Prostate cancer treatment insights

In his latest online article, Dr Mark Tuthill gives us his insights into prostate cancer treatment. He talks about the latest advancements in treatments, the targeted therapies available, how emerging treatments compare to traditional options, potential side effects and clinical trials for innovative prostate cancer therapies.

What are the latest advancements in treatments for prostate cancer?

The latest advancements in prostate cancer treatments primarily revolve around several factors. Firstly, there's a notable development in the use of targeted oral therapy for advanced prostate cancer. In the past, treatment options were limited to hormonal therapy and chemotherapy for addressing advanced cases. However, in recent years, the introduction of Olaparib has demonstrated remarkable effectiveness, particularly in treating patients with BRCA1 and BRCA2 positive advanced prostate cancer, a condition influenced by genetic factors.

Secondly, there's a significant stride in the realm of intravenous radiotherapy, with the emergence of more sophisticated approaches. Specifically, theragnostic treatment has entered clinical practice, employing radial ligands to target the PSMA receptor found in a substantial number of patients with advanced prostate cancer. This advancement allows individuals with advanced disease to undergo intravenous radiotherapy treatments.

Are there targeted therapies available for specific types of prostate cancer?

 There are various specific targeted therapies for early and advanced prostate cancer. In advanced cases, the main focus is on therapies that block the male hormone testosterone. Examples include darolutamide, enzalutamide, abiraterone, apalutamide, and some other drugs in the pipeline. We've known about the benefits of these drugs for over 10 years, and it's now clear that giving these targeted therapies earlier leads to much better outcomes for patients.

Another important therapy is Olaparib, used for castrate-resistant prostate cancer. It can be given alone or combined with abiraterone acetate (though not officially licensed in the UK). There are also theragnostic treatments targeting PSMA, a common molecule in prostate cancer cells which are used after hormonal and chemotherapy treatment.

How do emerging treatments for prostate cancer compare to traditional options?

The upcoming treatments for prostate cancer differ from the well-known options. Established treatments, widely recognised, involve chemotherapy, typically administered in both hormone-sensitive and hormone-resistant scenarios. Additionally, hormone-blocking medications like abiraterone, enzalutamide, and apalutamide are used in the hormone-sensitive setting for newly diagnosed individuals. On the other hand, newer treatment approaches primarily focus on targeted therapies. Unlike the broader application of traditional therapies, these drugs are specifically administered.

For instance, Olaparib is given to a small percentage of patients with castrate-resistant prostate cancer. Similarly, theragnostic treatment is reserved exclusively for patients with high PSMA-expressing prostate cancers, unfortunately these patients make up the majority of patients in the advanced disease clinic.

What are the potential side effects of new prostate cancer treatments?

The side effects of treatments vary based on the specific agent used. For instance, medications like Olaparib may share some side effects with chemotherapy, such as fatigue, lethargy, nausea, and changes in blood counts. However, overall, Olaparib is well-tolerated with high response rates. Most men would prefer Olaparib over undergoing chemotherapy again.

Theragnostic treatments generally have fewer side effects compared to chemotherapy. Although some men may experience fatigue, increased saliva production, and minor side effects like bone marrow suppression, the overall tolerance to this treatment is quite high. The key distinction between these newer therapies and older ones is that the newer options are more likely to be effective and are generally better tolerated.

Can you provide information on clinical trials for innovative prostate cancer therapies?

When discussing clinical trials, there are a couple of important considerations. Each clinical trial is designed to address a specific clinical question, and so not every patient is suitable for participation. For instance, if your prostate cancer is responding well to current treatment, you may not qualify unless the study specifically seeks individuals with stable or responding disease. The availability of clinical trials is also influenced by what is accessible locally. It's not realistic for every centre to have all available trials; they may successfully recruit for only one or two.  If in doubt, speak to your consultant who will discuss the options available to you locally and further afield if needed.

When meeting with your oncologist or team for the first time, it's crucial to inquire about potential clinical trials suitable for you. If there's a relevant trial available locally in your hospital, it's worth considering, but participation is not obligatory unless it's deemed beneficial for you. In some cases, especially when standard options have been exhausted, individuals might explore trials further afield, such as experimental medicine studies like phase one studies. However, the decision depends on various factors, including your specific circumstances, the trial's eligibility criteria, and your assessment of its value for you. It's important to recognise that while clinical trials contribute to developing new medicines, proven treatments in the clinic remain the primary choice for most people. If you are considering a research study, discussing it with your specialist is crucial.

Dr Mark Tuthill is an esteemed medical oncologist with over 20 years of experience. You can schedule an appointment with Dr Tuthill on his Top Doctors profile.