Tip:
Highlight text to annotate it
X
Farshid Dayyani, MD: In certain circumstances, chemotherapy might be appropriate to treat
prostate cancer.
Conventional chemotherapy has been tested for decades in the treatment of early stage
and advanced stage prostate cancer. So far, we don't have any evidence that using chemotherapy
earlier in the disease, meaning before the cancer has spread, will change anything in
the patient outcomes meaning they don't live longer. Therefore, the majority of the use
of conventional chemotherapy in prostate cancer has been in the advanced setting when the
cancer does not respond to hormone deprivation anymore. This so called castration resistant
state was very difficult to treat until about 2004. As a matter of fact, the only FDA approved
chemotherapeutic drug until then was mitoxantrone which did not prolong the patient's life,
but improved the pain level of the patient and that's how it was approved. In 2004, we
had two large randomized trials showing us an effect on overall survival with a drug
called docetaxel which improved by about three to four months the survival of the patients,
so this was our main treatment for patients with advanced prostate cancer over the past
decade. More recently, a second drug cabazitaxel which is related to docetaxel was approved
for patients whose cancer does not respond to docetaxel anymore. Again in this setting,
the patients who received cabazitaxel lived longer than those who received placebo. Now,
we have more and more drugs coming in that are not traditionally regarded as chemotherapeutic
drugs. They are more biologic drugs that affect testosterone signaling in the prostate cancer
cells and are highly effective, so in 2013 we tended to use chemotherapy drugs later
and later in the disease course given the better tolerability of the newer drugs.
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 current 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 can't 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 from 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.