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Treatment Advances

I vividly remember a conversation with an eminent professor, whose specialty is prostate cancer, at a research event. It was about two years after my stage 4 diagnosis, and we were chatting about my diagnosis and prognosis.

He told me that if I’d been diagnosed 10 years earlier, I’d probably have been dead after two years, such were the advances in treatments. His view was that in the first 5 years of that 10 years, he had seen significant advances in treatment, and in the second 5 years there had been massive changes.

Some of the advances

A lot of these advances seem to have come about thanks to the STAMPEDE trial (see my interview with its chief investigator, Professor Nicholas James).

When I was diagnosed, the standard treatment from the UK NHS was hormone therapy coupled with docetaxel chemotherapy. But for many years the stand of care was hormone therapy only. Combining the two treatments has seen survival advantage. Now research is also suggesting the use of triplet treatments, such as androgen deprivation therapy (ADT) plus abiraterone and prednisolone.1-3

A godsend for me

In my own case I started on hormone therapy immediately. I was diagnosed in May 2017 and was scheduled to start docetaxel in August. However, in June I heard about the results coming out of STAMPEDE that suggested abiraterone at the very least matched the survival rates of docetaxel, and I was thankful that my private insurers agreed to fund it for more. It has been a godsend as I remain stable 5 years later with a PSA level that is unrecordable.

One of the barriers to using PSA tests to screen men is that a high PSA reading sometimes led to overtreatment with biopsies and, potentially, prostatectomies being carried out on men when the cancer was never going to cause them a problem. I think this area has improved with mpMRI scans being used in the diagnostic pathway, and more men going onto active surveillance and avoiding treatments that can be debilitating and impact quality of life.

When coupled with biopsies being guided by the scans and carried out trans perineally rather than trans rectally, the risk of biopsies can be reduced, making PSA testing coupled with risk assessment tools more viable.

Identifying the pros and cons

For those diagnosed with earlier stages of prostate cancer requiring treatment, the treatments may seem bewildering, including prostate removal, various types of radiotherapy, HIFU (a form of ultrasound treatment delivered to the affected area of the prostate), and cryotherapy (which can be delivered to a small area of the prostate).

These treatments won’t be suitable for all men and may not be offered at your cancer center, but I’d urge newly-diagnosed men to thoroughly research all the options and consider the pros and cons before deciding on the route that’s right for them.

Other options

In the advanced prostate cancer arena, we’ve seen some promising results with drugs including apalutamide and darolutamide.

For men whose cancer has become castrate-resistant and spread to the bones, Radium 223 is a form of radiation delivered by injection that targets cancer cells while minimizing damage to surrounding cells. It is also meant to help reduce pain and distress from the cancer in the bones.4Lutetium 177 is another innovative therapy for castrate-resistant prostate cancer, although I believe not yet widely available apart from private care and potentially at considerable cost.

Lots of research

There is currently significant research into immunotherapy drugs and PARP inhibitors, and I suspect that the future of treatments for castrate-resistant prostate cancer may be personalized care using precision medicine where men have a genetic mutation.

I’m very grateful to researchers who continue to try to find ways to extend the lives of men like me, and I try to assist with research wherever I can. I’m also grateful to the people who go before us and become guinea pigs in clinical trials. They forge the way for future generations, and without them we wouldn’t have known about the effectiveness of abiraterone, which has been a godsend to me.

In closing, we’ve made massive progress in the last 15 years, and I expect to see even greater progress in the next 15 years. Some of the developments will come too late for me, but they will hopefully help to stop prostate cancer being the awful killer that it can be.

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