Prostate Cancer Treatment Updates
from the GU Community Education Event
At the Duke GU Cancer Community Education Event, a multidisciplinary team of oncologists and other prostate cancer specialists discussed how rapidly prostate cancer treatment is changing. Their central message was that prostate cancer is not one disease with one treatment. Increasingly, doctors can use information about the cancer’s biology, genetics, imaging and the individual patient to determine how much treatment is needed and which treatments are most likely to help.
For some men with newly diagnosed prostate cancer, treatment may not be necessary right away. The panel discussed active surveillance, which uses PSA testing, MRI and prostate biopsy to closely monitor cancers that are considered unlikely to cause harm. This approach can help some men avoid or delay the side effects associated with surgery or radiation. If the cancer shows signs of becoming more aggressive, treatment can then be started.
For men who do need treatment, radiation and surgery remain important options. The panel highlighted advances in radiation that have shortened treatment courses substantially for many patients. Instead of receiving radiation every day for eight or nine weeks, some patients can now receive as few as five treatments. Radiation is also being used in selected men whose prostate cancer has spread beyond the prostate, either by treating the prostate itself or by targeting a small number of metastatic tumors.
Hormone therapy, also called androgen pathway therapy, remains an important part of treatment for many men with higher-risk localized or advanced prostate cancer. The panel discussed newer evidence showing that adding medicines such as abiraterone to radiation and hormone therapy can improve outcomes for some men with very high-risk localized disease. At the same time, more treatment can mean more side effects. Newer tests are helping doctors determine which patients are most likely to benefit from additional therapy rather than giving everyone the same treatment.
One of the most important themes of the discussion was precision medicine. Tests such as Decipher and Artera AI can provide information about the biology and aggressiveness of an individual cancer. The goal is not simply to intensify treatment, but also to identify men who may safely need less treatment. The panel described this as an effort to use “as much as we need, but no more than we have to.”
Genetic testing is also becoming increasingly important, particularly for men with metastatic prostate cancer. Doctors may test the tumor itself and may also perform germline testing to determine whether a cancer-related genetic change was inherited. Changes involving genes such as BRCA2 and other DNA-repair genes can affect both treatment decisions and cancer risk for family members. The panel discussed PARP inhibitors as an example of how genetic information can identify patients who may benefit from a targeted treatment.
Another newer treatment discussed was capivasertib (Truqap), which targets a pathway involving the PTEN gene. The panel explained that PTEN normally helps put the “brakes” on cell growth. When PTEN is lost or deficient, the cancer can behave more aggressively, and this newer targeted approach may provide another treatment option for selected patients.
The physicians also discussed PSMA-targeted radioligand therapy, such as Pluvicto. This treatment uses a molecule that targets PSMA, a protein found on many prostate cancer cells, to deliver radiation directly to those cells. The panel described how this treatment, which was initially used later in the course of metastatic disease, is now moving earlier in treatment for selected patients. They also emphasized that it is not appropriate for everyone and that doctors are still learning how best to select patients and personalize the number and timing of treatments.
Finally, the panel emphasized the importance of clinical trials. Many of the advances now available to patients came from clinical research, and ongoing trials are exploring new immune therapies, targeted treatments, radiopharmaceuticals and ways to reduce the need for hormone therapy.
The overall message was encouraging: prostate cancer treatment continues to expand, and doctors are increasingly able to match treatment to the biology of each patient’s cancer. The full discussion is available in the accompanying audio for those who would like to hear the physicians discuss these developments in greater detail.