As we honor prostate cancer awareness month, what do you want to share with your patients and families?
We are excited that the treatment options for advanced prostate cancer continue to expand. In recent years we have three new therapies approved to treat metastatic treatment-resistant prostate cancer. We are now using imaging, such as the PSMA PET/CT scan, and genetic tests to guide the choice of treatment options for our patients. So, if you or your family member has a metastatic prostate cancer, please be sure to ask his doctor about the availability of genetics tests and PSMA PET/CT scan.
How do you collaborate with your colleagues in the prostate and urologic cancers program at Smilow Cancer Hospital to care for your patients?
Multiple disciplines are involved to best care for our patients with prostate cancer. I collaborate with urologists and radiation oncologists, who have focused interests in prostate cancer or other urological cancers at Smilow Cancer Hospital, not only to deliver the well thought-out care plan for each patient, but also to design clinical research to improve our understanding of the disease and to improve the outcomes for our patients.
I am collaborating with Dr. Isaac Kim, Chair of the Urology Department at Yale School of Medicine, on a clinical trial which is studying the role of prostate removal surgery (radical prostatectomy) in patients with newly diagnosed prostate cancer that has metastasized to distant organs. We want to see if a local therapy such as radical prostatectomy can improve the progression-free survival and overall survival.
What advances have made the biggest impact in the treatment of men with prostate cancer over the last 5 years?
The advances with the biggest impact in prostate cancer treatment in recent years include (a) the approval of PSMA-targeted radioligand therapy, Lutetium 177-PSMA for patients with PSMA-positive metastatic prostate cancer and (b) the approval of Poly-(ADP-ribose) polymerase inhibitors for patients with BRCA mutations and other DNA repair genes.
PSMA positivity is determined by PET imaging. ~90% of patients with metastatic prostate cancer are expected to have PSMA positive metastatic disease that can be demonstrated by PSMA PET scan. These patients are potentially eligible for this new therapy. The pivotal study showed that, compared with standard best supportive care, Lu177-PSMA improved the overall survival and reduce the risk of disease progression or death by about 60%.
PARP inhibitors, (e.g., olaparib and rucaparib) are for those with deleterious genetic alterations in DNA repair genes (e.g., BRCA2), which are seen in about ~20% of patients with metastatic prostate cancer. If you have a BRCA2 mutation, which is the most commonly seen DNA gene alteration in prostate cancer, the chance of response is nearly 90%.
What is your research currently focused on?
My current research focus on developing novel therapies for metastatic prostate cancer and biomarkers of treatment response. A previous clinical study that I led showed that combining olaparib, a PARP inhibitor, with cediranib, an anti-angiogenesis therapy, resulted in improved clinical activity compared to olaparib alone in patients with metastatic castration resistant prostate cancer. My current research focuses on identifying genetic signatures associated with the improved outcomes and responses to the combination therapy for our patients.
What is the outlook for new treatments for your patients in the next five years?
The outlook for new treatments for our patients in the next 5 years is bright. Many more treatment options are arising from the horizon. We are now using genetic tests and a PET imaging study to match and deliver right treatments to the right patients.
We also need to develop more effective and better tolerated treatments for our patients. We have several clinical trials available through Yale Cancer Center at Smilow Cancer Hospital for patients with various stages and phases of prostate cancer. In these trials, we are studying novel immunotherapy, hormonal therapy, novel chemotherapy, and others to improve the outcomes for our patients.