There has been much discussion about the timing of treatments now that we have new drugs available to treat advanced prostate cancer.

However, today’s technology does not allow us to know what the best sequencing of these drugs to maximize their efficacy would be, so we just punt along. We do not know whether or not we should use certain drugs before others and we do not know what impact one drug will have on the efficacy of another. The phase III trials we have conducted do not even attempt to answer these questions.

There are now the beginning of clinical trials to help us determine the optimum timing and sequencing of these new treatments, but what is often left out of the conversation is what drug would be the best fit for a man. Each of us has different goals, each of us has tumors that have responded differently and in some situations we have either personal preferences for or against certain types of treatments.

One of the more common personal preferences many men with advanced prostate cancer express is the goal to avoid or delay chemotherapy (with docetaxel). Others wish to avoid or delay the use of steroids because of a medical history of diabetes or osteoporosis.

So we need to move into personalized medicine that is both scientifically based (using clinical trial data) as well as personal preferences. We must always remember that there is never a situation where one size fits all.

Joel T. Nowak, M.A., M.S.W.