Prostate cancer is the most common non-skin cancer in the USA; 242,000 cases are expected this year. There is no way yet to distinguish between the benign ones that will stay in the prostate and the dangerous ones that will start creeping into the bones, the mostly likely place of spread.
Most doctors manage prostate cancer in the advanced stages by finding ways to decrease the testosterone level as it is felt that testosterone is responsible for the growth of prostate cancer. For decades, men who relapsed were treated with drugs or surgery that decreased the testosterone level. A common medication used in the late 1990s and early 2000 was Lupron or similar drugs. If men failed on Lupron or similar drugs, they were told to wait and get their affairs in order as death was imminent.
Then in the early ’90s, when troubled financier Michael Milken publicized his prostate cancer battle and the lack of funding. In 2005, the Department of Defense began to invest heavily, and drug companies got interested. Collaboration of activists, academics, government and drug makers led to more than 100 clinical trials.
Provenge bought him another 2 years with no cancer growth, long enough to qualify for a trial of enzalutamide last year. His prostate- specific antigen number, a measure of the disease’s progression , is down from 30 to 4.5, as good as it has been in decades.
Most trials are conducted on patients who have advanced disease. The drugs might be more effective if started earlier, but that’s yet to be proven.
Now, figuring out which patients will do well on which drugs is mostly a game of chance. “In the future, the hope is we’ll be smarter and be able to pick out the right therapies at the right time,”
So what are the drugs that have been shown to prolong life?
Provenge is a vaccine approved by the FDA that primes a man’s immune system to attack prostate cancer cells. A course consists of three treatments.
Cabazitaxel is FDA approved and consists of six cycles of treatment.
Abiraterone deprives tumors of testosterone.
Enzalutamide blocks the ability of testosterone to enhance cancer cells growth.
Radium 223 is awaiting FDA approval and carries radioactive particles deep into the bone where cancer from the prostate gland has spread and kills the cancer cells in the bone.
Bottom Line: Prostate cancer remains one of the most common cancers in men. New treatments are on the horizon and men need to speak with their doctors about the most effective treatments that can help prolong their lives.