Tag Archive for: advanced prostate cancer treatment

Questions to Ask About Your Prostate Cancer Treatment Plan

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Questions to Ask About Your Prostate Cancer Treatment Plan from Patient Empowerment Network on Vimeo.

What questions should prostate cancer patients ask about treatment options? Expert Dr. Rana McKay reviews the benefits of shared decision-making and shares key questions to ask about treatment plans. 

Dr. Rana McKay is an associate clinical professor of medicine at Moores Cancer Center at UC San Diego Health. Learn more about Dr. McKay.

Download Resource Guide

See More from Evolve Prostate Cancer

Related Resources:

How Has Advanced Prostate Cancer Treatment Evolved?

How Has Advanced Prostate Cancer Treatment Evolved?

 Prostate Cancer | Advances in Research and Technology

Prostate Cancer | Advances in Research and Technology

 When Should Prostate Cancer Patients Consider a Clinical Trial?

When Should Prostate Cancer Patients Consider a Clinical Trial?

Transcript:

 Katherine:

Speaking of sharing, shared decision-making has become the gold standard, really, for encouraging a successful relationship between a patient and their healthcare team. What does shared decision mean to you as a provider?  

 Dr. McKay:

Yeah. I think shared decision is an open dialogue. I think it’s an open dialogue with the physician, with the patient, sometimes, often times, the patient’s caregivers, and families, and loved ones may be involved in that process, where we’re talking about, first off, establishing the goals. Well, what are the goals? And I think, when we start with the goals then, we can say, “Okay. Well, what are the things that we can do to achieve those goals?” And I think sometimes we just dive right into, “Well, what are we going to do with the next step?”  

So, I think establishing what the goals of therapy are the things that matter to any individual patient and their family is important. And then, from there, working on, “Okay. Well, aligning with those goals, these are the different things that you can do. These are the pros and cons of the different things that you could do,” and making an informed decision about the next step.  

Katherine:

What questions should a patient ask about potential treatment options?  

Dr. McKay:

One, what are the different treatment options? You know, sometimes I think that statement doesn’t get said enough. What are the standard of care options? What are the clinical trial options? Ask are there radiation therapies, surgical options? That may be a relevant question for some individuals, some individuals, not.

Being very open like, “Okay, I’m hesitant about chemo. Let me explore that.” Well, where does that hesitancy stem from? What’s the fear about chemo? Are there chemotherapy-sparing options right now? Or how can we kind of dispel the fear or myth around chemotherapy?  

 So, I think these are the questions that I think a patient can ask. How is a therapy administered? Where do I go? How would I receive different therapies are given at different modes of administration? I think those are good questions. Who do I call if something happens to me on the weekend or on a holiday? Who do I reach out to? What are the phone numbers? Give me all the phone numbers. Get them in my phone. Save them in there, so you know, who to reach out to if you ever need something, if you ever need assistance. 

Understanding Prostate Cancer Treatment Options and Care Goals

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Understanding Prostate Cancer Treatment Options and Care Goals from Patient Empowerment Network on Vimeo.

How do prostate cancer treatment options and goals vary from patient to patient? Expert Dr. Rana McKay discusses standard approaches to treating advanced prostate cancer and factors that may impact care decisions.

Dr. Rana McKay is an associate clinical professor of medicine at Moores Cancer Center at UC San Diego Health. Learn more about Dr. McKay.

Download Resource Guide

See More from Evolve Prostate Cancer

Related Resources:

Overcoming Barriers | Advice for Accessing Prostate Cancer Clinical Trials

Overcoming Barriers | Advice for Accessing Prostate Cancer Clinical Trials

 Prostate Cancer | Advances in Research and Technology

Prostate Cancer | Advances in Research and Technology

 When Should Prostate Cancer Patients Consider a Clinical Trial?

When Should Prostate Cancer Patients Consider a Clinical Trial?

Transcript:

Katherine:

So, before we move onto understanding current treatment options, Dr. McKay, what are the goals of advanced prostate cancer treatment? And how do they vary by patient? 

Dr. McKay:

Yeah. I do think the goals can vary. I think in my mind, a lot of times, it’s making people live longer, making them feel better. Those are the two salient goals and if our therapies are not achieving one or other of those two goals then we need to rethink the strategy. But different people are different, and they may weigh the risks and benefits of any given therapy, or the slated benefit with the slated risk through a different lens. And I think it’s critically important to ensure that you’re having those communications with your doctor about the things that matter to you and the things that are really important to you. 

Especially, for people who have advanced prostate cancer. So, I think that can help your clinician strategize, “Okay, is this an individual who wants the kitchen sink everything that I can do even if that means more toxicity that I’m going to offer this thing? Or is this a situation where, you know what, unless there’s data that the kitchen sink is going to work, I really kind of want to temper things and try an approach that’s going to be effective, but maybe not associated with that degree of toxicity.” So, those kinds of conversations absolutely need to be happening.  

