There has been a large increase in men diagnosed with advanced and metastatic prostate cancer in the last several years (i.e. prostate cancer that has spread beyond the prostate) due to inadequate prostate-specific antigen screenings (PSA). Thankfully, in recent years, prostate cancer has seen a significant growth in available therapies.
A review of almost 800,000 cases of prostate cancer diagnosed from 2004-2013 found the annual incidence of metastatic prostate cancer during those years increased by 72 percent. Historically, the primary treatment for metastatic prostate cancer was depleting the body of testosterone, a process called androgen deprivation therapy (ADT). This process essentially makes the cancer cells dormant. Unfortunately, this therapy only works temporarily. Eventually, the cancer progresses and continues to spread. These patients are then diagnosed as having metastatic castrate resistant prostate cancer (mCRPC).
The primary goal for mCRPC treatment has been and continues to be prolonging survival and improving quality of life, minimizing the side effects associated with metastasis since mCRPC is considered incurable. Conventional chemotherapy was largely ineffective at doing either until 2004 when the chemotherapy drug Docetaxel was approved. Despite the drug’s success, there was a push for other therapies that could do this, yet avoid the potential toxic side effects associated with chemotherapy.
An activated T-cell vaccine against prostate cancer cells called sipuleucel-T (Provenge) was approved in 2010 for use for mCRPC treatment. Provenge was found to prolong survival with minimal to no side effects. Later analysis revealed an even greater benefit to patients when the vaccine is given early and an even greater benefit noted in African-American patients.
The years 2012 and 2013 gave way to a new class of drugs in prostate cancer called oral oncolytics. These are medications taken orally, avoiding the need for inconvenient infusions. Abiraterone acetate (Zytiga) was approved in 2012 followed by enzalutamide (Xtandi) in 2013. Both were found to be effective. Although the ways in which they work are different, their benefits on survival are similar. Side effects are minimal with many patients having no side effects at all. This year we saw a new oral oncolytic, apalutamide (Erleada), approved for earlier use in patients without metastasis.
Another new class of therapy in prostate cancer emerged in 2014, once again prolonging survival and improving quality of life. Radium-223 (Xofigo) is a unique therapy that is infused in the office setting via a simple IV. Xofigo is given once a month over a period of 5 months. The drug’s structure is similar to calcium and once infused it is largely taken up at the cancer sites in the bones. Xofigo delivers a radioactive dose to the cancer cells in the bone causing DNA damage and cancer cell death. This is significant since 80-90 percent of mCRPC patients have prostate cancer in the bone.
With this rapid release of therapies, and 300 new ones currently in development, prostate cancer has become extremely complex with many moving parts. For example, each of these therapies requires a different system of monitoring patients and they each carry different side-effect profiles. They can be given alone, in combination, or layered together over time. Management of this is constantly evolving.
This confusing and rapidly changing landscape has been the catalyst for large urology groups across the country to form specialized clinics called Advanced Prostate Cancer clinics, coined “APC clinics.” These clinics consist of a urologist, called an “APC Champion,” specifically dedicated to managing these patients, as well as cancer navigators, pharmacy staff and nurses dedicated to prostate cancer patients.
Having a specific urologist and team focused on advanced prostate cancer has been wildly successful and accepted by patients across the country, and Wichita is no different.