As men become more educated about screenings, and as the number of options for treatment increase, the words “you have prostate cancer” are becoming less and less of a death sentence. But up until very recently, the words “your cancer has metastasized” were as dire a pronouncement as there was.
Metastasis – the spread of cancer from its point of origin to other parts of your body – has always been difficult if not impossible to deal with, and all forms of metastatic prostate cancer have been deemed incurable. Now for the first time, however, research out of Memorial Sloan Kettering Cancer Center in New York City is providing some hope.
The FDA has recently approved six drugs for men with metastatic disease, all of which can increase survival. The new study indicates how the aggressive use of these drugs coupled with surgery and radiation can eliminate all detectable disease in certain patients with metastatic prostate cancer.
Twenty men with metastatic prostate cancer, five with extra-pelvic lymph nodal disease and 15 with bone with or without nodal disease, were treated in the study. After 20 months, one-fifth of the patients treated had no detectable disease, with normal blood testosterone and an undetectable prostate-specific-androgen (PSA).
The combined treatment regimen including surgery was well tolerated. Matthew J. O'Shaughnessy, MD, PhD, Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, explained, "While the role of local therapy in metastatic prostate cancer is still under investigation, aggressive resection of visible disease performed by experienced surgeons was critical to the outcome."
Fourteen out of the 15 patients with bone metastases reached an undetectable PSA when ADT, surgery, and radiation were used. Of the five patients with extra-pelvic lymph node involvement, four achieved an undetectable PSA after ADT and surgery, while the fifth needed radiation to hit that benchmark.
A second phase of the trial has been scheduled to further test the “multimodal” treatment.
The research has been published in Urology.