 Katherine:

With all the recent advances in treatment, is there a standard approach now to treating someone with advanced disease? And if so, what is it?   

Dr. McKay:

Yeah. There absolutely is a standard approach. There’s guidelines that are based off of the FDA-approved regimens of the different agents that can be utilized. There’s data regarding sequencing though, I think there’s more data that needs to be had on sequencing. There are guidelines on when to do germline testing, when to do tumor profiling, when to integrate PSMA PET imaging, the standard hormonal agents, who to use them. So, I do think that there are – there’s a set framework of appropriate management and treatment. But there’s a lot of personalization that is overlaid on top of that rubric. And I think that’s the art of medicine.  

Katherine:

Right. Is there testing to understand if a patient’s disease is more aggressive? Or maybe will respond to a certain type of therapy before you begin it?  

Dr. McKay:

Yeah. A very good question. And I think predictive biomarkers, as you described them, there are several for men with prostate cancer, but there’s not a ton of them. So, we know that homologous recombination repair alterations, HRR, gene alterations, particularly BRCA 1, 2, probably 2, we know that those are biomarkers of response to PARP inhibitors. We know that patients who have high tumor mutation burden, or have a mismatch repair, that those are markers of response to immunotherapy. We know that if people have a certain level of PSMA PET vividity on their PET scan, that that’s a biomarker for receiving lutetium PSMA.   

Those are the main biomarkers that are actually in use in the clinic to date. But I think there’s a lot more that I think are being explored from mutations in the androgen receptor, or amplifications in the androgen receptor, being potentially predictors of response to different degraders, different kind of hormonal agents. There’s certain tumor suppressor gene mutations that may predict that patients may do a little bit better with chemotherapy. So, there’s other markers that are being looked at, but they don’t have the same robustness as the BRCA 1, 2, and other ones that I talked about. 

Katherine:

Yeah. How does a patient’s health and lifestyle impact what treatment approach is right for them?  

Dr. McKay:

I mean, health and lifestyle, diet, and exercise, nutrition, sleep are so important. I think that one of the backbones of treatment for hormonal therapy is androgen deprivation therapy. There can be negative consequences with regards to muscle mass, bone mass, other things related to that therapy. So, I think it’s critically important for patients to maintain a healthy diet, making sure they’re getting appropriate exercise, weight-bearing, resistance training.  

And I think, too, this helps people with their functionality, with their ability, their reserve, and ability to tolerate treatment or tolerate more aggressive treatment. So, half of my clinic is talking about diet and exercise, and how to optimize individual health when people are on therapy. 

Katherine:

Yeah. Mentally, a good diet and sleep –  

Dr. McKay:

Yes.  

Katherine:

And exercise is going to be helpful.  

Dr. McKay:

Yes.  

Katherine:

As well. What about comorbidities? Do they play a role?  

Dr. McKay:

They absolutely do play a role. I think comorbidities like cardiovascular disease, diabetes absolutely can play a role. The hormone therapies, patients can have a propensity to gain weight, they can have a propensity to have worsened cholesterol being on hormone therapy, which can then affect somebody’s cardiovascular health. And so, some of the drugs cause increased hypertension. So, I think understanding the different comorbidities that any individual may have is important in selecting the best therapy, “Well, actually, if you’ve got X, Y, Z going on, maybe I’m going to shy away from this, but lean more towards that.”  

I think making sure that your physician knows about that and knows about changes that happen along the way. Sometimes, people with prostate cancer, many a times they have a long, natural history where they’re seeing the physician caring for them for their prostate cancer over many, many years.

And somebody’s medical history, when they first saw that individual, it’s going to change and evolve over time as different things happen. And so, I think keeping your clinician that’s caring for you for your prostate cancer informed of all the other non-cancer things that are happening I think is a really good idea.  

If you had a fracture, that’s actually a really important thing for somebody who’s got prostate cancer. Or “Gosh, my primary care just started me on Metformin because they think my blood sugar is a little bit off.” These are important things, I think, for clinicians to know about.  

Katherine:

Yeah. It’s all about communication, isn’t it?  

Dr. McKay:

Absolutely. Yeah.  

Katherine:

Don’t worry about over-sharing.  

Dr. McKay:

Yeah. 

Overcoming Barriers | Advice for Accessing Prostate Cancer Clinical Trials

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Overcoming Barriers | Advice for Accessing Prostate Cancer Clinical Trials from Patient Empowerment Network on Vimeo.

 How can prostate cancer clinical trial access issues be addressed? Expert Dr. Rana McKay discusses common issues with clinical trial access and credible resources to overcome the barriers to care.

