2018 Innovations – Prostate Cancer Treatment
Dr. Alex Shteynshlyuger is a board-certified urologist in NYC who specializes in treating men for prostate cancer.
Effective Treatment for Prostate Cancer Improves Prognosis and Survival of Men
Prostate cancer once spread beyond prostate has had few effective treatment options after failure of hormonal therapy. Metastatic prostate cancer meant a dire prognosis for men. New treatment options including Xtandi and Zytiga have shown benefit in late stages of prostate cancer.
Biggest Hope is Early Treatment
- Xtandi and Zytiga are “Super” hormonal therapies that are much more effective than traditional androgen deprivation therapy in blocking testosterone production. As a result, they are much more effective in situations where traditional ADT has no benefit.
- This suggests that it is very likely that Xtandi and Zytiga are even more effective in early metastatic prostate cancer and very advanced pre-metastatic disease. Currently, ADT is used when metastatic cancer is diagnosed. Yet the effectiveness of Xtandi and Zytiga in more aggressive disease is a magnitude higher than we ever experienced with ADT. In earlier disease, the effect is likely greater based on the biology of prostate cancer.
What does it mean?
We are experiencing the era of great innovation in treatment for prostate cancer. This has happened to other cancers (such as colon and breast cancer) but the prostate cancer field has been left behind until now. Looking at the biology of other cancers, such as colon cancer and kidney cancer, for example, we know that once we have an effective treatment for metastatic disease, a whole new world of treatment options emerges. For example, for advanced and metastatic colon cancer and kidney cancer, surgical removal offers improvement in survival, a major benefit.
Tradition vs Progress
Traditional teaching has been that once prostate cancer is beyond the prostate, surgery is not effective. Yet, the most rigorous studies have shown that surgery actually benefits men with more advanced prostate cancer the most and men with very low risk of prostate cancer may not benefit much.
With the new treatment options that are effective for metastatic prostate cancer, a new hope arises that for some men with metastatic or advanced disease surgery may offer an additional benefit. Additional studies would need to be performed to test this idea but the science is there. It is not a question if but a question of “when”.
When would we have the right medication cocktail that would be sufficiently effective to warrant surgical removal of the prostate in men with metastatic or very advanced prostate cancer? Is it Xtandi? Is it Zytiga? A combination of drugs such as Provenge and Xtandi? or one of the other drugs on the near horizon?
We see patients from all parts of New York City (Manhattan, Brooklyn, Queens, Bronx, Staten Island), Long Island, Westchester and New Jersey as well as other parts of the USA. We also see international patients from Canada, Japan, South America, Russia, Asia, Europe, Middle East, Africa, the Caribbean and other parts of the world.