Management of Advanced Prostate Cancer Undergoing Major Shift

As of June 2011, the management of advanced prostate cancer was undergoing significant changes due to the introduction of multiple new therapies, making treatment more complex but also offering new hope for patients. At the Society of Urologic Oncology Annual Meeting, experts discussed the evolution of treatment paradigms, including the layering of therapies, which could lead to advanced prostate cancer becoming a chronic disease. The recently approved immunotherapy sipuleucel-T (Provenge) and investigational treatments such as the vaccine PSA-TRICOM (Prostvac), the monoclonal antibody denosumab, MDV-3100, and abiraterone were highlighted as examples of these new therapies. Provenge, costing over $90,000 for three doses, was noted for its overall survival benefit of about 4.1 months, despite the inability to predict who will respond to the treatment. Denosumab was reported to delay skeletal-related events in patients with bone metastases and had the advantage of not affecting the kidneys. Additionally, cost-effectiveness studies on finasteride as chemoprevention for prostate cancer suggested optimal results when started at age 65 until age 80. Lastly, a study indicated that while obese men are less likely to have an abnormal digital rectal examination (DRE), an abnormal DRE in obese men is a stronger predictor of prostate cancer than in non-obese men.