Dr. Rana McKay is an associate clinical professor of medicine at Moores Cancer Center at UC San Diego Health. Learn more about Dr. McKay.

Download Resource Guide

See More from Evolve Prostate Cancer

Related Resources:

How Has Advanced Prostate Cancer Treatment Evolved?

How Has Advanced Prostate Cancer Treatment Evolved?

 Prostate Cancer | Advances in Research and Technology

Prostate Cancer | Advances in Research and Technology

 When Should Prostate Cancer Patients Consider a Clinical Trial?

When Should Prostate Cancer Patients Consider a Clinical Trial?

Transcript:

Katherine:

Are there barriers for accessing trials? And if so, do you have any recommendations for how to tackle those?  

Dr. McKay:

Yeah. I think there are barriers to accessing trials. I think it can be very overwhelming because there’s thousands of clinical trials that are being conducted for people with prostate cancer. And I think as a patient, sometimes it’s hard to navigate that. But I think the thing to take home is that you do not have to do it alone, and you should not do it alone because I think half of the trials that are out there, the large bulk of them may not necessarily be directly applicable to you or relevant for you.  

And so, I think talking to your clinician about that, I think seeking care, even if just for a second opinion at an NCI-designated cancer center, or NCI-designated comprehensive cancer center is probably a good idea. You know, if you’re hearing the same message from your local clinician then that’s great. If there’s more options that are being presented to you, that’s great, those are more options that you could tap into.

I think talking to patients who have gone on a trial may also help away some of the fear around participating in a clinical trial, and there’s lots of platforms where that could take place either asking your physician, or the American Cancer Society, or other societies can help connect patients to one another. 

When Should Prostate Cancer Patients Consider a Clinical Trial?

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When Should Prostate Cancer Patients Consider a Clinical Trial? from Patient Empowerment Network on Vimeo.

Prostate cancer clinical trials can advance research and expand treatment options, but where does participation fit into a treatment plan? Expert Dr. Rana McKay explains the benefits of joining clinical trials, common misconceptions, clinical trial phases, monitoring, and key questions to ask your healthcare team.

Dr. Rana McKay is an associate clinical professor of medicine at Moores Cancer Center at UC San Diego Health. Learn more about Dr. McKay.

Download Resource Guide

See More from Evolve Prostate Cancer

Related Resources:

Understanding Prostate Cancer Treatment Options and Care Goals

Understanding Prostate Cancer Treatment Options and Care Goals

 Questions to Ask About Your Prostate Cancer Treatment Plan

Questions to Ask About Your Prostate Cancer Treatment Plan

 Overcoming Barriers | Advice for Accessing Prostate Cancer Clinical Trials

Overcoming Barriers | Advice for Accessing Prostate Cancer Clinical Trials

Transcript:

Katherine:

But progress can only be made with patient participation in clinical trials, as we know. So, when should a patient consider participating in a trial? 

Dr. McKay:

Thank you so much for bringing this point up. I think our clinical research is critically important to advancing the field. Clinical trials, I think, are really – they offer our patients the treatments of tomorrow today, quite honestly. And I think the way trials are designed, they’re designed to test different treatment modalities, test in reference to the standard of care. I think at any point in time, anybody can think about enrolling on a clinical trial. I think sometimes there’s this false notion that, “I’m not going to enroll in a trial until later on, until I’ve failed all different kinds of treatments.” That’s not true.  

I think at any juncture along the way where a decision is being made around initiating a systemic therapy, or proceeding with a surgical intervention, or radiation intervention it’s always worthwhile to stop and ask, “Are there any clinical trials that I could be eligible for right now? And if so, what are they? So, I think it’s really important, I think, for patients to know that and to ask of their clinicians that are caring for them, “Are there any clinical trials?”  

And it may be that patients, not to say, may need to travel, but if they’re not necessarily at that institution where somebody may be receiving their care with a clinician asking their doctor, “Are there other trials at places close by where I can go and explore?” I think that’s a really important thing. 

Katherine:

What about common misconceptions? What are you hearing from patients about their fears and hesitations about participating in the trial? 

Dr. McKay:

Yeah. I think a lot of patients have a fear of, “I don’t want to be a hamster or a guinea pig. I don’t want to get placebo. I don’t want to get suboptimal care.” So, I think, to step back, I think the clinical trials are designed where actually patients are followed very, very closely, probably even more closely than I think would be in general with laboratory tests, PSA testing, imaging, at critical time points to assess that any therapies or strategies is working. Many trials are not necessarily placebo-controlled trials.  

Placebo-controlled trials are really only utilized in the context when somebody may – where the standard of care is to either do nothing or do one drug alone, not two drugs, and then, somebody’s getting one drug and getting a placebo. So, the placebo-controlled trials are really, first off, they’re later-staged studies, they’re usually Phase III studies, or large Phase II studies that have gotten pretty far on the runway of clinical trial and clinical drug development.  

