Prostate Cancer

Prostate Cancer

Research advances over the last 40 years have helped to make prostate cancer one of the most treatable of all cancers. Today, nearly all men who are in otherwise good health live at least five years after a prostate cancer diagnosis, up from 65 percent in the 1970s.

However, important research challenges remain. Recent trials have questioned the value of routine PSA testing to screen for prostate cancer, and researchers continue to search for a screening test that can accurately detect high-risk cases of the disease. New treatments are urgently needed for men with advanced stages of the disease, for whom survival remains low. In addition, racial disparities in prostate cancer mortality point to the need for better knowledge of the biology of prostate cancer, and improved access to care for many with the disease.
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2020

PARP Inhibitor Doubles Survival in Hormone Therapy-Resistant Prostate Cancer 

PARP Inhibitor Doubles Survival in Hormone Therapy-Resistant Prostate Cancer 

About a third of patients with metastatic castration-resistant prostate cancer (mCRPC) harbor specific gene mutations that inhibit the repair of DNA damage, with the most common of these being mutations in BRCA 1/2 and ATM. In the phase III PROfound trial (ClinicalTrials.gov identifier: NCT02987543) patients with mCRPC with at least one alteration in BRCA 1, BRCA 2, or ATM were randomized 2:1 to receive the targeted therapy olaparib—a poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitor—or the treating clinician’s choice of the anti-androgen drugs enzalutamide or abiraterone. The median overall survival was significantly longer in the olaparib group (median median 19.1 months) than in those receiving enzalutamide or abiraterone (14.7 months). Based on these results, the FDA approved olaparib for mCRPC with mutations in certain genes involved in DNA repair, in disease that has progressed following prior treatment with enzalutamide or abiraterone.   

More Information: 

N Engl J Med 2018; 378:645-657
N Engl J Med 2020; 383:2345-2357
FDA Approval

2017

Adding hormone therapy after surgery extends survival in men with persistently elevated PSA after surgery recurrent prostate cancer

Adding hormone therapy after surgery extends survival in men with persistently elevated PSA after surgery recurrent prostate cancer

A large clinical trial with 12 years of follow-up data demonstrates that adding the hormone therapy bicalutamide (Casodex) to standard radiation therapy helps men after prostate cancer surgery with persistent or recurrent disease detected only because of an abnormal prostate-specific antigen (PSA) level. In the study, hormone therapy was given both during and for two years after radiation. These findings provide strong evidence supporting the incorporation of hormone therapy into standard care for prostate cancer that persists despite surgery.

More Information: 

N Engl J Med. 2017; 376:417-428
New standard established for newly diagnosed advanced prostate cancer

New standard established for newly diagnosed advanced prostate cancer

 Adding the novel anti-androgen abiraterone (Zytiga) to standard prednisone and hormone therapy is shown to help men with newly diagnosed, high-risk advanced prostate cancer live longer. This multi-pronged treatment approach shuts down the body’s production of testosterone and other androgens more completely, resulting in more effective inhibition of prostate cancer growth. The FDA approved the regimen, becoming a new standard of care for men with these prostate cancers.

More Information: 

N Engl J Med 2017;377:338-351
FDA Approval

2015

Adding chemotherapy to hormone therapy helps men with metastatic prostate cancer live longer

Adding chemotherapy to hormone therapy helps men with metastatic prostate cancer live longer

Badge indicating that research was paid for using federal funds

A large, federally funded clinical trial shows that adding docetaxel (Taxotere) chemotherapy to standard initial hormone (androgen deprivation) therapy for advanced prostate cancer extends patients’ lives by more than a year, on average. This marks the first study to identify a strategy that prolongs survival for men with newly diagnosed metastatic prostate cancer. In 2016, a second large study affirmed that docetaxel extends survival in this setting.

More Information: 

N Engl J Med 2015; 373:737-746
Lancet 2016; 387(10024): 1163–1177

2012

New treatment option for advanced prostate cancer

New treatment option for advanced prostate cancer

Enzalutamide (XTANDI) is proven to extend survival in men with advanced prostate cancer that persists despite all other standard treatments, including hormone therapy and chemotherapy. The drug is approved later in the year.

Enzalutamide works by blocking testosterone from binding to the androgen (male hormone) receptor, a process that would otherwise help fuel prostate cancer growth.

More Information: 

New England Journal of Medicine
FDA
Experts caution against unnecessary PSA screenings for prostate cancer

Experts caution against unnecessary PSA screenings for prostate cancer

Debate continues on the value of prostate-specific antigen (PSA) testing for prostate cancer screening.

In May, the U.S. Preventative Services Task Force (USPSTF) recommends against PSA screening, concluding that it does little to reduce the number of deaths from prostate cancer and can lead to unnecessary biopsies and treatment.

Later that year, however, ASCO issues guidance recommending that physicians discuss the benefits and risks of PSA testing with their otherwise healthy male patients who have life expectancies of greater than 10 years. The guidance notes that PSA testing may still offer important benefits for this group of men, but that the risks outweigh the benefits for men with shorter life expectancies.

More Information: 

US Preventative Services Task Force
Journal of Clinical Oncology
Cancer.Net

2010

New targeted drug approved for certain advanced prostate cancers

New targeted drug approved for certain advanced prostate cancers

FDA approves abiraterone acetate (Zytiga) in combination with the drug prednisone for patients with advanced prostate cancer whose disease progresses despite prior hormone therapy and standard chemotherapy with docetaxel. Abiraterone blocks the production of male sex hormones, including testosterone, which fuel prostate tumor growth. Since only one other agent, cabazitaxel (Jevtana), has been shown to prolong survival in this population of patients, the treatment represents a much-needed new option.

