Cancer Symposium Focuses on Prostate Cancer
BIDMC Researchers Discuss Prostate Cancer at the First Annual Cancer Symposium
Date: 1/1/0001
BIDMC Contact: Zineb Marchoudi
Phone: (617) 678-6449
Email: zmarchou@bidmc.harvard.edu
Paradigm shifts are big. When they happen in medicine, they can change the way people feel about a disease.
According Martin Sanda, MD, Director of the Prostate Cancer Care Center, and a speaker at this week’s Cancer Symposium, researchers are on the verge of just such a shift for prostate cancer.
Despite modern interventions, 28,000 men die from the disease each year. Not only that, while survival rates for men undergoing treatment are high – 95 percent survive 10 or more years after surgery or radiation therapy – many men suffer undesirable side effects from their treatment. But novel treatments and diagnostics may be on the horizon according to BIDMC researchers who spoke at a mini-symposium focused on prostate cancer on Thursday morning, Oct. 23.
The paradigm shift Sanda predicts is being driven by a desire to select the best and most appropriate treatment possible for each individual patient. One trend in personalized medicine, a key theme of the overall Cancer Symposium, centers on identifying the information needed to guide treatment. That information, according to several presentations, is often buried among the molecules and genes at the root of a patient’s cancer.
Sanda, however, contrasted such sophisticated individualized treatment with the information that currently guides prostate cancer treatment: age.
Young men get surgery, old men get radiation, and those with advanced disease receive chemotherapy and hormones, he said. “It’s a cookie cutter approach.”
Sanda suggested that clinicians need to consider using more information in their decision making, such as prostate tumor size, prostate-specific antigen (PSA) levels, other health factors such as obesity, and lifestyle. In addition, he suggested that effort be put into developing novel treatments, including a re-surging interest in immunotherapy and vaccines.
Another trend in personalized medicine centers on developing appropriate treatments for different forms of a disease. As part of this work, existing radiation and hormone therapies are being honed to be more effective, more targeted, and less invasive.
For instance, Steven Balk, MD, Hematology/Oncology, discussed the development of drugs that target the androgen receptor, a receptor that regulates male genes. Androgen deprivation therapy is the standard treatment for men with metastatic prostate cancer. While this approach has an 80 percent response rate, he said, many men relapse, suffer unwanted side effects, and have few alternate treatments. Balk, however, reviewed four mutations that involve the androgen receptor and corresponding potential targeted therapies. “We need to use androgen deprivation therapy in combination with other modalities, like kinase inhibitors and vaccines, and block the androgen receptor more effectively,” he said.
Radiation therapy is also being improved with new tools that allow more precise treatment of small, localized, early stage tumors. Irving Kaplan, MD, Radiation Oncology, described one such tool, the CyberKnife, which delivers a pencil-width beam of radiation to treat tumors. Coupled with imaging tools, CyberKnife radiosurgery allows physicians to “aim before they shoot,” said Kaplan, thereby providing more precise treatment with fewer side effects.
Imaging tools are also allowing clinicians to provide more individualized treatment. Magnetic resonance imaging, said Neil Rofsky, MD, Director of MRI, can help clinicians diagnose prostate cancer earlier. For example, some patients have rising PSA levels, an indicator of prostate cancer, but negative biopsies. An MRI can pinpoint a small, localized tumor and direct a needle biopsy to help reduce false negatives.
Rofsky is also correlating imaging data with pathology results and gene expression profiles of tumor tissues. Such rich data can be used to identify new treatment targets as well as new diagnostic markers, he said.
Ultimately, these new therapies will each be applicable to some patients, and not to others. “Surgery, radiation, hormone therapy, and chemotherapy – each is effective, and each has its downsides,” said Sanda. “The question of which is best for which patient? There is not a blanket statement. It depends on the situation.”