And it’s in the context of, you know, “Well, if I didn’t do the clinical trials, I’m probably not going to do anything,” or I’m not going to – you know, “If I decided to not do the trial, I would get no treatment, but if I’m doing the trial, there’s a 50 percent chance I’ll get no treatment and 50 percent chance I may get something. So, we have to think about, “Well, what is the standard of care?” and the standard of care matters because that is what it’s being compared to. If the clinical situation is that the standard of care is to monitor, then that’s where a placebo may be utilized.  

But if a standard of care is that somebody should get treatment with X drug, then that X drug would be in the controlled arm of the study.  

Katherine:

Yeah.  

Dr. McKay:

But not every trial has a placebo.  

Katherine:

What would you say to someone who is nervous or hesitant about participating in a trial?  

Dr. McKay:

Yeah. Very good question, I think. Talk to your clinician. Talk to your doctors about those fears. What are the reservations? What are the concerns? Sometimes, I think the unknown is always – the fear of the unknown kind of causes a lot of angst. But when people are on a clinical trial, when you’re on a clinical trial, you are in control. Some people don’t believe that, but you are, at any point in time, you can decide to stop. You don’t even need to have a reason for why you decide to stop. At any point in time, if something is not working for you, you have choice.  

And so, I think that is something that is really important for patients to know that you’re actually in control, you’re being watched very closely, being watched very carefully for safety toxicity. If there’s a toxicity, people are not going to – you’re not going to just stay getting the same regiment in the exact same way if you’re not tolerating it. If something isn’t working, you’re not going to continue receiving the therapy that’s no longer working just because you’re on a clinical trial. 

Katherine:

Right.  

Dr. McKay:

And you’re in control; at any point in time, you could say, “I don’t want to participate anymore.” 

Prostate Cancer | Advances in Research and Technology

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Prostate Cancer | Advances in Research and Technology from Patient Empowerment Network on Vimeo.

What are the latest prostate cancer research advancements? Expert Dr. Rana McKay discusses recent prostate cancer treatment approvals, ongoing research, and genetic testing developments.

Dr. Rana McKay is an associate clinical professor of medicine at Moores Cancer Center at UC San Diego Health. Learn more about Dr. McKay.

Download Resource Guide

See More from Evolve Prostate Cancer

Related Resources:

Understanding Prostate Cancer Treatment Options and Care Goals

Understanding Prostate Cancer Treatment Options and Care Goals

 When Should Prostate Cancer Patients Consider a Clinical Trial?

When Should Prostate Cancer Patients Consider a Clinical Trial?

 Overcoming Barriers | Advice for Accessing Prostate Cancer Clinical Trials

Overcoming Barriers | Advice for Accessing Prostate Cancer Clinical Trials

Transcript:

Katherine:

Well, let’s dive into developing research and what it could mean for patients. Are there recent research highlights that you could share with the audience?  

Dr. McKay:

Absolutely. I think the newest approvals that have occurred in prostate cancer have been the approvals of combination PARP inhibitors, which block the ability of cancer cells to repair their DNA combined with hormonal agents such as abiraterone (Zytiga) or enzalutamide (Xtandi) for patients who have specific mutations in their tumor and their tumor is no longer responding to treatment. Those are the newest FDA approvals that were recently highlighted and shared.  

Katherine:

What areas of research do you specialize in? 

Dr. McKay:

The areas of research that I specialize in are particularly around novel therapeutics for patients with advanced prostate cancer, biomarker development precision medicine strategies for patients across the spectrum. And actually, also, in the localized setting, thinking about how we can attempt to cure more patients with prostate cancer by integrating our systemic therapy with surgical and radiation strategies to improve survival outcomes for patients and ultimately, cure it for patients by using effective systemic therapy early on so patients never recur.   

Katherine:

We’ve been hearing a lot recently about innovations in technology. How are these advances accelerating prostate cancer care?  

Dr. McKay:

Innovations of technology have absolutely been revolutionizing prostate cancer care I think from the diagnostic side, there’s new imaging modalities that are getting more refined. On the molecular side, there’s now different kinds of genetic tests. And our ability for us to do these tests, and do them quickly, and get results in real time that we can make decisions on we’ve come a long way from when we first sequenced the human genome. We’re now able to do that so quickly multiple times over in a very streamlined kind of way. And then, I have to say that there’s been tremendous improvement in our modalities of administrating therapies.  

So, our therapies are getting more novel, they’re getting more precise. What I mean, by that is targeted radioligand therapy, targeting linking a small molecule that binds PSMA, labeling it with a payload that is radiation therapy or kind of radio therapy/radio particle doing the same thing with chemotherapy, developing antibody drug conjugates. There’s androgen receptor degraders. There’s different ways of administrating immunotherapy by specific antibodies. So, there’s just the different sorts of treatments that are out there.  

