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What advances to expect in prostate cancer treatment in coming years?
My PSA is still undetectable as I approach the one-year mark. Given my high-risk pathology and biology, however, I realize that biochemical recurrence (BCR) is still possible sometime in the future, despite my efforts to reduce that risk through exercise, better sleep, and an “anti-cancer” diet.
Hopefully, these efforts will help prevent BCR—or, if it does occur, perhaps delay it long enough for imaging and treatments to improve substantially.
With that in mind, we are just learning that Moderna and Merck announced that a personalized mRNA cancer vaccine reduced the risk of melanoma recurrence and spread in a late-stage trial. It makes me wonder: Could similar personalized treatments become available for prostate cancer recurrence relatively soon?
What other advances might we realistically expect in the coming years, particularly in:
* Hormone therapy, including treatments that are more effective and/or have fewer side effects
* Radiation therapy: treatments with real-time targeting, and smaller margins
* Imaging, especially since current scans often cannot detect small amounts of recurrent prostate cancer unless PSA has risen to a higher level
* Personalized or immune-based treatments such as cancer vaccines
I’d really appreciate it if anyone who has researched these developments could share what you have found. I think it would be helpful for all of us to stay informed—not only so we understand what may be coming, but also so we know what questions to ask our doctors and, hopefully, have some things to look forward to.
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@jeffmarc , I’m well aware of the side effects. My course of treatment was thoroughly researched with colleagues I trusted. I’m from California, but have been living in VA for past 10 years. Also retired 10 years ago. UVA was my COE, and Dr Showalter my oncologist. I was high risk with one core coming back 4+4. Contained with no cribriform from biopsy. Elected HDRBrachytherapy following up with 21 sessions of EBRT. Did not use ADT. My PSA was 12 before treatment. My first f/u after treatment, PSA was 1.2. Next test in 7 weeks. 73 years old in excellent health. I would say that my colleagues were about 60/40 in favor of my decision. After the first PSA, it became 80/20 now in favor. I’m a GP and had many patients who had PCa with a variety of treatments. The majority were on ADT. Like you, for multiple years. I found that 90% were having side effects. Unfortunately, two of my patients became severely depressed and took their life’s. Was that because of ADT? The phycologist treating them listed it as a strong factor. You certainly are one of the lucky ones. I wish we could analyze your CBC and come up with some miracle drug that offsets ADT side effects. The journey continues. As stated, AI will be able to personalize treatment options for each patient. The applications are mind blowing. Good luck in your journey.
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2 Reactions@cbball
It’s interesting that ADT doesn’t really affect everybody the same. In my case, having been on it for nine years, It has never caused fatigue or mood issues. I’ve worked with a few people that have not had any side effects from it. I worked with many more that have had serious side effects from it. Unfortunately, it really is the only thing we have right now for people that have just been diagnosed, to have it stopped in its tracks, At least for a while.
Of course, The bone deterioration, muscle deterioration and hot flash issues do become problematic for almost everybody. If you don’t get the mood issues or the fatigue, the drug is a lot easier to deal with. There is a much longer list of possible side effects, but those are really the ones that most people deal with.
@soli
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@jeffmarc Reading some of your texts certainly attest to your immense knowledge of PCa. Your helpful advice fighting this disease is certainly appreciated. Mentioned before, I’m retired medical, and also a PCa survivor. Your journey has been long and very eventful. I commend your fortitude and advice to men that sorely need it. In response to the previous post of Duke using AI to determine the effectiveness of ADT therapy, I believe we need to see additional data and specifics. ADT is a very sensitive subject for men after getting the diagnosis of PCa. It’s probably the most talked about aspect of treatment. QOL needs to be one of the top indicators when considering treatment. In my experience, urologists and to a lesser degree prostate specific oncologists rarely discuss in detail ADT and the effects it generally has on the body. All too often, it’s a one size fits all approach, and most men just accept what the doctor says. I can now look back and see 2 types of medicine occurring…traditional medicine for the last 50 years, and AI medicine. Most of my colleagues , that are still practicing, are very weary of AI. I recently spoke to a good friend who is an Internist/Cardiologist and in his mid-sixties. He’s certainly at the “burn out” stage, and mentioned; “It’s getting pretty discouraging when I see a new patient come in that have their entire diagnosis and plan of treatment mapped out by using AI. One more year, max.” I’m sure this is playing out with many incredible doctors in their 50-60’s, and we all loose. Now, will AI change medicine for the better outcomes? Absolutely! Will the pharmaceutical and the medical establishment fight it? Probably. But, back to the specifics of ADT usage and this particular patient hearing that AI and a prestigious COE Medical Center have found some possible new information on usage…it’s only just going to get larger in every aspect of medicine. I pray compassion and the physical nature of Doctor/Patient relationships will remain.
