How do you know if a prostate cancer treatment plan is effective? Dr. Sumit Subudhi, a Medical Oncologist, explains how a patient’s treatment response is monitored for its effectiveness.
Dr. Sumit Subudhi is a Medical Oncologist at The University of Texas MD Anderson Cancer Center.
How can you tell if treatment is working?
So, I actually use three criteria to figure this out. One is the patient’s self, their symptoms. So, some patients’ symptoms are related to the urinary tract system, such as they may have frequent urination, or they can have pelvic pain in that area or blood in the urine or problems with ejaculation.
Other patients have pain because they have metastasis to the bone, and so the bone pain can be a symptom. And when a treatment is working, these things will actually start resolving. And so, you’ll see that these symptoms start disappearing without pain medications or other things. So, symptoms is No. 1.
No. 2 is in prostate cancer, unlike many other cancers, we actually have a serum test, or blood tests, that we can follow, which is the PSA. And usually when that’s going down, that’s reassuring.
The third is scans – radiographic scans, such as CAT scans and bone scans, help us monitor the disease. In an ideal world, all three will be going in the same direction. Meaning if the treatments working, the patient’s symptoms have improved, if they had symptoms. The PSA is going down and third, the scans show that things are improving. But the truth is we don’t live in an ideal world.
And to me, the patient’s symptoms always trumps. And I’ll give you an example. Early on in my career, I had a patient that was getting hormonal therapy, and their PSA was zero. And he started having right hip pain. He had a traditional scan – a CAT scan and bone scan – done which showed that everything was stable. And remember, the PSA was zero. And so, I told him, I looked at your history carefully, and you had a right hip repair 10 years ago. I have a feeling that that’s probably what’s causing it.
So, he went to go see his orthopedic surgeon. And he comes back, and he says, no, the orthopedic surgeon says it’s your fault. So, I did an MRI, and the patient and the surgeon were absolutely right. So, I got tricked, because I fell in love with the PSA. And ever since then, the patient’s symptoms trumps everything else. It’s my job to figure out and rule out that this is not prostate cancer. So, my point is don’t fall in love with the PSA, because even if it’s zero, that doesn’t mean that you’re in the clear.
How long do you monitor a patient before you make the decision that the current treatment not working, let’s move on to something else?
Yeah, good question. So, for each type of treatment and for each patient, I personalize how often I will see them.
For example, if someone is having significant pain, then I’m more likely to see them more often in clinic to make sure the pain is under control, but also to monitor how their treatment is going. And that means I’ll also scan them or do radiographic scans with the CAT scan and bone scan more frequently. Now, someone that’s more asymptomatic, you’ll see the intervals are longer. So, it’s really personalized for each patient. And the type of treatment they’re receiving, as well. So, it depends if they’re getting chemotherapy versus hormonal therapy versus a PARP inhibitor. So, all these play a factor, so it’s not a one-size-fits-all.