We’ve just come such a long way from hormone therapy, which is still very important in chemotherapy to other different modes of action with the different systemic treatments we have.  

Katherine:

What about individual patients? Is there research into understanding a person’s – just one person’s disease?  

Dr. McKay:

Absolutely. I mean, that is in essence, precision medicine. I think we are now molecularly profiling tumors that is standard of care for anybody with advanced disease to undergo hereditary tumor profiling and – or hereditary profiling of just normal cells in the body, if there’s any sort of genetic abnormalities. But also, the tumor itself, and able to do that all for the actual biopsy specimen, or surgical specimen, and also blood. And then, based off of that individual’s genetic makeup, or the genetic makeup of the tumor, or the immune profile of the tumor actually trying to target therapy.  

There is a clinical trial that we are eagerly developing through the alliance, which we hope will open to enrollment before the end of the year, called the PREDICT Study. And this study is using that very notion of taking somebody’s DNA and RNA from their specific tumor, and based off of their results, strategizing the treatment around what kind of genetic makeup is in the tumor. And I think we’re moving towards that.  

Katherine:

What about common genetic mutations and what are you learning about people who have other genetic mutations like the BRCA mutation?  

Dr. McKay:

For patients who have BRCA mutations, first I’ll say, the prevalence of BRCA mutations varies across the stage of prostate cancer that somebody has. In the localized setting, the prevalence is a lot lower on the order of 2 to 4 percent depending on somebody’s risk profile. In the advanced setting, it is higher, 6 to 8 percent. Patients who have BRCA alterations are particularly susceptible to PARP inhibitors, which are oral drugs that can be given that when given in an individual who’s got a BRCA mutation, can cause cell death; can cause a tumor cell to die. And so, that’s a very good thing.  

I think the other thing, if thinking about the type of BRCA alterations, if there’s something that’s hereditary, this information is prognostic and predictive in that in can guide how people are going to – how we think they may do and what they may respond to. But it’s also really important because it can inform cascade testing for family members. It could also inform screening for secondary cancers in that individual who has prostate cancer with a known BRCA alteration. So, I think there’s a lot of personalization that happens based off of the molecular profiling results.  

How Has Advanced Prostate Cancer Treatment Evolved?

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How Has Advanced Prostate Cancer Treatment Evolved? from Patient Empowerment Network on Vimeo.

How has the advanced prostate cancer research landscape evolved? Expert Dr. Rana McKay discusses how prostate cancer treatment options have expanded and how PSMA PET imaging has revolutionized detection.

Dr. Rana McKay is an associate clinical professor of medicine at Moores Cancer Center at UC San Diego Health. Learn more about Dr. McKay.

Download Resource Guide

See More from Evolve Prostate Cancer

Related Resources:

Prostate Cancer | Advances in Research and Technology

Prostate Cancer | Advances in Research and Technology

 When Should Prostate Cancer Patients Consider a Clinical Trial?

When Should Prostate Cancer Patients Consider a Clinical Trial?

 Overcoming Barriers | Advice for Accessing Prostate Cancer Clinical Trials

Overcoming Barriers | Advice for Accessing Prostate Cancer Clinical Trials

Transcript:

Katherine:

Dr. McKay, I’d like to have you tell us how the landscape of advanced prostate cancer has changed over your career.  

Dr. McKay:

Oh, my goodness. It has absolutely rapidly evolved over the last decade. I think when I was just starting my career, it was right around the time where abiraterone (Zytiga) and enzalutamide (Xtandi) were being heavily tested and just getting approved and entering into the clinic.

And as we think about all of the evolution that’s happened since that time, we now have multiple androgen receptor pathway inhibitors in the clinic. We have radioligand therapies in the clinic, radium-223. The first radioligand therapy across any solid tumor malignancy to improve overall survival and on the heels of that, most recently, lutetium PSMA, which is a targeted radioligand therapy.

There are several different kinds of chemotherapies, and I think two more diagnostics have evolved. We are now integrating molecular profiling across multiple areas in the disease natural history and actually have several FDA-approved treatments based off of results of molecular profiling, whether that be germline hereditary testing or just tumor testing like, PARP inhibitors and immunotherapy.

And then, additionally, to kind of continue on that same thought of our diagnostics changing is one of the greatest disruptors in our treatment of prostate cancer has been the introduction of PSMA PET imaging that has really revolutionized our ability to be able to detect disease at lower levels of PSA.   

And that’s opened up options for focal therapy, radiation therapy, and other sorts of strategies. So, it’s really been just remarkable, all of the different advances that have occurred in prostate cancer over the last decade. 

