5 things we now know about prostate cancer
From 1 in 20 000 to 1 in 7: How prostate cancer risk increases with age
After skin cancer, it’s the most common cancer diagnosed in men globally, and risk increases with age. In fact, age is the most important risk factor. For men under age 39, the risk is about one in 20 000. Between ages 40 and 59, that risk jumps to one in 45 men. For those ages 60 to 79, around one in seven will be diagnosed.
At the same time, the incidence of prostate cancer appears to be rising among younger men, though researchers don’t yet know why, says dr. Charles Drake, M.D., Ph.D., Vice President, Prostate Cancer and Cross Cancer Immuno-Oncology, Johnson & Johnson.
But not all prostate cancers behave the same. Some tumors are slow-growing; others are aggressive. In addition to tracking PSA to help determine how aggressive a tumor is, genetic testing can provide important clues. For example, mutations in BRCA1 and BRCA2 are associated with more aggressive disease and can influence treatment decisions, explains Dr. Drake.
When prostate cancer is diagnosed, doctors use biopsy results and imaging to determine where the cancer is located and whether it has spread. Stages 1 and 2 mean the cancer remains confined to the prostate. Stage 3 means it has grown beyond the prostate or into nearby tissues. Stage 4 is metastatic, meaning the cancer has spread to distant lymph nodes, bones or other organs.
Understanding the stage and grade (how aggressive the cancer appears) helps doctors determine when treatment is needed and which approach is most appropriate.
PSA screening can detect prostate cancer before symptoms appear
Like many cancers, early detection is one of the most important factors in prostate cancer outcomes. When the disease is diagnosed while it’s still localized to the prostate, it’s often curable. If it spreads to other parts of the body (metastatic prostate cancer), a cure is usually no longer possible.
The good news is that detecting prostate cancer in its earliest stages can be relatively straightforward, thanks to PSA testing.
Current guidelines suggest men discuss a baseline PSA test with their healthcare provider between ages 45 and 50, followed by regular screening every two to four years for most men 50 to 69 years of age. Some men may need to begin earlier. African men, for instance, tend to develop prostate cancer at younger ages, and the disease is often more aggressive than it is in other populations, says Dr. Drake.
While early-stage prostate cancer is typically asymptomatic, there can be warning signs:
- Urinary changes, including difficulty starting urination, weak or interrupted urine flow, pain or burning during urination; difficulty emptying the bladder; frequent urination (especially at night); or blood in the urine or semen
- Pain in the back, hips or pelvis that doesn’t go away
- Painful ejaculation
Dr. Drake also urges patients not to panic if a PSA result comes back elevated.
“There’s no low PSA level at which you can’t have cancer, and there’s really no high level at which you definitely have cancer,” he says.
Inflammation and benign prostatic hyperplasia (an enlarged prostate) can also cause PSA levels to rise. What matters most is the trend over time. In general, a stable PSA over many years is reassuring, underscoring the importance of regular monitoring.
How prostate cancer survival has improved—and why stage at diagnosis matters
In many ways, prostate cancer diagnosis and treatment is one of medicine’s biggest success stories.
Patient outcomes illustrate just how far prostate cancer care has advanced, though survival continues to vary substantially by stage at diagnosis.
Decades ago, a prostate cancer diagnosis carried a much higher risk of death than it does now. In the 1960s, for instance, 50% to 60% of men diagnosed with prostate cancer in Northern Europe died within five years. By 2016, the five-year relative survival had risen to almost 94% in Sweden and around 92% in Finland. This progress reflects earlier detection through PSA testing, advances in imaging technologies such as CT scans, MRI and bone scans and significant improvements in treatment options.
Although a sharp PSA decline can signal treatment response, it doesn’t indicate a cure; ongoing monitoring is still needed.
For patients whose cancer progresses despite ADT, chemotherapy is the standard of care.
There’s also a new treatment called radioligand therapy, which targets prostate-specific memory antigen (PSMA) on cancer cells and delivers radiation directly to the tumor. Another promising area: immunotherapy.
Several years ago, a class of medicines called T-cell engagers began showing potential in prostate cancer in early clinical studies. One part of the molecule binds to a tumor cell, while the other recruits and activates immune cells called T cells to attack the cancer.
Many men live for years with prostate cancer, but treatment can present daily challenges
As with any cancer diagnosis, the emotional impact on patients and their families can be immediate.
Many patients understandably equate cancer with an imminent death sentence, says Dr. Drake. “But then I’m able to say, ‘Listen, hormonal therapy works. Chances are you’re going to do well,’” he says. “And that’s an incredible relief.”
At the same time, treatment side effects—including fatigue, reduced libido, erectile dysfunction, loss of muscle mass, weight gain and hot flashes, as well as an increased risk of cardiovascular events - can affect quality of life and place strain on relationships.
While some effects cannot be fully reversed, others can be managed through lifestyle changes, says Dr. Drake. A healthy diet and strength training, for example, may help offset weight gain and muscle loss.
The future is focused on personalized prostate cancer care
Precision medicine is among the most promising areas of prostate cancer research.
One important advance is genetic testing, which can identify alterations that may influence treatment decisions, including mutations in homologous recombination repair (HRR) genes, such as BRCA1 and BRCA2.
Another potential treatment involves patients with metastatic disease who may be eligible for radioligand therapy targeting PSMA.
Researchers are also exploring new opportunities for precision medicine. One involves patients whose tumors have lost PTEN, a tumor suppressor gene associated with aggressive disease and treatment resistance.
Dr. Drake is equally optimistic about the future of combination therapies. He sees potential for immunotherapies to be paired with antibody-drug conjugates (ADCs), targeted medicines that link a tumor-seeking antibody to a potent cancer-fighting drug.
The hope is that combining ADCs, immunotherapy and hormone therapy will lead to even better outcomes. - Source: https://www.jnj.com/health-and-wellness
