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Prostate cancer is unique to males because women don’t have a prostate.
It’s a gland that sits in between the bladder and the rectal region and basically is a gland
that allows lubrication to some extent, and unfortunately the vast majority of men the
older you get the more likely for you to develop prostate enlargement and often times unfortunately
develop cancer, which is basically a growth within the prostate gland.
I like to tell my patients that the most important part once you’ve been diagnosed with cancer
is to actually identify the right team of people that you want to work with, whether
it’s a surgical team, a radiation oncology team, or a medical oncology team.
I believe that patients with high risk prostate cancer or what I call, locally advanced disease,
or advanced disease, do require a multi-disciplinary approach which means it’s not only one treatment,
but that is a group of people offering multiple lines of therapy that can actually improve outcomes.
So I always believe that a second opinions are super important when you’ve been diagnosed with cancer.
Even if you’re comfortable with your doctor, you still want to see someone to actually
help you understand a bit more.
I would think of prostate cancer in three different ways.
Patients who have localized disease, patients who have locally advanced disease, and patients
who have advanced disease or incurable disease.
So for men with localized prostate cancer meaning that the cancer is confined to the
prostate gland, the standard of care in the United States is actually a bit more complex
than one single treatment.
It includes radical prostatectomy, which is the surgical removal of your prostate gland,
For men with localized disease, improvement in technology has allowed us to actually do
minimally invasive surgeries.
A lot of people now are doing laparoscopic prostatectomies or
using the robotic da Vinci to do the prostatectomies.
it can also include radiation therapy which is basically giving you radiation from the
outside, also called external beam radiation therapy.
Or also you could receive what we call Brachytherapy or seeds which is basically radiation therapy
but done internally.
Basically what you do is you actually put seeds of radiation in the prostate gland and
they get released over time and that actually does the radiation instead of getting radiation
from the outside.
There are many other techniques, obviously there are many other treatment options that
men could explore, it does include HIFU, which is high intensity frequency ultrasound,
which is FDA approved in the United States.
Cryotherapy which is sort of freezing your prostate gland, it will [inaud.] if you will.
And perhaps another treatment choice, active surveillance has become part of what we do
in the United States, which means there are selected men who have low, indolent, non-aggressive
prostate cancer that can be considered for active surveillance which means we’re going
to follow you without intervention and at any given time if things change we may actually intervene.
For men who have locally advanced disease, which is disease that is still localized to
the prostate gland, but by virtue of their features, you know, can actually, [inaud.]
we may find disease outside the prostate gland but luckily next to the prostate gland, where
the seminal vesicles which are a couple little glands sitting underneath the prostate gland.
Or it’s involving the cord of the gland or even in the lymph nodes, then those standard
options change a bit.
They may include surgery, they may also include radiation therapy, but often times it includes
the combination of both either systemic therapy and local treatment.
And for men with advanced disease the standard of care is suppressing the testosterone production.
Testosterone is the major fuel that drives prostate cancer growth, once you have it.
So, the goal is what we call castration, which is a harsh statement for most of us, but the
reality is where the goal is quite simple.
We want to remove the fuel that is feeding your cancer cells.
That fuel is made in the testicles and therefore the goal for us is to suppress that production.
That can be accomplished in two ways, one is surgical castration which is basically
the removal of both testicles. Or the other way and probably most commonly utilized now
in over the last two decades or so, is medical suppression of testosterone which is basically
you get an injection either monthly, every two, every three months, however we do it,
and it suppresses the testicular production just by virtue of blocking the signal that
goes between your brain and your testicles telling the testicles to make testosterone.
Only until recently perhaps actually the last two years the standard of care had evolved
a bit and now for selected men who have significant disease outside the prostate gland, we offer
them not only suppression of that testosterone production but also [inaud.]
chemotherapy with a treatment called docetaxel.
We recognize that one treatment doesn’t fit all, meaning that the same chemotherapy
may not work for five different patients and the biggest question that we have right now,
not only in prostate cancer but certainly in oncology, is how we can do a little bit
more of what we call precision medicine, which is I want to understand your disease and I
want to actually treat you based upon your makeup not what happens to 100 other people.
Every man who dies with prostate cancer or from prostate cancer, they do so because they
develop this disease called castration-resistant disease, which is simply defined by you’re
not making male hormone and your PSA going north or you’re developing symptoms from
your disease or your scans are changing despite the fact that you don’t have male hormone production.
So when that happens we have over six lines of therapy approved in the last five years.
We have powerful oral agents that are able to block adrenal production of hormones that
mimic testosterone and can go activate [inaud.]
cancer growth of the prostate.
We have oral agents that block that antenna directly.
We have newer chemotherapies that are also effective.
They lead to survival improvement and make people live longer, control symptoms effectively,
maintain quality of life, and control disease progression in the later progression of disease.
And more recently you know, we have radionucleotides that are agents that actually are specifically
designed to target bone disease, also with survival improvement and there is immunotherapy
which is probably the hottest topics to speak today in solid tumor oncology,
an agent that actually works through the immune system to improve your survival, to improve
your ability to live longer.
I think a particular website that I find reliable is Cancer.net where patients can actually
really go and understand, you know, basically the entire scope of prostate cancer, from
the diagnosis, how do we define the disease, how we manage the disease, treatments and
also opportunities for them to understand a little bit more about their illness.
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