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The research arena for advanced prostate cancer has really been exciting over the past two
years. Two new oral drugs have been approved by the FDA, Zytiga for metastatic castrate-resistant
prostate cancer prior to chemotherapy and Xtandi for metastatic castrate-resistant prostate
cancer after chemotherapy. Both of these drugs are what are considered second line hormone
therapies. The first line of hormone therapy is typically an LHRH agonist called Lupron
and what that does is it shuts down all the testicular production of testosterone and
we know that most prostate cancers early on are very sensitive to testosterone and if
we lower a man's testosterone level, those cancers will go into remission or lie dormant,
but typically for a finite period of time. Eventually, these cancers become smart and
will learn how to use less testosterone or manufacture the testosterone themselves or
increase the testosterone receptors on their surface. These newer drugs Zytiga and Xtandi
work differently to lower the testosterone levels down or lock the receptors where these
testosterone molecules will bind. These drugs in large scale phase III clinical trials have
shown significant improvement in overall survival in men with advanced metastatic prostate cancer
that is castrate-resistant.
Some prostate cancers are high risk, aggressive, and more likely to spread. Others are low
risk, least likely to have bad outcomes. The biopsy says cancer, but correct diagnostic
tools provide limited information about how aggressive a man's individual disease is,
so most men decide to treat prostate cancer immediately. Once treated, many men experience
serious long term side effects, like incontinence and *** impotence. Immediate treatment
is not always needed, but right now a man cannot be sure if his cancer is the kind that
is likely to require treatment or if he is okay to wait for now. What if there was a
test that could determine how aggressive prostate cancer is? Genomic Health is developing a
new test to do just that. By reviewing the underlying biology of the tumor and using
genes for multiple biologic pathways, the test can predict the aggressiveness of prostate
cancer when diagnosed, allowing a man to make a more informed treatment decision with confidence,
taking care of himself with more information, and greater peace of mind.