A Decade of Dramatic Change in the Treatment of Prostate Cancer

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Numerous drug approvals for treatment of prostate cancer hold hope for patients, but more research is needed to convert it to a chronic disease.
Numerous drug approvals for treatment of prostate cancer hold hope for patients, but more research is needed to convert it to a chronic disease.

Major treatment strategies have been approved over the past decade, dramatically increasing survival rates and changing the treatment paradigm for prostate cancer. Greater improvements are expected within the next decade through precision medicine.

In 2005, there were only a handful of approved medications. However, today there are many more and they work by several different mechanisms, allowing them to extend life in novel ways.

In 2005, the relative 10-year survival rate for prostate cancer was 92% and the relative 15-year survival rate was 61%, according to the American Cancer Society.1

Today, the numbers are significantly higher: the relative 5-year survival rate for all stages of prostate cancer is almost 100%, the relative 10-year survival rate is 99%, and the 15-year relative survival rate is 94%.2

“The greatest advances in the management of prostate cancer in the last decade have come directly from our understanding of the biology of what causes prostate cancer cells to become resistant to treatments we had a decade ago,” said Anthony D'Amico, MD, PhD, of Brigham and Women's Hospital and Dana-Farber Cancer Institute, in Boston, MA.

He said the Prostate Cancer Foundation (PCF), which was formerly the Association for the Cure of Cancer of the Prostate (CaP CURE), helped usher in a new era in terms of research. It included leading scientific and clinical experts and it helped expedite new treatments.

In 2004, the U.S. Food and Drug Administration (FDA) approved docetaxel after the publication of two random controlled trials, one of which was led by a PCF clinical investigator.3

Over the past decade, the FDA has approved the pure luteinizing hormone–releasing hormone antagonist degarelix (Firmagon), the first immunotherapy for prostate cancer, sipuleucel-T (Provenge), and a taxane-based chemotherapy, cabazitaxel (Jevtana).

The FDA also approved denosumab (Prolia/Xgeva) as a treatment to increase bone mass in patients at high risk for fracture receiving androgen-deprivation therapy (ADT).

Enzalutamide (Xtandi) has been approved to treat men with metastatic castration-resistant prostate cancer that has spread or recurred, even with medical or surgical therapy to minimize testosterone. Enzalutamide was approved for patients who have previously been treated with docetaxel.

In May 2013, the FDA approved radium Ra 223 dichloride (Xofigo) to treat symptomatic late-stage metastatic castration-resistant prostate cancer that had spread to bones, but not to other organs.

“Provenge and radium 223 dichloride have helped a lot for patients in the late stages of the disease,” Dr. D'Amico told Cancer Therapy Advisor. “In the future, we hope to do more than just extend life more than several months in late stage disease.”

It is now estimated that one in seven men will be diagnosed with prostate cancer during his lifetime and approximately 220,800 new cases of prostate cancer will be diagnosed in 2015 alone.4 The American Cancer Society predicts in 2015 there will be approximately 27,540 deaths from prostate cancer.

RELATED: Post-diagnostic Dietary Changes Among Men with Prostate Cancer Beneficial

Yair Lotan, MD, who is a professor of urology and chief of urologic oncology at University of Texas Southwestern Medical Center, in Dallas, TX, said no one agent has been a home run, even though there have been significant advances in the past decade.

“The advancements of the past decade have been mostly small incremental changes. Each of the new therapies provides modest survival benefits, 3 to 4 months,” Dr. Lotan told Cancer Therapy Advisor. “There is still a desperate need for effective therapy for patients with castrate resistant prostate cancer and it is unclear whether this will be provided by novel targeted therapies.”

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