Evolving Research | Advanced Prostate Cancer Treatment

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Evolving Research | Advanced Prostate Cancer Treatment from Patient Empowerment Network on Vimeo.

Prostate cancer research continues to evolve, but what’s important for patients to know? Expert Dr. Xin Gao shares updates about recent clinical trial developments, where research stands, and the outlook for future prostate cancer treatments.

Dr. Xin Gao is a Medical Oncologist at Massachusetts General Hospital. Learn more about this expert Dr. Gao.

See More From INSIST! Prostate Cancer

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Prostate Cancer Research Updates from ASCO 2023

 Establishing Treatment Goals: What Are Options for Advanced Prostate Cancer Therapy

Establishing Treatment Goals: What Are Options for Advanced Prostate Cancer Therapy?

 How Is Advanced Prostate Cancer Treatment Personalized

How Is Advanced Prostate Cancer Treatment Personalized?

Transcript:

Katherine:

This actually leads me to my next question which is about research news. 

Prostate cancer research is evolving quickly, like so many other cancers. And it’s important for patients to stay up to date on developing news. So, are there research advances that patients should be aware of? 

Dr. Gao:

Yeah, I mean some of the treatments that I just mentioned, PARP inhibitors, pembrolizumab (Keytruda) for MSI higher and mismatch repair deficient tumors and lutetium. Those have come out of recent major clinical trials and have become the standard of care in a lot of different…in various different settings for patients. And there are always new research trials, clinical trials, that are going to either move some of these established treatments to earlier lines of setting, earlier lines of treatment, or using them in maybe combination with other drugs where we might learn that they’re more useful if we combine it with another drug or maybe combine it with hormone treatments earlier rather than later. 

So, there are always clinical trials for advanced prostate cancer. There are even newer trials, novel therapies, completely new treatments that have been studied in the laboratory in say petri dish models of cancer or animal, mouse models of prostate cancer, but have shown enough early exciting data to try to move them into human beings and hopefully help advanced prostate cancer patients.  

Katherine:

As we wrap up, Dr. Gao, I’d like to get your thoughts. How do you feel about where we stand with advanced prostate cancer care? 

Dr. Gao:

Yeah. I think there have been a lot of advances in advanced prostate cancer care in recent years. Newer and better treatment strategies seem to come along every couple of years, and I think what we’ve seen for advanced prostate cancer patients over the past, really, since probably 2015 or so, is a significant improvement in outcomes, long-term outcomes like survival and slowing down of the cancer. 

And it’s…I think it’s important to acknowledge that and to acknowledge that the clinical trials in recent years have really led to a lot of improvements and really the hope that in the coming years, there’s going to be additional research, additional clinical trials, newer treatments hopefully, that will continue to improve outcomes for advanced prostate cancer patients. I also think that it’s really critical to evaluate the specific patients’ cancer characteristics, things like the genetic testing that I mentioned earlier, as well as their sort of life situations and other medical comorbidities to come to a shared decision about what makes the most sense in terms of their cancer management.  

Genetic testing might open up the option for certain FDA-approved therapies or consideration of certain targeted therapies that still might be in clinical trials. And clinical trials, again, are also an option for additional treatment strategies that otherwise would not be available. 

How Is Advanced Prostate Cancer Treatment Personalized?

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How Is Advanced Prostate Cancer Treatment Personalized? from Patient Empowerment Network on Vimeo.

Tests results, including results of biomarker testing, may help to personalize advanced prostate cancer treatment. Expert Dr. Xin Gao shares an overview of the testing that patients should undergo and how the results are used in determining a treatment plan for optimal care.

Dr. Xin Gao is a Medical Oncologist at Massachusetts General Hospital. Learn more about this expert Dr. Gao.

See More From INSIST! Prostate Cancer

Related Resources

Prostate Cancer Research | Updates From ASCO 2023

Prostate Cancer Research Updates from ASCO 2023

 Establishing Treatment Goals: What Are Options for Advanced Prostate Cancer Therapy

Establishing Treatment Goals: What Are Options for Advanced Prostate Cancer Therapy?

 Evolving Research: Advanced Prostate Cancer Treatment

Evolving Research | Advanced Prostate Cancer Treatment

Transcript:

Katherine:

I’d like to talk about what goes into deciding on a treatment path. What testing is used to understand a patient’s individual disease?  

Dr. Gao:

There is a lot of testing that we do for – to try and characterize a patient’s individual disease and try to select an optimal management strategy for their specific cancer and their specific situation.  

We look at the biopsy, the pathology. The most common type of prostate cancer is called adenocarcinoma, but rarely we see certain other types under the microscope, things like neuroendocrine or small cell prostate cancers that tend to be treated in a different way. We look at things like the Gleason score.  

