A lot has been written about the need to identify better biomarkers to both assist in the initial diagnosis of prostate cancer and then to help determine which cancers are potentially dangerous from those that are actually indolent. Finding these markers is vital, I too have written about the great need for them.
However, in the middle of this conversation and the ensuing controversy about PSA screening that has resulted from our failure to develop adequate biomarkers, we have lost sight of the other very important concern, the lack of biomarkers for men with advanced prostate cancer. Honestly, the controversy over PSA screening has so over shadowed the prostate cancer debate, the concern about advanced disease has just melted away.
“There is a need for identification of accurate and simple-to-use prognostic factors for men with prostate cancer that has spread beyond the prostate, so that patients and their doctors can determine which treatment regimen makes the most sense for their situation,” said Andrew Armstrong, M.D., a medical oncologist at Duke and lead investigator on a study looking to identify these biomarkers. “Our study was aimed at developing accurate predictors which may be used to assist in clinical decision-making and also in planning clinical trials for men whose disease has stopped responding to hormone therapy.”
Dr. Armstrong’s study has identified four risk factors that help predict how long men may survive with metastatic prostate cancer. These risk factors could help doctors choose more effective treatments, including the timing of their use.
The researchers examined the records of more than a thousand men who participated in a study that eventually led to the FDA’s approval of the chemotherapeutic drug docetaxel (Taxotere). This study was completed in 2004. Dr. Armstrong’s study identified four independent risk factors that predicted whether a patient’s PSA levels — which indicate the presence or absence of cancer — went down in response to treatment, Armstrong said. The factors included the presence of significant cancer-related pain; anemia (low blood counts); the extent of cancer spread to other organs; and progression of cancer in bone.
“Using these predictors, we were able to assign patients to risk groups of good — indicating an average survival of about two years; intermediate — with survival of about 1.5 years — and poor, with survival of less than a year,” Armstrong said. “By knowing a patient’s prognosis and expected responses to chemotherapy, we are better able to discuss and determine whether a more or less aggressive treatment plan might be advisable.”
Researchers will present their findings on a poster at the 2009 American Society of Clinical Oncology meeting in Orlando, on Sunday, May 31. The study was funded by the Duke University Comprehensive Cancer Center.
I can only hope that this is a beginning of our trying to understand advanced prostate cancer. Without a better grasp of the disease, we will continue to treat men arbitrarily, not knowing what might help and how aggressively to treat.
We need to discuss what men should be treated, in other words, are there men who will not receive any survival benefit from treatment, but might have their quality of life further degraded without any upside? This is a tough conversation, but a vital one.
Joel T Nowak MA, MSW
My husband,John,was diagnosed with prostate cancer in March 2007. I’ll try to be summarize. He did external beam radiation and seed implants (May/July 07). His PSA was then of evaluated at 6, 9, 12, 15 months. It never decreased. They began to concede that the treatment did not work for him. They then suggested we have prostate removal surgery. They sent us to the City of Hope (the gold standard for treatment/surgery here in SoCal)for surgery consultation. During protocol review by their Tumor Board Review members of John’s case,they became suspicious of two tiny spots that were noted on his lower spine scans (they had always been there on previous scans) and said that they wanted John to have 3 months of hormone therapy to see if the spots would respond to treatment-“just to be on the safe side” The thinking being that if they changed that meant they were cancer, if not that they were probably arthritis or scaring or something else beside the cancer. After three months the PET scan revealed no changes and we were told to go back to the City of Hope of surgery – we were given the green light. City of hope scheduled his surgery and did a couple of pre-op tests to get things rolling – an EKG and chest xray. A few days later we get a call saying the surgery was being cancelled due to new developments regarding his chest xray. This is what the report says: Evidence of extensive bone metastases of the thoraic spine. This had nothing to do with the tiny other spots seen previously. So after we picked ourselves up off the floor and discussion with his local doctor, a biopsy was scheduled. The biopsy came back negative. Now the “tumor board” wants to review it all again. We can not understand why we can’t get a clear conclusion/diagnosis of whats happening. How did we get from OK its a go and clear bone scans to in less than a month to you’ve got extension bone metastases? Our dilemas and or questions are:
1) Why did his PSA respond so positively (6.2 to 1) on the three month hormone treatment, but apparently the cancer still spread “extensively” throughout his spine? AND he has had no pain?
2) His bone biopsy which included the marrow etc. came back negative for any cancer?
3) And all the PET/CT scans came back clear?
We are in shock. In a matter of a month we went from OK let’s get the prostate out to advanced bone metastases? The doctors are seem impatient with our questions and insensitive to our shock. In the meantime – since January when he had his last Lupron shot no additional treatments have been done. We have not gone to any support groups, forums, or anything. We’ve totally just relied on the doctors to guide us which I now feel was a big mistake. I don’t even know if this is what I’m suppose to do at this kind of site. So, I apologize in advance if you are now scratching your head wondering why I’m writing to you or this site. And the truth is, I don’t know. I guess I just don’t know where else to start.
I am sorry that you and your husband have had this type of experience. I do admit, your story is among the more difficult I have heard.
Yes, I am glad you wrote this comment, the reason for this site is simply to help and educate people about advanced prostate cancer.
I would offer the following suggestions to you:
1- join my advanced prostate cancer internet group at: http://health.groups.yahoo.com/group/advancedprostatecancer/ You will have to get a yahoo email address, but it is free. Then post your story (you can just cut and paste this comment) to the group. We have over 380 current members, most who have advanced prostate cancer or are family, spouses and partners of men who have the disease. They have a wealth of information and experience.
2- Move your primary prostate cancer medical care to a medical oncologist who specializes in treating advanced pc. This is a very important step.
After you post to the group we can spend time trying to help you understand what is happening and help you to decide on your next steps.