Navigating Prostate Cancer: Insights, Advances, and Personalized Care

December 13, 2023 - Understanding prostate cancer is pivotal not just for enhancing early detection and treatment but also for reducing the impact of the second leading cause of cancer death in men. 

In the United States, the financial toll of metastatic prostate cancer is staggering, exceeding $55,000 annually for individuals with employer-sponsored health insurance and $43,000 for those covered by employer-sponsored Medicare supplement plans. These figures underscore the importance of developing effective clinical and policy approaches for preventing, screening, and treating prostate cancer.  

What Is Prostate Cancer? 

Prostate cancer involves the formation of malignant cells in the walnut-sized gland of the male reproductive system — the prostate. It occurs when cells in the prostate undergo uncontrollable growth, producing a portion of the fluid found in semen. Positioned beneath the bladder and in front of the rectum, the prostate's size can vary with age. 

While there are various types of prostate cancers, adenocarcinomas, originating from gland cells, are the most common. The growth rates of prostate cancers vary, and pre-cancerous conditions like prostatic intraepithelial neoplasia (PIN) may be discovered during a prostate biopsy. High-grade PIN is a potential precursor to prostate cancer, emphasizing the importance of early detection. 

How Common Is Prostate Cancer? 

Prostate cancer is the most common cancer among American men, second only to skin cancer. A man is more likely to develop prostate cancer than colon, kidney, melanoma, and stomach cancers combined. The risk of developing prostate cancer increases with age, with about 6 in 10 cases found in men over 65. 

The incidence of prostate cancer declined notably from 2007 to 2014, associated with reduced screening following changes in recommendations. However, since 2014, the overall incidence rate has steadily increased by 3% annually. Advanced-stage prostate cancer has seen a more pronounced uptick at around 5% per year. 

The statistical risk is rare in men under 40, and the average age of initial diagnosis is approximately 66. 

Prostate cancer ranks as the second leading cause of cancer-related deaths in American men, after lung cancer. About 1 in 41 men will die from prostate cancer. Despite its potential severity, it's important to note that the majority of men diagnosed with prostate cancer do not face fatal outcomes. Remarkably, over 3.1 million men in the US diagnosed with prostate cancer are still alive today. 

The death rate from prostate cancer significantly declined by 50% from 1993 to 2013 due to advancements in early detection and treatment. However, the decline has slowed in recent years, possibly indicating a rise in diagnoses at advanced stages. This underscores the ongoing importance of vigilance and proactive healthcare measures in the fight against prostate cancer.

How Is Prostate Cancer Treated? 

Prostate cancer treatment encompasses a variety of approaches, and the decision on which path to take is a collaborative effort between the patient and their healthcare provider. Several common treatments include the following: 

1. Expectant management 

• Active surveillance: This approach involves regular monitoring through PSA tests and biopsies. Treatment is initiated only if the cancer displays signs of growth or symptoms. 
• Watchful waiting: In this strategy, no proactive tests are conducted, and symptoms are addressed as they arise. This strategy is typically recommended for individuals with a life expectancy of 10 years or less.

2. Surgery 

• Prostatectomy: This surgical procedure encompasses the removal of the prostate. A radical prostatectomy goes a step further, involving the extraction of seminal vesicles, which are glands producing fluids integral to semen. 

3. Radiation therapy 

• External radiation therapy: This treatment method utilizes high-energy rays directed at cancer cells from outside the body. 
• Internal radiation therapy (brachytherapy): This procedure involves the surgical placement of radioactive seeds or pellets into or near the cancer to eliminate cancer cells. 

4. Other investigative therapies 

• Cryotherapy: This less common approach uses a specialized probe to freeze cancer cells. 
• Chemotherapy: Providers administer drugs orally, intravenously, or both to shrink or eradicate cancer that has spread. 
• Biological therapy: This treatment collaborates with the body's immune system to combat cancer or manage treatment side effects. 
• High-intensity focused ultrasound: This method utilizes high-energy sound waves to target and destroy cancer cells, although it is less commonly employed. 
• Hormone therapy [androgen deprivation therapy (ADT)]: This approach blocks cancer cells from accessing hormones necessary for growth. 

