Advances in Understanding Prostate Cancer

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Topics include: Treatment

How far have we come in understanding and diagnosing prostate cancer? In this interview, Patient Power founder, Andrew Schorr, visits with renowned expert Dr. William Catalona, from Robert H. Lurie Comprehensive Cancer Center of Northwestern University, to discuss advances in understanding prostate cancer. Dr. Catalona describes a “tremendous explosion” of information available to investigate the disease and stresses the importance of patients working with a specialist to determine the best treatment path. 

This virtual town meeting was sponsored by the Patient Empowerment Network through educational grants from Astellas, Medivation, Inc. and Sanofi. 

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:

Hello and welcome to Patient Power. I'm Andrew Schorr. Well, many people who have done their research about prostate cancer hear about one of the renowned urologists in the field, who is a leader of the program here at Northwestern, at the Lurie Cancer Center.  That's Dr. William Catalona.  Thank you for being with us once again, Dr. Catalona. 

Dr. Catalona:

My pleasure. 

Andrew Schorr:

We've spoken before. So you often meet men when they're first diagnosed with prostate cancer and then may be their doctor for many years.  Sometimes it is advanced. Sometimes you hope surgery or other initial therapies can work, but sometimes it doesn't. But that doesn't mean the end these days, does it? 

Dr. Catalona:

No, it certainly doesn't.

Andrew Schorr:

So you have monitoring and a variety of treatments that go on.  You've been very involved over the years with the PSA tests, and there have been debates about should every man have it as part of their physical. But it is certainly has a role in ongoing monitoring, doesn't it?  

Dr. Catalona:

It does.  

Andrew Schorr:

Tell us about that. Tell us about testing now and helping as men live with prostate cancer to understand what to do and how they're doing.

Dr. Catalona:

I see.  So in the context of men who have already been diagnosed with prostate cancer and are using the PSA to monitor it, yes.  So the PSA is really the most accurate test for monitoring prostate cancer. It's not absolutely perfect, because there are some prostate cancers that are very, very aggressive and so aggressive that they don't produce PSA. But for more than 95 percent of prostate cancers, the PSA is an excellent monitor of whether the cancer is remaining stable, whether it's regressing or whether it's progressing.  

And so depending on the clinical situation, the patient should monitor their PSA perhaps as often as every three months. In other situations where it doesn't appear to be progressing rapidly, it could be every six months or to annually.

Andrew Schorr:

Now, you alluded to something as you were saying that where it sounds like prostate cancer for different men is different even when it's advanced.  It's heterogeneous, if you will. 

Dr. Catalona:

That's right.  So there's not just one single factor that causes prostate cancer. So when we say heterogeneous, there are probably several different mechanisms that can cause prostate cancer. And some of these will cause the prostate cancer to be very, very aggressive, similar to lung cancer or pancreatic cancer, and others can cause prostate cancer to progress very, very slowly.  And so not all prostate cancers driven by the same mechanisms, and therefore some of the tests we use to discern the aggressiveness of prostate cancer may be more effective in certain types of cancer but less accurate in other types of prostate cancer. 

Andrew Schorr:

How are we doing with that as far as getting the picture of each man's cancer now?  Because, let's say, with the PSA test, a man's PSA goes up, he may feel, I don't want to say like a failure, but like he's losing the battle, you know, and you have other tests.  How are we in really more accurately understanding one man's situation?

Dr. Catalona:

So one of the issues that comes up now is there are now four or five commercially available genetic tests for determining the aggressiveness of prostate cancer and perhaps for really treatment decision?making. Should a patient get adjuvant radiation therapy, should they get chemotherapy?  And so one of the questions is which of these tests is the best, and the patients often ask this.  

And just to give you an example, one of the tests, the genetic markers are all based on how rapidly the cells proliferate.  And so for patients whose prostate cancers are driven primarily by proliferation genes, then those tests may be very accurate for those patients, but for other patients whose tumor is being driven by a different pathway, then this particular genetic test may not be the most accurate test.  

Others of the commercially available tests will have gene patterns of four different kinds of genes, and so they may be more accurate for the second type of tumor that are detected. And at the present time, there have not been any head?to?head studies, so we really don't know, you know, which is the best test. And probably some are going to perform better for some tumors, and others are going to perform better for other tumors.  They're all pretty good, but right now we really don't know how best to apply them in clinical practice.  

Andrew Schorr:

Dr. Catalona, you've been at this a long time, and the areas where you said previously we don't know, many questions have been answered over the years. And these questions that you still don't know, I know you're confident that you will answer them. So for the man and his family that are sort of along for the ride and hopefully playing more of an active role in their care, what would you say to them so that they can work with you, have the right doctors, get the right answers so they can do better?

Dr. Catalona:

Well, I think the most important thing—you're absolutely right.  There has been really a tremendous explosion of information about prostate cancer with the new tools that are now available to investigate the disease. Next-generation sequencing, modern cancer biology, you know, we have great tools now that can be applied to these tumors to sort them out and decide which treatment may be best for which patient.

And, you know, I think the most important thing is for the patient to have a doctor that he trusts but someone who also is kind of plugged in to what is going on internationally. It's not just an American enterprise now.  There are now international teams who are making great discoveries every day. 

Andrew Schorr:

I want to thank you for your devotion to men with prostate cancer and their families, the families touched by this over so many years, and I hope that in your career you will continue to get answers so that men particularly with advanced prostate cancer can live longer and live better.  Thank you for all you do, sir.  

Dr. Catalona:

Thank you.  

Andrew Schorr:

Andrew Schorr with Dr. William Catalona from Northwestern who's devoted his life to helping families touched by prostate cancer and continues to be on the trail of how we can do better. Remember, knowledge can be the best medicine of all. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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Page last updated on May 20, 2016
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