That tells us a bit more about sort of the aggressiveness of this cancer, as well as the PSA, you know, it’s a very good correlate for how the cancer is doing in general once somebody has been diagnosed with prostate cancer. For imaging tests, we commonly rely on imaging. We look at prostate MRIs to get an idea of the local extent of the prostate tumor. We get things like bone scans and CAT scans to look at the entire rest of the body to see if or where the cancer may have spread to.  

And there are newer imaging tests like the PSMA PET scan, which we commonly use now, which is a much more sensitive test for detecting prostate cancer in 2023 compared to traditional scans like CAT scans and bone scans. I also commonly make use of genetic testing and molecular information.  

So, for any patient with an advanced prostate cancer, I do recommend both what we call a germline test, which is testing for inherited cancer genes that a patient could have gotten from the parents and pass onto their kids, as well as somatic testing, which is testing the cancer itself to see what genetic mutations or alterations might’ve developed within their cancer. And that can actually factor into certain treatments that the patient may or may not be more likely to benefit from if they have these genetic mutations. 

Katherine:

Dr. Gao, a patient sent in this question prior to the program. What other genetic testing, beside BRCA markers, are important for deciding future targeted therapies and how are each of them used? 

Dr. Gao:

Yeah, that’s a great question. Targeted therapies have been used in a lot of different cancers and it’s only really within the past few years that we’re using them as a standard of care routinely in prostate cancers. So, BRCA2 and BRCA1 mutations are some of the more common mutations or genetic alterations that are targetable in prostate cancer. Recently, there have been multiple FDA approvals of different drugs that are called PARP inhibitor, which are able to target the cancer if they have BRCA1 or BRCA2 mutations.  

Beyond BRCA2 and BRCA1, there’s a panel of what’s called homologous recombination repair genes and that’s defined differently in varying extents, depending on the specific drug. That has been FDA approved, but in general, it’s about 12 to 14 genes total and they actually include the BRCA2 and BRCA1 genes.  

So, some of the ones that have been…it seems like the data shows maybe more activity or better efficacy with these PARP inhibitors include a gene called PALB2, P-A-L-B 2. It’s not a very common mutation that we see, but it is something that we should look for because even if it’s not common overall for the patient who has it, it could be a very helpful and useful gene to know that that they have and it certainly would warrant treatment with a PARP inhibitor. 

The other sort of dozen  or so…10-12 genes in this homologous recombination repair pathway, the data, I would say, is still early and it is still somewhat limited in terms of how much people with those gene mutations truly benefit from these PARP inhibitors, but I do think it’s important to look for them, to know that if they do have one of these genetic mutations that it does make a PARP inhibitor an option for them. And then, beyond these HRR genes, I always look for something called a microsatellite instability or mismatched repair deficiency. These are sort of genetic features or really a panel of about four genes involved in a cellular process called – a DNA repair process called mismatch repair.  

For those patients that have either mismatched repair deficiency or microsatellite instability high cancers, I do recommend that they consider an immunotherapy medication called pembrolizumab which is FDA-approved regardless of cancer type for any MSI high or mismatched repair cancer and they’ve shown pretty solid activity for those kinds of cancers. 

Eight Factors That Impact Advanced Prostate Cancer Treatment Decisions

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Several key factors come into play for advanced prostate cancer treatment decisions. In the “Which Factors Impact Advanced Prostate Cancer Treatment Decisions?” program, expert Dr. Atish Choudhury from Dana-Farber Cancer Institute shares insight about these factors that aid in working toward optimal patient care. 

1. Age

Though age is only number, age is one of the factors to look at in advanced prostate cancer treatment decisions. Several other factors play into treatment options, and when the factors are added together they comprise a balanced picture for optimal care.

2. Fitness Level

The physical fitness levels of patients can vary by age, so this is why it’s important to consider it as a treatment factor. Patients who incorporate exercise into their lives before, during, and after cancer treatment generally have shorter and easier recovery times compared to patients who live a more sedentary lifestyle. Physical fitness also boosts the immune system to help fight infections.

3. Activities

The activities in each patient’s life are also vital in helping to guide treatment decisions. If travel is important to a patient for their happiness and/or to see friends and family, this is important to weigh along with other options. Other considerations like whether a patient wants to work, volunteer, hobbies, household chores, or other things the patient wants to resume must be considered as part of their care plan.

4. Overall Life Expectancy

Different than age, each patient’s overall life expectancy is taken into consideration to weigh against treatment options. The harshest treatments may be considered too extreme for those who aren’t expected to have an extended life expectancy, but the patient’s care team can discuss these considerations with the patient and their loved ones. Make sure to ask your care provider if you have questions or concerns.