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2 ReactionsHi @pesquallie
I too have seen studies such as RTOG 9601 suggesting that the benefit of adding ADT to salvage radiation depends substantially on the PSA level at the time of radiation and other risk factors. I’ve also seen evidence that, for some patients, 6 months of ADT may be sufficient rather than 24 months.
Could you provide more specifics or links about the Duke Health study you referenced, in which AI was used to identify men who might safely avoid long-term ADT? I’d be particularly interested in understanding how the AI model identified patients who did not appear to benefit from prolonged ADT, and whether this approach has implications for patients receiving early salvage radiation at low PSA levels.
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2 Reactions@pesquallie
This would be a real surprise to most people that get ADT after they’ve been notified they have prostate cancer. And almost every case, the tumors shrink and the growth of the prostate cancer stops. At least for a while. For somebody who has a very aggressive case, it can keep it under control for years.
I know in my case when my PSA started rising after salvage radiation I was put on ADT. Instead of my PSA continuing to rise it dropped back down to undetectable for 2 1/2 years. So you are saying that wasn’t ADT that was just a coincidence? An awful lot of people have Found ADT has stopped their cancer from growing and spreading while they’re waiting for treatment.
That sure makes what you are saying seem unproven.
@calipiotr
Duke health is using AI and they believe their results will prove that ADT is being misused and is neither helpful nor recommendable for many men. Testosterone does not feed prostate cancer per many new results. It helps control prostate cell growth,
Actually it seems like the last five or ten years has seen tremendous progress in diagnosis and treatment options. I can see another ten year just to keep sorting out the different scenarios and best practices, and then another twenty or thirty years before they're fully adopted by doctors, medical groups, and insurance companies!
Just this week I heard two completely opposite things, that in UK on the one hand the National Health Service recommended NOT doing routine PSA tests, and the Lancet published a huge study saying they should not only make them routine but be much more aggressive about making sure they reach everyone (of appropriate age and sex).
Meanwhile there are billions of dollars sloshing around the introduction of AI and "precision medicine" not just for prostate cancer but cancer in general. The first products out will likely be tests for everyone, tests for active patients, tests for long-term tracking, tests, tests, tests! And with this comes discovery of new genes to test for, and new subclasses of cancers, so we know which to treat and which treatment to use. This is like the reinvention of medicine for the technology age - Big Pharm has been fighting against this for decades, they didn't want to fragment the patient base, they wanted one drug for everyone, unfortunately that's not how things work and they've slowly been dragged into reality. Now they may go completely the other way, like this recent Merck/Moderna treatment for melanoma: they take a sample of your cancer's genes and make a totally individual treatment for it! This is still early days, but look at the precision involved in something like that! And the cost ... well, with any luck this will sort out into a few major categories that can be more generally diagnosed and treated.
So I think, overall, your wish is already granted, and you can be fairly optimistic that ten years from now you can look back at how cave man medicine still was back in the Jurassic Park that was the year 2026!
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1 Reaction@calipiotr
I actually pointed out a number of clinical trials that are going on right now. This May interest you.
https://connect.mayoclinic.org/comment/1650945/
@soli
With enough funding and AI technology 10 years is very safe to be a time period to have a cure for prostate cancer. And that's assuming the current state of AI which will only get more efficient. IF only every family affected by cancer wanted to make their voice loud enough it would be very possible and achievable. Certainly after my all testing I will set up website to start the process.
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