New Treatments for Prostate Cancer
Provenge
The U.S. Food and Drug Administration recently approved use of the prostate cancer treatment Provenge, made by Dendreon Corporation of Seattle. The company said the treatment will be available at 50 clinical 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 Dr. 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.
Radiation Therapy
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 beam therapy uses subatomic particles called protons. Neutron beam therapy uses subatomic particles called neutrons.
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 continuous monitoring of the prostate in real time during delivery of radiation therapy to make sure that radiation therapy treats just your cancer and not your surrounding organs.
Proton Beam Therapy
Only a few centers offer proton beam radiotherapy in the United States. Greater precision in administering radiation is claimed for this approach, and with reduced scatter of the proton beam, a higher dosage of radiation can be administered in a precise way to the tumor reducing side effects. The results of studies done thus far suggest excellent outcomes in patients treated with proton beam 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. Proton beam therapy will be available at Seattle Cancer Care Alliance in the near future.
Therapy for High-Risk Cancer
Some men have cancer that is considered to have a high risk of recurring despite potentially curative treatment. SCCA is at the forefront of developing new ways to improve the effectiveness of both prostatectomy and radiation therapy. These approaches involve treating both the cancer in the prostate and any cancer that might have spread early in the development of the disease. They are available for patients who prefer either an operation or radiation therapy, and all are designed by physicians at SCCA using leading-edge research into how prostate cancer grows and spreads.
Active Surveillance
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, it is clear that most men with low-grade cancer, particularly those men over age 70, will have evidence of prostate cancer that never causes 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 also increased the number of men diagnosed with cancer, even though many 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. For a large number of men therapy can be safely delayed, perhaps indefinitely. This approach is termed “active surveillance,” which is different from the old concept of “watchful waiting,” which may have involved too much waiting and not enough treatment when it was needed.
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.
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.
Clinical Studies
Some promising new treatments are only available in clinical trials. Ask your doctor if there is a clinical study that might be right for you.