Prostate cancer touches all of our lives at some point. Most of us know someone who has had or has even died of it. And although most cases of prostate cancer do not kill the patient, it is still the No. 2 cause of cancer death among American men — second only to lung cancer.
If we catch it early, while the cancer is still contained within the prostate, the cancer is curable. However, once the cancer becomes metastatic (leaves the prostate and spreads to other parts of the body), we no longer have a way to cure it.
Although we don’t yet have a cure for advanced prostate cancer, certain treatments slow it down and help the patient enjoy several more months, and sometimes years, of good-quality life before they succumb. Fortunately, researchers have developed several new promising treatments.
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Advanced prostate cancer proved a fertile test bed for developing a new type of immunotherapy, which is customized to the individual patient. Immunotherapy manipulates the body’s own natural defenses against disease and stimulates the immune system to focus more attention on the cancer.
Provenge (sipuluecel-T) involves an innovative process that trains a patient’s body to fight prostate cancer. First, blood is taken from the patient and the white blood cells that fight disease are mixed in a test tube with prostate cancer cells. This stimulates the cells to recognize and fight the cancer cells, much like turning a hound dog on to the scent of its prey.
Next, these white blood cells are allowed to divide again and again, and the colonies of the cells multiply until quite a clone army of prostate cancer-loathing white blood cells develops. These cells are then replaced into the patient’s circulatory system to flow through the body and seek out and attack the cancer cells. On average, this helps extend the patient’s life for about four months. Some patients’ lives aren’t extended at all. And some patients’ lives are extended for more than a year.
Once cancer leaves the prostate, it almost always goes to the skeleton. For some reason, bone offers the most fertile ground for metastatic prostate cancer to take root. The cancer consumes the skeleton, causing pain and broken bones. Sometimes this is the first actual symptom a patient feels from prostate cancer. Researchers used this avenue to develop a new treatment for advanced prostate cancer.
As the cancer eats away at the patient’s bones, the body tries to patch up those bones with calcium. Radium 223 (Xofigo) is a radioactive element that resembles calcium. Doctors inject this into the patient’s bloodstream and, like a heat-seeking missile, the radium 223 finds the exact areas where the cancer erodes the skeleton.
The body incorporates this radioactive element into the parts of the bones being destroyed. Then the radiation given off by the molecule damages the DNA of the cancer, which prevents the cancer cells from dividing and growing. This therapy adds, on average, about three more months of quality life to a patient with advanced metastatic prostate cancer.
The male hormone testosterone stimulates advanced prostate cancer to grow. For years the mainstay treatment for metastatic prostate cancer has been the suppression of testosterone production in the testicles. Physical castration or chemical castration with hormone shots markedly decreases the patient’s testosterone levels and can often slow the cancer for years. But the adrenal glands also make a small amount of testosterone and sometimes this is enough to stimulate the cancer’s growth.
Scientists developed a new daily pill called abiraterone (Zytiga) that inhibits testosterone production at an earlier more basic step in the process, and this suppresses testosterone production from both the testicles and the adrenal glands. This extends lives an extra four months on average.
Although these treatments are not a cure, they represent real progress in treatment and help pave the path toward a cure. The testing of these medications was done on patients with very advanced disease. When these therapies are employed earlier in the disease process, the patient benefits even more.
Many local hospitals and clinics in Idaho have these treatments available. Consult with your health care provider about the best treatment for you.
Dr. Jared G. Heiner is a board-certified urologist who has practiced adult urology in the Treasure Valley since 2006. He is now with Idaho Urologic Institute in Meridian. Heiner has a special interest in treating prostate disease and prostate cancer. He earned his bachelor’s in music from BYU and attended medical school at the University of California, San Diego. Heiner completed his internship and urology residency training at the Medical College of Georgia in Augusta, Ga.
Learn more about the prostate and prostate cancer
The prostate is a small gland that is part of the male productive system. Generally about the size of a walnut, the prostate sits below the bladder and in front of the rectum, according to WebMD.com. The prostate helps make some of the fluid in semen, which carries sperm from the testicles during ejaculation.
About one in seven men will be diagnosed with prostate cancer during his lifetime. Ask your doctor for guidelines about testing.
More men’s health news: Thinking about a vasectomy?
March is a popular month for vasectomies as many men schedule their procedure and recovery to coincide with the NCAA college basketball tournament, and some health providers offer special programs during the month. The Idaho Urologic Institute, for instance, soon will be holding its annual “Vas Madness” campaign. Vasectomy patients will receive a survival-kit gift bag with gift cards to restaurants, tickets to the Boise Hawks and other fun items. Check with your health provider for more information about the vasectomy options available in the Treasure Valley or contact Idaho Urologic Institute directly at 639-4900 or idurology.com.
Vasectomy is a surgical procedure for male sterilization or permanent contraception. Vasectomy is done in a clinic setting under local anesthesia. It generally costs less than a tubal ligation (female sterilization), which involves general anesthetic and a longer recovery period. Discomfort is usually minimal and recovery is normally a few days of rest. Most men are able to return to their normal routine after the two-to-three day recovery period with the only restriction being no heavy lifting for seven to 10 days.
Contemplating a vasectomy? Read an article online by Dr. Todd Waldmann, a Treasure Valley urologist, to learn more about the procedure and what you need to know. You’ll find the article online at IdahoStatesman.com/living/health-fitness. You can also visit the Urology Care Foundation at urologyhealth.org/urologic-conditions/vasectomy and webmd.com/sex/birth-control/vasectomy-14387 for more information.