More Information: 

N Engl J Med 2011; 364: 1995-2005
New drug for patients whose disease progresses despite other treatments

New drug for patients whose disease progresses despite other treatments

The FDA approves cabazitaxel (Jevtana), given together with the drug prednisone, for men with advanced stages of prostate cancer that has progressed despite prior hormone therapy and chemotherapy with a drug called docetaxel (Taxotere). The approval, the first for this group of patients who have few other options, was based on data showing cabazitaxel increases survival compared with standard mitoxantrone (Novantrone) chemotherapy in patients who have already received docetaxel treatment.

More Information: 

Lancet 2010; 376(9747): 1147-54
First-ever "therapeutic vaccine" for prostate cancer becomes available

First-ever "therapeutic vaccine" for prostate cancer becomes available

The FDA approves a therapeutic vaccine called Provenge for patients with advanced prostate cancer, based on studies showing that it modestly improves survival compared to use of a placebo. This new treatment option is designed to boost a patient's own immune system to fight their cancer. The potential impact of the treatment remains to be seen, however, as physicians and patients weigh its modest benefits with its high cost.

More Information: 

N Engl J Med 2010; 363: 411-22

2009

Men urged to discuss routine PSA testing with doctors

Men urged to discuss routine PSA testing with doctors

Badge indicating that research was paid for using federal funds

Three large, randomized trials provide conflicting results on the use of PSA screening and lead experts to question whether this screening method translates into improved survival and actually saves men's lives. Initial results from two of the trials indicate that PSA testing has a minimal effect on overall survival and leads to the diagnosis and treatment of slow-growing cancers that are unlikely to be life-threatening. The third study finds that PSA testing every two years among men age 60 and older reduces the risk of prostate cancer death by 40 percent. Given the conflicting evidence, leading medical societies urge men to discuss the risks and benefits of screening with their doctors.

More Information: 

Cancer.Net; Prostate Cancer: Risk Factors and Prevention
N Engl J Med 2009; 360: 1310-19
N Engl J Med 2009; 360: 1320-28
Radiation after surgery or hormone therapy improves survival

Radiation after surgery or hormone therapy improves survival

Badge indicating that research was paid for using federal funds

Findings from a long-running clinical trial show that radiation therapy after surgery (known as adjuvant radiation) reduces the risk that prostate cancer will spread and increases survival time by nearly 30 percent in men with early-stage disease. A separate study finds that adding external beam radiation treatment to standard hormone therapy in prostate cancer that has spread to the surrounding areas can reduce the risk of death by more than 40 percent.

More Information: 

Cancer.Net; Prostate Cancer: Treatment Options
Journal of Urology; 181(3): 956–962

2008

Advanced prostate cancers respond to new treatments in early studies

Advanced prostate cancers respond to new treatments in early studies

Two new targeted drugs appear promising in early studies among patients with advanced stages of prostate cancer. In one study, a drug called abiraterone acetate (Zytiga) reduced levels of prostate-specific antigen (PSA) by up to 90 percent in men who no longer responded to hormone therapy. A second trial shows that adding the drug custirsen to standard chemotherapy significantly reduced PSA and pain levels, compared to an alternative combination. (Custirsen is designed to make prostate cancer cells more sensitive to chemotherapy.) In 2011, the FDA approves abiraterone acetate, in combination with prednisone, for men whose advanced prostate cancer progresses despite other therapies, including docetaxel (Taxotere) chemotherapy.

More Information: 

Journal of Clinical Oncology 2008; 26(28): 4563-71
New blood test helps predict prostate cancer outcomes

New blood test helps predict prostate cancer outcomes

The FDA approves the CellSearch test for predicting survival and monitoring the impact of treatment in men with advanced prostate cancer. The test counts circulating epithelial cells in the blood and can be used to help doctors make more informed decisions about the best treatments for individual patients. Research continues to determine the most appropriate use of the test in everyday practice.

More Information: 

Clinical Cancer Research 2008; 14(19)
Potential prostate cancer-associated virus identified

2005

High-dose radiation helps men avoid cancer recurrence

High-dose radiation helps men avoid cancer recurrence

Badge indicating that research was paid for using federal funds

Studies find that men with localized prostate cancer who receive radiation treatment at a higher dose than was traditionally provided are less likely to have their cancer recur than men who receive conventional radiation. The high-dose approach is made possible by technological advances that allow doctors to precisely target more radiation to the tumor, while sparing healthy tissue.

More Information: 

Lancet 2005; 366(9485): 572-78

2004

New chemotherapy for hard-to-treat prostate cancers

2003

First drugs proven effective for reducing prostate cancer risk

First drugs proven effective for reducing prostate cancer risk

Two large trials report that finasteride (Proscar) and dutasteride (Avodart) reduce the risk of developing prostate cancer by up to 25 percent, compared to placebo. However, debate persists about the optimal use of these drugs for prostate cancer prevention. Key issues of controversy include whether these agents increase aggressiveness of tumors that do arise, and whether they only inhibit less aggressive tumors that would not have been dangerous without treatment in the first place.

More Information: 

Cancer.Net
Journal of Clinical Oncology 2009; 27(9): 1502-16

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