It’s been a big couple weeks of headlines in the news for prostate cancer.
Let me help you make sense of it all. Let's try to be as logical as Spock.
I’m a prostate cancer survivor and cancer biologist so I spend probably more than my share of time thinking about prostate cancer and from a number of angles.
Prostate cancer is almost an inevitable fate for men in America and for many other men around the world if you live long enough, but a significant fraction of the cancers are not life threatening. Others, unfortunately such as the cancer I had surgery for 2 1/2 years ago (read my cancer “coming out” post here), are to the contrary very serious.
No watchful waiting for these.
How good are we at telling the difference? What’s the best way to detect the cancers that are dangerous? How can we best help men with prostate cancer? What about those men whose cancer has recurred?
These questions are just a handful of the many important ones out there and it can be confusing.
What’s the scoop on the latest headlines?
First there was the bombshell that the federal task force recommended that all PSA testing be stopped. They claimed that PSA testing did more harm than good. Most rational people who are well-educated about prostate cancer that I have talked to in the biomedical community think the task force made a huge mistake. As I put it, they threw the baby out with the bathwater. It is not time to abandon PSA testing, but rather a prime opportunity to refine it and adopt a more logical system of testing. Bottom line, I think men should still get tested but guided by something similar to the new guidelines that I've proposed. At risk men such as those with a first degree relative who has had prostate cancer (e.g. my two brothers), especially at a young age, should get tested.
Second, we heard promising news that J&J’s drug Zytiga (Abiraterone) worked so well in a trial that the trial was stopped so all men could receive the treatment. Very encouraging news. Zytiga works by inhibiting production of testosterone. It is intended to be used for so called hormone resistant prostate cancer (which is the form of prostate cancer that kills men) for which older drugs no longer work. Zytiga has shown promise both for treatment of men with prostate cancer prior to their surgery (shrinks tumor before removing prostate) AND later in the course of the disease. Bottom line, Zytiga is just one of numerous new prostate cancer drugs in the pipeline so the fact that it works well is good news. Fans of another prostate cancer therapy, Provenge, which involves the use of immune cells and costs $100K, have nit-picked at issues related to Zytiga, but overall I think Zytiga is more promising personally.
Third, it was reported that taking breaks from hormone-deprivation therapy may increase mortality. Let me explain. One of the weapons against prostate cancer is treatment of patients with drugs that block production of testosterone because testosterone is like fuel for prostate cancer. However, inevitably cancers find a way to become resistant to the anti-testosterone therapy. Nonetheless hormone deprivation is an important tool and can keep cancer at bay for years. One such drug is called Lupron. The catch is that Lupron has very nasty side effects.
My father, who had prostate cancer at age 58 and then had a recurrence about a couple decades later, took Lupron for a time. He hated it. Most men do hate Lupron and hence the impetus for wanting to take a break now and then from getting the hormone deprivation therapy. Now scientists report that taking such breaks, which helps alleviate the nasty side effects of the drug, has a cost: men taking breaks from hormone deprivation therapy are more likely to have their cancer be worse. Bottom line, this is not unexpected, but is still bad news that if men want the max benefit from anti-hormone therapies they are going to have to put up with the side effects without breaks.
What would Spock make of all this? I think he'd be favor of continuing PSA testing, but in a more logical manner. I believe he'd be encouraged by the news on the drug front and he'd advocate taking no breaks from hormone deprivation even if the side effects are nasty. Maybe Spock could invent a way to beam cancer out of the body!