Urologic oncologists have been looking for a cure for the seemingly incurable disease prostate cancer and it seems that they have made a breakthrough. A pilot study of multimodal therapy for non-castrate metastatic prostate cancer is showing promising results, leading researchers to believe that a cure may finally be on its way.
According to MedPage Today, despite the long history of this incurable disease, a treatment that consists of androgen deprivation (ADT), surgery, and radiotherapy has rendered promising results. Apparently, 19 of 20 men have undergone the treatment, and for of four years, PSA levels have become undetectable. Unfortunately, such low levels of PSA are not often permanent.
In light of the study, it may be hard to determine why it is actually promising, especially since metastatic prostate cancer still seems far from being curable. According to Urology editor-in-chief Eric Klein, MD, of the Cleveland Clinic, many have believed that metastatic prostate cancer is incurable, however, there is a catch.
“What’s special is that in the past we have believed that we could never truly cure someone with metastatic prostate cancer,” said Klein. “The patient with the longest follow-up is now 5 years out, has no evidence of prostate cancer, an undetectable PSA, and a normal testosterone, which means that all the effects of the androgen deprivation therapy that he’s been on are gone. I have never seen that in my career before.”
Moreover, the patient was diagnosed with “incurable” prostate cancer, and Klein recommended ADT for his care. The patient apparently wanted a second opinion and proceeded to Memorial Sloan-Kettering Cancer Center in New York City, where Howard Scher, MD, and his team decided on a more dramatic approach to treating metastatic prostate cancer.
Scher concluded that surgery is not enough to eliminate the disease, and the same goes for radiotherapy.
“Our colleagues in radiation therapy have shown that patients who receive radiation and hormones do better than those who get radiation alone or hormones alone. We’re just using surgery as the local treatment,” told MedPage Today. “We also know that if a patient has an established bone lesion, hormones alone don’t eliminate all of the diseases there, either. So we’re using hormones and radiation for visible bone lesions.”
Scher’s proposed approach was acknowledged by Klein, who stated that it needed testing and validation in a much larger scale. Apparently, two heads are definitely better than one since Scher and Klein’s ideas resulted in the possibility of a multimodal approach being more effective to reach their goals.
“We rarely drive the PSA level to zero with androgen deprivation alone, but with a multimodal approach, we may be able to do that,” Klein began. “Driving the PSA to zero and then having the patients’ testosterone recover was the endpoint of the study. The paradigm shift is that if we can’t get patients with metastatic disease to a PSA of zero with a multimodal approach, we’re not going to cure anybody. The fact that they were able to get four patients to PSAs that were undetectable and normal testosterones, that’s pretty exciting.”
Moving forward, the investigation of this newfound approach will proceed in a multi-arm, multistage study. The possibility of including additional therapies and newer androgen receptor targeting agents is also likely. The teams at MSKCC group will continue to conduct studies in order to discover more about the biology of prostate cancer and what effects multimodal therapy can do against it.
Apparently, MSKCC and Klein are not alone in the battle against prostate cancer, according to Men’s Health, Samuel Denmeade, MD, a professor of oncology and urology at Johns Hopkins University, is also working on a way to battle this incurable disease with a different approach. As compared to Klein and MSKCC’s strategy to fight prostate cancer, Denmeade aims to discover if testosterone can serve as a way to fight the disease.
Based on the findings of Charles Huggins, MD, a professor at the University of Chicago back in the 1940s, blocking testosterone production can kill prostate cancer cells. However, the cancer cells survive on androgen receptors that testosterone binds to. Although the latter seemed to be a dead end, Denmeade discovered that exposing testosterone-starved cancer cells to sudden high doses of the hormone suppresses cancer. Currently, Denmeade and his team are testing the capabilities of bipolar androgen therapy, and the results showed that a third of their patients had their tumors shrink. As an added bonus, these patients were indeed happy and even regained sexual function.
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