“Froedtert & The Medical College participated in a trial where we gave patients just 12 treatments. Results were promising enough to be shared with the National Cancer Institute,” Dr. Lawton said. “We are now conducting another trial for patients who have localized prostate cancer to test the effectiveness of an even shorter course. Half of the patients will receive 12 treatments and the other half will receive five.”
“Although the premise of shorter treatments needs further study, our ongoing trials look positive in terms of safety, effectiveness and quality of life for men undergoing radiation treatment,” Dr. Lawton said.
Chemotherapy, Immunotherapy and Hormone Therapy
Research has led to the approval of new drugs for prostate cancer, according to Kathryn Bylow, MD, Medical College of Wisconsin medical oncologist. The first is cabazitaxel, a chemotherapy drug approved for patients who are no longer responding to the first line chemotherapy drug — docetaxel. “Cabazitaxel is specifically formulated to target drug resistance that can develop with docetaxel,” Dr. Bylow said.
The other is an immunotherapy drug called sipuleucel-T, which was found to extend survival for certain patients. This drug is approved for patients who are asymptomatic, but have metastatic prostate cancer that no longer responds to hormone therapy. “In prostate cancer, it’s the first immunotherapy to show any kind of survival advantage,” Dr. Bylow said.
Sipuleucel-T is created using the patient’s own cells, making it a complicated, expensive treatment, according to Dr. Bylow. Still, it’s an exciting development, because it opens the door for other possible immunotherapies, some of which are being tested in trials now.
“Another important drug is abiraterone, a hormone therapy,” Dr. Bylow said. “It decreases levels of testosterone and attacks the hormone pathway in a new way. It has been studied with very promising results in patients whose cancer progressed on hormone therapy and chemotherapy.” Froedtert & The Medical College are participating in clinical trials for abiraterone.
When to use chemotherapy for prostate cancer is also being studied. “Breast cancer is way ahead of us in looking at using chemotherapy early in the treatment process,” Dr. Bylow said. She cited a study available at Froedtert & Medical College which is evaluating the use of chemotherapy in addition to hormonal therapy for patients with cancer that has spread beyond the prostate.
The Big Picture
Looking at the big picture in prostate cancer treatment means tackling risk vs. benefit, according to William See, MD, Medical College of Wisconsin urologic oncologist, and chair of Urology. For some patients, prostate cancer poses a serious threat to survival, while for many others, the cancer will grow so slowly patients will likely die of something else.
“It’s critical to make that distinction,” Dr. See said. “If we treat all of those patients, everyone incurs the risks associated with treatment, whereas relatively few people obtain a survival benefit.”
The cases at either end of the spectrum are easy to distinguish — patients who clearly need treatment and patients who just need to be monitored. “Now, the problem is, there’s a large gray area in the middle,” Dr. See said, referring to cases where it’s more difficult to determine if the benefits of treatment will outweigh the risk of side effects.
“Often, when we see a patient with a newly diagnosed, prostate cancer where the risk/benefit picture is unclear, it’s analogous to having walked into a movie halfway through,” Dr. See said. “We’re not sure what’s happened before, and we’ve only seen a few frames of the film. With that limited view, it’s impossible to predict the rest of the plot. By seeing more of the movie, we get a better sense of the likely outcome. This strategy is called active surveillance.”
Special Report 2011 William See, MD 15
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