Prostate cancer is the most common cancer in men and one of the most dangerous. The medical advances that have been made in the treatment and diagnosis of prostate cancer are enormous. Systemic changes must keep up with it, but for that, we need to change the way we think and approach prostate cancer in a new way.
Targeted approach to prostate cancer treatment
Published June 26, 2024 17:05
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Not so long ago it was said that 22,000 new cases of the disease are diagnosed annually in Poland, and there are about 5,500 deaths. Now it is estimated that these new cases could be as many as 25 thousand. This is a challenge for the health care system. With better and better treatment, patients are living longer and better.
The most important risk factors are age, race, lifestyle and oncologic family history. As in any disease, so in prostate cancer, diagnosis is key. It is well known: the earlier - the better, as the method and treatment options largely depend on the stage of the disease. - Nearly 25 percent of newly diagnosed patients have already metastasized, says Jakub Zolnierek, MD, clinical oncologist, and adds that in Western countries this percentage is much lower. In the case of disseminated prostate cancer, it is too late for treatment with radical methods. For this group, drug treatment remains. In some patients, however, under the influence of the applied treatment with classical forms of hormone therapy with a castrationist approach, after a temporary improvement, the cancer moves forward. Most patients, when resistance to castration occurs, have already metastasized.
Changing thinking about prostate cancer
We now know that the choice of therapy is affected by more than just stage. As in breast or lung cancer, mutation matters. The analogy with breast cancer is most valid here. It turns out that some of the most significant in prostate cancer are mutations in the BRCA2 and BRCA1 genes. - BRAC2 and BRCA1 defects in prostate cancer are rare - they account for a maximum of 10 percent, but with 22,000 newly diagnosed annually, that's a lot, the oncologist says, adding that if we have a person with a mutation, the diagnoses are at a higher stage of progression and at a higher degree of malignancy. These are aggressive tumors resistant to the treatments we currently have. The solution is PARP inhibitors, or molecularly targeted drugs. - PAPR inhibitors enhance the damage to cancer cells. The next step is to combine them with modern hormonal drugs. We should use these combinations as early as possible," says the oncologist, and explains what current practice looks like: When we see that classic forms of treatment fail, we do diagnostics. Meanwhile, PARP inhibitors should be used earlier. - In a patient in whom we have a family history of BRC-dependent cancer, having the disease at a younger age, having already disseminated prostate cancer at the time of diagnosis, should prompt us to do this diagnostics earlier, so that we know what to expect, because the tumor will grow faster, respond less well to chemotherapy, to hormone therapy, and it will be increasingly necessary to look for new options," he says.
A guy comes to the doctor
A guy comes to see a doctor... and unfortunately he encounters a formal limitation, because the financing tool is there. - But it is pathologically related to the contracting of hospital services. Although we do everything in the outpatient clinic, we can only do the examination in the oncology clinic, only in facilities that have contracted services for hospitalization. Talks are underway with the Ministry of Health, they recognize this problem and want to change this," says J.Zolnierek. According to the oncologist, any man who comes to the outpatient clinic with suspected cancer and a loaded family history should be referred to a genetic counseling center - which can initiate such diagnostics.
What needs to be done?
- Make patients and doctors more aware and simplify diagnostics in terms of financing, the oncologist concludes. This will save money at a later stage, eliminating misleading therapeutic choices. Studies show that with PARP inhibitors, we can control prostate cancer several months longer, and extend life by as much as 7 months. - It is important to realize that advances in oncology are small steps," explains Jakub Zolnierek, MD. - From these small steps, after 2 decades, life with disseminated prostate cancer has increased from 30 months to 60 months.
