New Treatments for Prostate Cancer
Seattle Cancer Care Alliance (SCCA) offers the latest treatment options for men with prostate cancer. Our doctors have been involved in the research that has led to the development of many therapies available today.
There have been many advancements in radiation treatment over the years. External beam radiotherapy, intensity-modulated radiotherapy (IMRT), and 3D-conformal radiation therapy all accelerate subatomic particles called electrons to generate waves of high-energy photon radiation. Proton therapy uses subatomic particles called protons. Neutron beam therapy uses subatomic particles called neutrons.
In March 2013, SCCA Proton Therapy, A ProCure Center opened on the campus of UW Medicine's Northwest Hospital and Medical Center, making proton therapy available to cancer patients in the Pacific Northwest for the first time. SCCA medical oncologists and radiation oncologists are excited to have the opportunity to utilize proton therapy to treat prostate cancer. Research studies have demonstrated the efficacy of proton therapy, its relative safety even with higher doses, and a low incidence of incontinence and bowel dysfunction for men undergoing this treatment. The results of studies done thus far suggest excellent outcomes in patients treated with proton therapy. The results are approximately like those seen in patients treated with high doses of IMRT. The potential improvements in side effects remain a topic of some debate, as some studies suggest a higher rate of rectal toxicity than with IMRT. Learn more about proton therapy for prostate cancer.
GPS for the Body
In 2008, SCCA brought in new technology that improves external beam radiation treatment. This is the Calypso System, now referred to as GPS for the Body, manufactured by Calypso Medical. SCCA radiation oncologists were critical in developing this system. It provides clinicians with an innovative solution for target localization, and it allows them to continuously monitor the prostate in real time during radiation delivery to make sure only the cancer—not surrounding organs—is treated.
The U.S. Food and Drug Administration approved use of the prostate cancer treatment Provenge, made by Dendreon Corporation of Seattle, in 2010. The treatment is now widely available at sites around the country, including Seattle Cancer Care Alliance. SCCA was the location for several of the clinical studies to test Provenge prior to regulatory approval. These were led by Celestia S. Higano, MD, a medical oncologist who specializes in prostate cancer and a professor of medical oncology at the University of Washington. Read more about Provenge and its availability at SCCA.
Therapy for High-Risk Cancer
One in five men with prostate cancer is diagnosed with high-risk localized prostate cancer. Among these men, who account for most of the 27,000 prostate cancer deaths in the United States each year, less than 50 percent are cured. High-risk prostate cancers have a propensity to spread even when, by all clinical appearances, the disease is localized. SCCA is at the forefront of developing new treatment strategies that involve treating both the cancer in the prostate and any cancer that might have spread early in the development of the disease. A new generation of systemic therapies is showing clinical promise when combined with surgery or radiation therapy. Read more about treating high-risk prostate cancer.
Approximately half of men diagnosed with prostate cancer and treated with surgery or radiation have cancer that is at very low risk for causing serious problems for them in the future. Although it seems counterintuitive that men who have cancer may not need therapy, most men with evidence of low-grade prostate cancer, particularly those over age 70, will not have cancer-related problems over their lifetime. This suggests that many prostate tumors grow very slowly and never progress to clinical cancer, even over decades. The extensive use of prostate-specific antigen (PSA) screening over the past 20 years has increased the number of men diagnosed with cancer, many of whom would never have needed treatment.
The open issue of how to best measure PSA or other markers to diagnose cancer is a different question from who needs treatment after a diagnosis of prostate cancer has been made. For a large number of men, therapy can be safely delayed, perhaps indefinitely. This approach is termed “active surveillance.” In active surveillance, men are monitored with serial PSA measurements and repeated prostate biopsies to carefully check for any changes that may suggest the need for treatment. This is different from the old concept of “watchful waiting,” which may have involved too much waiting and not enough treatment when it was needed.
SCCA is leading a multi-institutional study of how best to determine who needs therapy and how to detect clinically significant and insignificant cancer. This study is sponsored by the Canary Foundation.
Some promising new treatments for prostate cancer are only available in clinical studies. Ask your doctor if there is a clinical study that might be right for you.