By John Halligan, M.D.
As we finish up Prostate Cancer awareness month in September, I’m reminded of the significant advances that have happened in the treatment of prostate cancer during my 25 year career. I think back prior to the PSA screening era when most men presented either with a tumor that was large enough to be felt, or metastatic cancer involving the bones in the lymph nodes. Our chances of treating these men with locally advanced cancers was quite slim with the surgical and radiation oncology options available at the time. Men who had metastatic disease had an average survival of about three years and after first-line hormonal therapy failed, had very little in the way of systemic treatment options. We have made incredible progress since then on all fronts.
Screening for prostate cancer led to a marked increase in the detection of earlier and smaller prostate cancers. Initially, there was likely overtreatment of some cancers which were unlikely to have caused problems for the patient. However, as our understanding of the biology of prostate cancer advanced, surgeons and radiation oncologists were better able to select the patients whom we could safely watch and not give them the side effects of treatment for a cancer that was unlikely to ever cause problems. We also then had the opportunity to catch the more aggressive prostate cancers earlier in their course, giving them a much higher chance of cure with either surgery or radiation with or without hormonal treatments.
In addition, for those men who even now are occasionally still found to have cancer that has spread beyond a curable approach, we have much more effective systemic treatment options including multiple lines of hormonal therapies that can be used in sequence and show continued responses. Newer chemotherapies are now seen as an effective option for prostate cancer and show marked declines in PSA and improved patient quality of life and survival. Immunotherapy is beginning to show promise in prostate cancer, and other biologic treatments are making their way into our treatment armamentarium.
The curative options for patients with aggressive, local cancers that need to be treated have markedly improved. Our surgical colleagues have improved their techniques and with the addition of the da Vinci robotic prostatectomy have decreased the side effects and recovery time from surgery while maintaining cure rates. On the radiation front, our technology has markedly advanced, allowing us to treat men with higher doses of radiation more precisely with lower side effects and higher cure rates. Intensity modulated radiation (IMRT) and onboard imaging on our modern treatment machines has allowed us to visualize our target with greater accuracy, resulting in less normal tissue being treated. The new accelerators by Varian, Tomotherapy and Elekta have brought state-of-the-art technology across the country. We feel lucky to have all of these technologies available within our group.
In addition, we are fortunate here in Alaska and in our group to also have the CyberKnife radiation option which can treat some patients with prostate cancer in just five days with relatively minimal side effects and very high chance of cure because of the highly focused radiation given with real time tracking of the tumor.
With all the advances of prostate cancer detection, biologic understanding, surgical and radiation technologies as well as new systemic options, we are glad to see prostate cancer patients having earlier detection, more options for treatments, better quality of life and overall survival when they are faced with a diagnosis of prostate cancer. I’m excited to see even more developments which I know will be happening over the next several years to further improve the treatments for prostate cancer patients.