In this patient education video, Dr. Jorge A. Garcia provides an introductory explanation of prostate cancer, its treatment options, and advances in treatment and research.
Cancer.Net®: Doctor-Approved Patient Information from ASCO®
Prostate Cancer: An Introduction
What is Prostate Cancer?
Jorge A. Garcia, MD Member, American Society of Clinical Oncology: Prostate cancer is unique to males because women don’t have a prostate. It’s a gland that sits in between the bladder and the rectal region and basically is a gland that allows lubrication to some extent. Unfortunately, the vast majority of men, the older you get, the more likely for you to develop prostate enlargement, and often times unfortunately develop cancer, which is basically a growth within the prostate gland.
The Treatment Team
Dr. Garcia: I like to tell my patients that the most important part once you’ve been diagnosed with cancer is to actually identify the right team of people that you want to work with, whether it’s a surgical team, a radiation oncology team, or a medical oncology team.
I believe that patients with high risk prostate cancer or what I call, locally advanced disease, or advanced disease, do require a multi-disciplinary approach which means it’s not only one treatment, but that is a group of people offering multiple lines of therapy that can actually improve outcome.
So I always believe that second opinions are super important when you’ve been diagnosed with cancer. Even if you’re comfortable with your doctor, you still want to see someone to actually help you understand a bit more.
Dr. Garcia: I would think of prostate cancer in 3 different ways. Patients who have localized disease, patients who have locally advanced disease, and patients who have advanced disease or incurable disease.
So for men with localized prostate cancer, meaning that the cancer is confined to the prostate gland, the standard of care in the United States is actually a bit more complex than one single treatment. It includes radical prostatectomy, which is the surgical removal of your prostate gland.
For men with localized disease, improvement in technology has allowed us to actually do minimally invasive surgeries. A lot of people now are doing laparoscopic prostatectomies or using the robotic da Vinci to do the prostatectomies.
It can also include radiation therapy, which is basically giving you radiation from the outside, also called external beam radiation therapy.
Or also you could receive what we call Brachytherapy, or seeds, which is basically radiation therapy but done internally. Basically what you do is you actually put seeds of radiation in the prostate gland and they get released over time and that actually does the radiation instead of getting radiation from the outside.
There are many other techniques, obviously there are many other treatment options that men could explore. It does include HIFU which is high intensity frequency ultrasound, which is FDA approved this year in the United States. Cryotherapy which is sort of freezing your prostate gland, it will [inaud.] if you will.
And perhaps another treatment choice, active surveillance has become part of what we do in the United States, which means there are selected men who have low, indolent, non-aggressive prostate cancer that can be considered for active surveillance which means we’re going to follow you without intervention and at any given time if things change we may actually intervene.
For men who have locally advanced disease, which is disease that is still localized to the prostate gland, but by virtue of their features, you know, can actually, [inaud.] We may find disease outside the prostate gland but luckily next to the prostate gland, where the seminal vesicles which are a couple little glands sitting underneath the prostate gland. Or it’s involving the cord of the gland, or even in the lymph nodes, then those standard options change a bit.
They may include surgery, they may also include radiation therapy, but often times it includes the combination of both either systemic therapy and local treatment. And for men with advanced disease, the standard of care is suppressing the testosterone production.
Testosterone is the major fuel that drives prostate cancer growth, once you have it. So, the goal is what we call castration, which is a harsh statement for most of us, but the reality is where the goal is quite simple. We want to remove the fuel that is feeding your cancer cells. That fuel is made in the testicles and therefore the goal for us is to suppress that production.
That can be accomplished in 2 ways. One is surgical castration which is basically the removal of both testicles. Or the other way and probably most commonly utilized now in over the last 2 decades or so, is medical suppression of testosterone, which is basically you get an injection either monthly, every 2, every 3 months, however we do it, and it suppresses the testicular production just by virtue of blocking the signal that goes between your brain and your testicles telling the testicles to make testosterone.
Only until recently, perhaps actually the last 2 years, the standard of care had evolved a bit and now for selected men who have significant disease outside the prostate gland, we offer them not only suppression of that testosterone production but also [inaud.] chemotherapy with a treatment called docetaxel.
Recent Advances in Prostate Cancer Treatment
Dr. Garcia: We recognize that one treatment doesn’t fit all, meaning that the same chemotherapy may not work for 5 different patients. And the biggest question that we have right now, not only in prostate cancer but certainly in oncology, is how we can do a little bit more of what we call precision medicine, which is I want to understand your disease and I want to actually treat you based upon your make up not what happens to 100 other people.
Every man who dies with prostate cancer or from prostate cancer, they do so because they develop this disease called castration-resistant disease, which is simply defined by you’re not making male hormone and your PSA going north or you’re developing symptoms from your disease or your scans are changing despite the fact that you don’t have male hormone production.
So when that happens we have over 6 lines of therapy approved in the last 5 years. We have powerful oral agents that are able to block adrenal production of hormones that mimic testosterone and can go activate [inaud.] cancer growth of the prostate. We have oral agents that block that antenna directly. We have newer chemotherapies that are also effective. They lead to survival improvement and make people live longer, control symptoms effectively, maintain quality of life, and control disease progression in the later progression of disease.
And more recently you know, we have radionucleotides that are agents that actually are specifically designed to target bone disease, also with survival improvement and there is immunotherapy obviously which is what probably the hottest topics to speak today in solid tumor oncology, an agent that actually works through the immune system to improve your survival, to improve your ability to live longer.
Where to Get More Information
Dr. Garcia: I think a particular website that I find reliable is Cancer.net where patients can actually really go and understand, you know, basically the entire scope of prostate cancer, from the diagnosis, how do we define the disease, how we manage the disease, treatments and also opportunities for them to understand a little bit more about their illness.
[Closing and Credits]
Cancer.Net®: Doctor-Approved Patient Information from ASCO®
ASCO's patient education programs are supported by Conquer Cancer Foundation of the American Society of Clinical Oncology. ConquerCancerFoundation.org
Dr. Mary Wilkinson, Dr. Raymund Cuevo, and the staff at Medical Oncology & Hematology Associates of Northern Virginia
Carolyn B. Hendricks, MD, The Cancer for Breast Health
Hasbro Children’s Hospital
Helen F. Graham Cancer Center at Christiana Care Health System
The Adele R. Decof Comprehensive Cancer Center at The Miriam Hospital. The Miriam Hospital is a teaching hospital of The Warren Alpert Medical School of Brown University
Video Footage and photography courtesy of:
St. Jude Children’s Research Hospital Biomedical Communications
Moffitt Cancer Center
University Hospitals Case Medical Center Seidman Cancer Center
The opinions expressed in the video do not necessarily reflect the views of ASCO or the Conquer Cancer Foundation.
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