Treating advanced prostate cancer

Advanced prostate cancer, also known as metastatic or stage 4 prostate cancer, spreads beyond the prostate to distant parts of the body. While it is often incurable, new treatments and diagnostic advancements are improving survival rates and quality of life.

Personalized Treatment Approaches

Oliver Sartor, M.D., a Mayo Clinic oncologist specializing in prostate cancer, emphasizes that treatment plans are highly individualized. "Prostate cancer differs significantly from person to person," he explains. Genetic testing can help determine targeted drug therapies or immunotherapies based on both inherited and tumor-specific DNA. The location of metastasis—whether in bones, lymph nodes, or elsewhere—also influences treatment choices.

The Role of PSA Testing

Early detection through a PSA test (prostate-specific antigen) can reduce the risk of advanced prostate cancer. While the test has some controversy due to the potential for detecting non-threatening cancers, Dr. Sartor advocates for its use, saying, "A PSA test diminishes the risk of being diagnosed with advanced disease by detecting cancer early. I get a PSA myself." He recommends men start testing at age 50, or earlier for African Americans and those with a family history of prostate cancer.

Radiopharmaceutical Breakthroughs

For patients with advanced castrate-resistant prostate cancer, a new treatment, also known as lutetium Lu 177 vipivotide tetraxetan, offers renewed hope. These FDA-approved Radiopharmaceuticals target prostate-specific membrane antigen (PSMA) proteins in cancer cells. Eligibility is determined using a PSMA PET scan, which detects the presence of PSMA proteins.

Dr. Sartor notes that while responses vary, about one-third of patients see significant benefits. "The patients who respond best have a lot of PSMA PET uptake and do not have liver involvement," he says. Research is ongoing to expand its use earlier in treatment, potentially before chemotherapy.

With continued advancements in prostate cancer care, Dr. Sartor remains optimistic: "I believe this therapy can safely benefit a significant number of patients who are not receiving it today."