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New Treatments for ‘Quiet Disease’ Prostate Cancer

Image of New Treatments for ‘Quiet Disease’ Prostate Cancer. "Testing for prostate cancer is important because it’s a disease which is treatable and curable if it's detected at an early stage, and it's localized to the prostate," said Dr. Gregory Chesnut, a urologic oncologist and associate professor of surgery at the Uniformed Services University of the Health Sciences. "Our intention is for curative treatment, and we have excellent outcomes."

Prostate cancer is one of the most common cancers in men, with the National Cancer Institute estimating over 280,000 diagnoses in 2023. However, promising new treatments and updated testing guidelines are leading to better patient outcomes.

"Prostate cancer accounts for nearly 27% of all new cancer diagnoses and more than 10% of cancer deaths in men," said Dr. Gregory Chesnut, a urologic oncologist and associate professor of surgery at the Uniformed Services University of the Health Sciences. “It’s a very real disease.”

New Treatments Approved by the U.S Food and Drug Administration

According to Chesnut, two recent advances in prostate cancer treatment may lead to improved outcomes for patients. One is a method for more precise detection of cancer cells outside the prostate, using an imaging test for prostate-specific membrane antigen protein.

"It was approved by the U.S. Food and Drug Administration to find recurrent or metastatic prostate cancer, or to guide primary treatment in certain high-risk prostate cancers," said Chesnut. "It’s now offered widely throughout the United States."

The second new advancement is in radiologic treatment of prostate cancer that is metastatic, which means cancer cells can spread to other parts of the body. A medicine that uses a small amount of radioactivity to kill cancer cells was approved by the FDA in March 2022, according to Dr. Kevin Banks, a radiologist and nuclear medicine physician at the San Antonio Military Medical Center.

"It travels through the blood stream, seeking out prostate cells wherever they are in the body," said Banks. "It binds to the prostate-specific membrane antigen protein on the prostate cancer cell surface and delivers a microscopic amount of radiation. The specific type of radiation given generally travels less than one millimeter, and no more than a maximum of two millimeters, allowing it to kill the cancer cells while leaving surrounding healthy tissue unharmed."

Prostate Cancer Survival Rate Higher for Military Health System Beneficiaries

In addition to new treatments, a study from USUHS offers good news for men being treated for prostate cancer within the MHS. The study found the five-year survival rate for late-stage prostate cancer is higher for MHS beneficiaries than for the general public.

"Ultimately, all men, whether you had high-risk or high-stage prostate cancer did better across all age groups and across all ethnicities within the MHS," said Chesnut.

"The disease rates were the same whether they were treated inside or outside of the MHS, but the outcomes were better. I think that's a recognition of what we do well in the military," said Chesnut. "We screen patients well, we have access to primary care for appropriate screening and counseling, and access to specialty care. Patients have access to urology care, to medical oncology care, to radiation oncology care. It’s often all in the same building."

Banks thinks there could even be better results to come.

"The results are certainly positive and show the quality of care being provided by the Defense Health Agency," he said. "The data would have been from before [the medicine] entered use in the MHS, so hopefully any follow-up research would show an even better five-year survival rate for our beneficiaries."

Changes in Testing Guidelines

Chesnut said changes to prostate cancer screening guidelines, and a new understanding of how to treat prostate cancer in early stages, is also helping patients.

"Testing for prostate cancer is important because it’s a disease which is treatable and curable if detected at an early stage, and it's localized to the prostate," said Chesnut. "Our intention is for curative treatment, and we have excellent outcomes."

However, Chesnut said prostate-specific antigen tests, the primary prostate cancer screening test, were not being recommended from 2012 through 2018.

"For patients and doctors, when there’s a prostate cancer diagnosis, the instinct is, we need to go to general quarters and we need to treat this," said Chesnut. "Prior to 2012, patients were sometimes being treated when they didn’t need treatment. Now we know better. You don't have to treat every prostate cancer. We serve our patients best when we diagnose prostate cancer in a timely manner, when we correctly identify which cancers need immediate treatment and which can safely undergo surveillance. Personalized treatment decisions and use of emerging technologies for the individualized treatment plan is best for each patient."

The U.S. Preventive Services Task Force now recommends men ages 55 to 69 make individual decisions about screening for prostate cancer after discussing the benefits and harms with their doctor.

Chesnut recommends prostate cancer screening be a routine part of men's health conversations like mammograms are for women. "It’s easy for us to talk past prostate cancer, because it's not going to get the big headlines. It’s a sort of a quiet disease."

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Last Updated: August 22, 2023
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