For Men With Advanced Prostate Cancer: Individualized Care Plans
“Men with metastatic prostate cancer are living longer than ever,” says Kenneth Pienta, M.D., the Donald S. Coffey Professor of Urology. “Over the last three years, several new therapies have been approved to treat this disease, and the picture is changing all the time.”
What’s also changing is the recognition that advanced cancer has more subtle subtypes than simply being responsive or resistant to hormonal therapy. “Hormone-naïve” metastatic prostate cancer responds well, sometimes for many years, to hormonal therapy, which drops testosterone to very low or “castrate” levels. “This puts the cancer in remission,” says Pienta, “but it inevitably grows back, and when it does it is resistant to the low-testosterone environment. We tell these men that they have ‘hormone-refractory’ or ‘castration-resistant’ prostate cancer.”
Until a few years ago, the only treatment for hormone-refractory prostate cancer was chemotherapy. “Now, we have access to immunotherapy, systemic radionuclides, and second-generation anti-androgen therapies,” and these new treatments, in turn, are leading scientists to understand that there are subtypes of prostate cancer. Some treatments are more effective in some men than in others.
“As our understanding changes of how prostate cancer evolves with treatment, our team is helping to define how best to sequence and combine our growing armamentarium of therapeutic agents for maximal patient benefit,” says Pienta, “so we can give the right drugs, in the right combinations, at the right time.”