5. Medical Issues

A patient’s existing medical issues must also be considered along with other key factors. For example, if a patient has heart or lung conditions, these may be important considerations with some treatment options. Autoimmune conditions may also be a concern. Make sure that your care team is aware of all your health conditions to ensure your best care.

6. Cancer Considerations

Considerations about the cancer itself must also be weighed among key factors. Specifics like the cancer stage, grade, and whether and where the cancer has spread must be taken into account when making a decision about the treatment strategy against the cancer.

7. Patient Preferences

Of course, a patient’s preferences for their treatment and life during and after treatment must be considered. Patients have different preferences for how much value they place on quality of life and long-term survival. Care team members will take these preferences into account in treatment options.

8. Side Effects

After cancer treatment starts, side effects may be more or less severe than anticipated. Depending on the patient’s side effects, treatment adjustments like treatment type, frequency, or dosage may be adjusted for optimal patient care. Make sure to let your care provider know about all side effects that you experience. A side effect that you are tempted to dismiss may be fairly simple to make adjustments for. You as the patient are your own best advocate. If you have questions about side effects before you start treatment, make sure to ask your care provider. 

 

Prostate cancer treatment decisions must look at several key factors to narrow down treatment options for the best care of each patient. If you want to learn more about prostate cancer care and treatments, check out our prostate cancer information.

Tools for Choosing the Right Prostate Cancer Treatment Approach

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Tools for Choosing the Right Prostate Cancer Treatment Approach from Patient Empowerment Network on Vimeo.

Dr. Rana McKay discusses the factors that impact advanced prostate cancer treatment decisions. Dr. McKay reviews potential treatment side effects and explains how patients in treatment are monitored.

Dr. Rana McKay is a medical oncologist at UC San Diego Health and an associate professor in the Department of Medicine at the UC San Diego School of Medicine. Learn more about Dr. McKay, here.
 
 

Related Resources:

What Is Personalized Prostate Cancer Medicine?

Tools for Partnering in Your Prostate Cancer Care

Transcript:

Katherine Banwell:

Since prostate cancer affects men differently, let’s review what factors could impact which treatment is right for their individual disease. How about we start with symptoms? 

Dr. Rana McKay:

So, yeah. I mean absolutely. I think symptoms are definitely something that plays into effect. Sometimes when patients are first diagnosed, they may not have symptoms. But, you know, boney pain, symptoms of urinary obstruction. You know, there’s specific treatments and strategies that we can deploy to help with those kinds of things. You know other factors that I think I – we take into account when we’re making decisions about which agent should any one patient receive is where are their sites of metastases? Is there disease just in the bones and lymph nodes or are there other organs involved? What’s the genomic make-up of the tumor? There are certain treatments that we would utilize if someone had a certain specific you know, genetic make-up for their tumor. You know, other things that are really important are what kind of drugs has the patient seen before or has that tumor been exposed to? Because that also helps us strategize for what to give them in the future.  

Katherine Banwell:

Do you take into consideration the patient’s comorbidities and their age and overall health? Things like that?  

Dr. Rana McKay:

Absolutely. Yeah. I think we need to absolute take that in account. I think – I think age is one thing. But I think functional status is just as – as important as the actual number itself because people are very different regarding the things that they can do at various age limits and so, that absolutely takes into account weighing the side effects of any given therapy and how that may interact with someone’s existing comorbidities and it may be something that we have to work with a team of other doctors to basically make sure that there is comprehensive, well-rounded care for any one patient.   

For example, some therapies may increase the risk of hyper-tension or increase the risk of volume overload. And so, if somebody has issues with that already we may have them see a cardiologist so we can make sure that, you know, we’re kind of addressing the totality of the patient experience. 

Katherine Banwell:

What do you mean by volume overload? 

Dr. Rana McKay:

Volume overload, I mean if they’ve got too much fluid on board. So, maybe if they have heart failure or something like that, and we have a therapy that’s going to cause them to retain fluid. And so then, we would have to work with a cardiologist to make sure that they don’t run into issues.  

Katherine Banwell:

Mm-hmm. Once a man is undergoing treatment for advanced prostate cancer, how are they monitored to see if it’s actually working? 

Dr. Rana McKay:

So, a lot of ways. So, one is by just, you know, visiting with the patient. Making sure that their symptoms are in check. Making sure that they’re not developing new aches or pains that are worrisome. It’s by checking their labs in addition to their organ and bone marrow function. We would check their PSA. And PSA isn’t the whole story. But it is one factor that contributes to us determining whether treatment may or may not be working. It’s also doing intermittent scannings. So, you know, CT scans of the organs, of the lymph nodes. Bone scan and now we actually have PSMA based imaging, which can be integrated to help assess where the disease is and not yet being utilized to assess whether something is working, because we haven’t really defined the criteria there. But, it can be utilized as well.