Clinical Trials 

Clinical trials are pivotal in advancing prostate cancer treatment by testing new therapies, refining standard treatments, and exploring precision medicine approaches. These trials assess the safety and efficacy of novel medications, immunotherapies, and diagnostic tools, aiming to improve patient outcomes. Additionally, they contribute to understanding biomarkers for personalized treatment, monitoring side effects, and incorporating patient perspectives for a holistic evaluation.  

Clinical trials also play a crucial role in developing innovative strategies, shaping the future of prostate cancer care, and providing patients with access to cutting-edge interventions. Participation is voluntary and follows strict ethical guidelines, ensuring informed consent and prioritizing patient well-being. Clinical trial participation allows individuals to explore new treatment options for safety and efficacy. 

For instance, on November 21, 2022, the FDA granted Investigational New Drug approval to begin studying theranostic SAR-Bombesin for the treatment of prostate cancer. On November 7, 2023, the researchers announced that 50 patients had been imaged with 64Cu-SAR-Bombesin in its US-based diagnostic trial, SABRE (NCT05407311), for participants with prostate-specific membrane antigen-negative prostate cancer. 

Complementary and Alternative Medicine 

Complementary and alternative medicine, encompassing practices outside standard cancer treatments, includes acupuncture, vitamins, herbal supplements, and diet. While some lack scientific validation, studies show that acupuncture therapy has been widely used in clinical trials of pain caused by prostate cancer in recent years. It can relieve pain caused by prostate cancer to some extent. Based on the traditional Chinese Medicine theory, acupuncture can regulate the balance of qi (the vital energy that circulates through the body) and blood by stimulating acupuncture points, which aim at improving physiological function.  

Additionally, a study revealed that a plant-based diet is linked to a 52% lower risk of prostate cancer progression and recurrence among 2,038 men with stage 1–3a prostate cancer. Health plant-based dietary indices (hPDI) did not show statistically significant trends but indicated lower risk.  

The researchers suggest that plant-based diets, particularly among older men and those with higher walking pace, may benefit prostate cancer survivors, emphasizing the potential for diet and exercise counseling to improve clinical outcomes. This study adds to existing evidence supporting the advantages of a plant-based diet for prostate cancer. Further research is needed, but combined with other data, it contributes to the development of potential nutritional guidelines for men at higher risk of prostate cancer.  

The Prostate Cancer Foundation reports that vegetarian diets decrease the risk of heart disease and cancer by 29% and 18%, respectively, and a 2022 study in the American Journal of Clinical Nutrition found a 19% lower incidence of prostate cancer associated with a plant-based diet. 

Diagnostic Advances 

Early diagnosis of prostate cancer is crucial, and healthcare technologies are instrumental in this process. Advanced diagnostic tools, including digital rectal exams and the PSA test, play a pivotal role. Digital rectal exams involve a gloved finger assessing the prostate for abnormalities, while the PSA test measures prostate-specific antigen levels in the blood. Innovative procedures like PSMA PET scans use targeted molecules and radioactive substances to detect prostate cancer cells, aiding in diagnosis and treatment planning. 

Additionally, transrectal ultrasound and MRI procedures provide detailed images of the prostate, guiding biopsies to determine cancer grade through the Gleason score. This score, ranging from 6 to 10, indicates the cancer's aggressiveness, influencing treatment decisions. Healthcare technology's role extends to treatments like transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH), which, while not cancer, can share symptoms with prostate cancer. 

Personalized Prostate Cancer Care 

The prognosis and treatment approach considers various factors, including cancer stage, PSA levels, Gleason score, Grade Group, and the extent of cancer within the prostate. Emerging technologies continually refine diagnostic precision and therapeutic outcomes. Importantly, ongoing research and development in healthcare technology contribute to the evolving landscape of prostate cancer care, emphasizing the dynamic nature of advancements in the field. As technology progresses, integrating innovative tools promises to enhance diagnostic capabilities and treatment strategies for prostate cancer patients. 

Moreover, precision medicine approaches, guided by genetic insights, are gaining prominence. Biomarkers are being identified to tailor treatments to the specific characteristics of an individual's cancer. This shift toward personalized medicine ensures patients receive interventions best suited to their unique conditions, potentially improving efficacy and minimizing side effects.  

In this era of rapid technological progress, integrating data-driven strategies and personalized medicine holds promise for a more targeted and effective approach to prostate cancer diagnosis and treatment.