I am a medical oncologist and clinical researcher – I spend half my time treating men with prostate cancer and the other half searching for better treatments so that more men can be cured.
I am excited to say that I continue to see the signs of major progress towards our goal of curing all men with prostate cancer. We have made unprecedented strides in understanding the genes that cause prostate cancer. We now have more powerful and better tolerated medicines, surgical techniques, and radiation modalities.
One of the most exciting recent stories revolves around prostate specific antigen (PSA) testing and a medicine called abiraterone. The story ends with an amazing development – high-risk aggressive prostate cancer, when caught early with PSA testing, has an excellent new treatment option!
Let’s start in the late 1980’s, when a blood test called PSA changed the landscape of medicine. Before PSA testing, prostate cancer was almost always diagnosed too late to be cured. With the advent of PSA testing, prostate cancer is typically diagnosed early enough to be cured. But not all prostate cancer can be cured even when caught early. This is because there are different types of prostate cancers. They can be divided into low risk, intermediate risk, and high risk. The high-risk prostate cancers, even if diagnosed early, are often not curable. This is where abiraterone is changing things.
Abiraterone: A Game-Changing Prostate Cancer Medicine
Abiraterone is a medicine that starves the cancer by reducing the supply of testosterone. It was first proven in a 2011 clinical trial to extend the lives of men with prostate cancer that had already spread (i.e., metastatic or stage IV prostate cancer). To try to enhance the effect of abiraterone, clinical researchers tested it in earlier stages of the disease with the hope that treating more aggressively at an earlier stage would be more effective.
What they found was astonishing. Adding abiraterone to the standard treatment for early-stage high-risk prostate cancer (radiation therapy and two years of testosterone lowering), profoundly reduced the risk that the cancer will relapse, by more than 70%. Further analysis is needed to be sure that the men treated with abiraterone truly live longer and are more likely to be cured.
Abiraterone is very expensive and cost continues to be a barrier preventing patients from gaining access to this treatment. Nevertheless, there is good reason to be optimistic, and men with early-stage high-risk prostate cancer should have a conversation with their treating physician about abiraterone. Of course, this assumes the cancer is caught early, easily done through PSA-based screening.
Take Control of Your Health
The bottom line: discuss PSA testing with your urologist. It is not for everyone – especially men older than 70 or with serious life-threatening conditions. Your health is in your hands. Prostate cancer, when found early, is curable, and with the help of abiraterone, we may be moving to an era where we are able to cure most high-risk prostate cancer.