Dr. Sebastien Hotte
Oncologist, Juravinski Cancer Centre
Dr. Stanley Flax
Urologist, North York General Hospital
Dr. Thierry Lebeau
Chief of Urology,
CIUSSS de l’Est-del’Ïle-
President & CEO, PROCURE
Advances in prostate cancer treatment have burgeoned in the past decade, giving new hope to patients and their loved ones. Today, a prostate cancer diagnosis is bad news, but it’s not always bleak. Thanks to new treatment options, patients can expect to continue enjoying their active lives for longer than before, even during treatment.
New research and recent advances
“It has been a busy 10 years,” says Dr. Sebastien Hotte, a medical oncologist at the Juravinski Cancer Centre. “There are a lot more prostate cancer treatment options than there used to be.”
Prostate cancer patients’ treatment route depends on the state of their disease. Some prostate cancer is localized or non-metastatic, meaning it hasn’t spread beyond the prostate. Prostate cancer can sometimes be slow-growing and the decision to treat, and with which method, should be discussed with their doctor.
“Generally if patients require treatment, the two conventional modes are surgery or radiation,” says Dr. Stanley Flax, a urologist at North York General Hospital. “Now, numerous new modalities are being developed.” Dr. Flax notes that the trend is toward more targeted focal therapies, such as high-intensity focused ultrasound and cryoablation, which could potentially reduce the risk of incontinence or erectile dysfunction in some patients.
The more traditional treatments have also seen promising advances. “Surgically, we’ve developed more robot-assisted surgery,” says Dr. Thierry Lebeau, Chief of Urology at CIUSSS de l’Est-de-l’Ïle-de-Montréal. “We’ve also seen improvements in radiation therapy, with more focused treatments.”
Thanks to new treatment options, the life expectancy of prostate cancer patients has increased dramatically, and patients can expect to continue enjoying their active lives, even during treatment.
Delaying time to metastasize with new treatments
Prostate cancer can grow and spread (metastasize) to other parts of the body, including the lymph nodes or bones. Castration-sensitive prostate cancer still responds to medical or surgical treatments that lower testosterone, whereas castration-resistant prostate cancer no longer responds to these treatments. Triple therapy for metastatic Castrate-Sensitive Prostate Cancer (mCSPC) is a promising new development affording patients prolonged survival. Non-metastatic Castrate-Resistant Prostate Cancer (nmCRPC) is a type of prostate cancer that hasn’t spread to other parts of the body but is no longer responding to testosterone-lowering therapies. nmCRPC has traditionally been difficult to treat, but early treatment and new treatment options, including next-generation testosterone-lowering therapies, are extending patients’ lives. “This has been a huge advance,” says Dr. Flax.
Dr. Hotte notes that new hormonal therapies are making a big difference for nmCRPC patients’ quality of life and delaying the time their cancer takes to overtly metastasize.
The importance of collaborative decision-making
Making the decision of which treatment to pursue is often a joint decision-making process between men, their loved ones, and their health care practitioners. While treatment recommendations depend on medical diagnostics, individual factors also come into play. Men’s varying wishes, values, and preferences about quality of life and maintaining their activity levels make reviewing the different treatment options and their side effects essential.
“Although we can recommend preferred options, it’s not us who will be taking the treatment,” says Dr. Hotte. “It’s important to get a good sense of the patient. With prostate cancer, we have the advantage of having a few choices for these men.”
“Since prostate cancer isn’t often a very aggressive disease, we have time to discuss the different options and to give patients information,” says Dr. Lebeau. “I direct my patients to good sources of information, like the PROCURE website.”
Support along the patient journey
PROCURE is a charitable organization that educates and supports people affected by prostate cancer. Laurent Proulx, PROCURE’s President and CEO, had prostate cancer himself and discovered that men didn’t want to talk about it. As a result, he was motivated to get involved with PROCURE.
“We have over 100,000 visitors on our website each month,” he says. “We’re going beyond the boundaries of Canada, helping patients and caregivers all around the world.”
PROCURE offers webinars, help phone and chat lines, and well-referenced resources. It also helps connect men with prostate cancer with others who have gone through a similar patient journey — something that’s invaluable when it comes to support and decision-making. “It’s good for patients to speak to one another,” says Dr. Lebeau. “PROCURE has events where men can meet and they tend to speak freely about their experiences. That’s mostly where I orient my patients.”
A promising outlook
Canada’s researchers and health care practitioners — along with the valued patients who participate in clinical trials — are working diligently with industry partners and academic cooperative groups like the Canadian Cancer Trial Groups (CCTG) to bring the newest treatments and technologies to Canadian patients.
“Most of my research involves looking into new therapies,” says Dr. Hotte. As a surgeon, Dr. Flax focuses on developing new biopsy techniques, while Dr. Lebeau is involved in clinical research on surgical outcomes. “It’s a very active research field in which things are always changing for the better,” Dr. Hotte says.
Patients can also play an active role in their care. Monitoring prostate-specific antigen (PSA) and understanding the role of PSA doubling time can be helpful. Patients should speak with their health care professional to learn more.
Thanks to new advances, patients with advanced prostate cancer can expect to live longer and with a better quality of life than before. They have many new treatment options, giving patients more choice and the opportunity to continue doing the things they enjoy.
Addressing the Top Questions Men with Prostate Cancer Ask
Men diagnosed with prostate cancer face many challenges. Here are some of their most frequently asked questions.
What are the signs and symptoms of prostate cancer?
Common signs and symptoms of prostate cancer include urinary problems, blood in the urine or semen, erectile dysfunction, and weakness or numbness in the legs or feet. However, these signs and symptoms can all be indicative of other problems as well, so getting tested for prostate cancer is essential, especially for men over the age of 50. Not all men with prostate cancer will experience signs or symptoms and should discuss prostate cancer screening with their physician.
What are the treatment options available for prostate cancer?
Depending on the type and progression of the disease, a variety of treatment options are available. These include procedures like surgery, high-intensity focused ultrasound, and radiation, as well as prescription medicine given as a pill or intravenously. Patients should speak to their doctor for the best treatment options available for them.
What are the side effects of treatment?
Side effects vary depending on the treatment route, but may include urinary or sexual problems, fatigue, bone loss which may lead to fractures, cognitive or memory impairment, and rashes. New treatment advances can reduce major side effects and allow prostate cancer patients on treatment to maintain an excellent quality of life.
Are there any holistic treatment options I can explore?
Clinical trials have shown that vigorous exercise on a regular basis has a number of positive effects on men with prostate cancer. Eating a well-balanced diet and addressing emotional needs may also be beneficial.
What is PSA, and what does this marker mean?
Prostate-specific antigen (PSA) is a protein made by the prostate gland and found in the blood. PSA blood levels may be higher than normal in men who have prostate cancer, benign prostatic hyperplasia (BPH), or infection or inflammation of the prostate gland. PSA is often a good marker of prostate cancer disease burden. Talk to your doctor to learn more about tracking your PSA levels.
Where can I go for support?
Friends and family are often great supports to lean on, and patient associations like PROCURE (procure.ca and 1 855 899-2873) are also excellent options.
This article was brought to you by one of Canada’s leading research-based pharmaceutical companies.