanced Prostate Cancer Center at Arizona Urology Specialists in Phoenix. “Now, the constant development of new drugs and new technology continue to push out survival well beyond five years.”
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.
“Right now, I’m just hopeful,” says Dennis Williams, who was treated with immunotherapy, one of a newer class of treatments for advanced prostate cancer.
Williams, 75, was first diagnosed with prostate cancer in 2001 and learned in 2017 that the disease was starting to spread. Since receiving immunotherapy and subsequent treatment, he says he’s keeping to his routine – two or three workouts a week, attending sporting and other events with his 11 grandchildren, and doing missionary work for his church.
“I attribute a lot of what I can’t do to the fact that I’m 75,” not to his cancer, says Williams, who retired from the grocery industry and a second career with a school district.
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.
“How can you go wrong when someone says they’ll put things in your body that will fight the cancer?” says Williams.
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 Importance
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.
“If we get an opportunity to treat men with advanced prostate cancer early, I believe that the immunotherapy is more effective than if we wait,” says Stewart.
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.
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, Stewart and many other urologists at these clinics have expert staff who help patients navigate the treatment journey. Just helping sort out the treatment options or financial issues can make a difference.
Information Keeps People Living
There are a lot of places where people can get information to help with decisions and guidance, says Stewart. He recommends the American Urological Association and the American Cancer Society, in addition to his clinic’s website.
Williams credits his doctor for providing helpful materials to help him understand all the treatment options, including immunotherapy. “They’ve kept me well informed,” he says, adding that they also have helped him navigate insurance coverage issues. Now he says, “I’m feeling fine.”
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