Prostate cancer treatment needs to be tailored

Study Calls for a Tailored Approach to Prostate Cancer Screenings in Black Men

Prostate cancer treatment needs to be tailored

A recent study found that, due to higher incidence of prostate cancer in black man, PSA testing may need to be started earlier in this population, and be done more frequently.

BY Katie Kosko

PUBLISHED May 02, 2017

A “one size fits all” approach to prostate-specific antigen (PSA) screening for prostate cancer may not be the right way to go about it, according to a new study published online in CANCER, which suggests that policies may need to be tailored to high-risk black men.

The American Cancer Society states that among black men in the United States, the incidence of prostate cancer is 60 percent higher than that of white men, and they are also more than twice as ly to die from the disease.

A team of researchers from the Fred Hutchinson Cancer Research Center in Seattle, the University of Michigan in Ann Arbor and Erasmus University in the Netherlands examined the reason why this disparity occurs by using three models of prostate cancer incidence and PSA screening in the U.S. to estimate disease onset and progression. The data was taken from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute from 1975 to 2000.

The researchers noted that by age 85 an estimated 30 to 43 percent of black men develop preclinical — asymptomatic — prostate cancer, making them 28 to 56 percent more ly to develop preclinical disease than men of any other race.

“We found that the interval from getting preclinical cancer to being diagnosed is long — 10 years or more on average — and is similar in black and white men,” Ruth Etzioni, Ph.D., Fred Hutchinson Cancer Research Center, said in a statement.

“But during that interval, cancers in black men tend to progress faster.

What this means is that in developing screening policies for black men, it will be important to consider beginning screening them at an earlier age and potentially screening them more frequently than would be recommended by general population guidelines.”

The study found that among men with preclinical disease, black men have a similar risk of being diagnosed with prostate cancer (35 percent to 49 percent) compared with the general population (32 percent to 44 percent) in the absence of screening. Their risk of progression to advanced disease by the time they’re diagnosed is 44 percent to 75 percent higher than in the general population, with a 12 to 13 percent risk in black men versus a 7 to 9 percent risk in the general population.

Etzioni and her colleagues suggest that black men should have their baseline PSA tested at least three and up to nine years earlier than men in the general population.

In addition, Etzioni stressed that additional research is needed to determine the best policies for prostate cancer screening in black men. The authors also noted that this may be a time to start focusing on more personalized approaches to screening in high-risk black men.

Last month, the United State Preventative Services Task Force drafted new guidelines for PSA screening, now recommending that men aged 55 to 69, talk with their physician about screening, and then decide on the best course of action together.


Tailor Prostate Cancer Tx by Adverse Effects Profile

Prostate cancer treatment needs to be tailored

Each treatment for localized prostate cancer has its own distinct adverse effects profile, and physicians need to consider the comparative harms of each strategy when deciding which course is best suited for individual patients. This is the message from two separate studies and an accompanying editorial, all published online March 21 in the Journal of the American Medical Association.

“To date, men with clinically localized prostate cancer have never been better informed about the trade-off they have to make between oncological outcomes and now clearly defined potential adverse effects of available treatments,” Freddie Hamdy, MD, University of Oxford, United Kingdom, writes in the editorial.

“These new studies provide a useful addition to the evidence, which will help physicians and patients to make difficult decisions about the management of this ubiquitous disease,” he adds.

In the larger of the two studies, Daniel Barocas, MD, MPH, Vanderbilt University Medical Center, Nashville, Tennessee, and multicenter colleagues report outcomes among 2550 men with intermediate- or high-risk disease who underwent either radical prostatectomy, external-beam radiation therapy (EBRT), or active surveillance. The patients were followed for 3 years.

Surgery had the greatest adverse effects on sexual performance, they report.

“At 3 years, the adjusted mean sexual domain score for radical prostatectomy decreased more than for EBRT,” the investigators report. The mean difference in scores between the patients who underwent surgery and those who underwent radiation therapy was -11.9 points; the mean difference was -16.2 points between those who underwent surgery and those who were under active surveillance.

In contrast, decline in the same sexual domain scores for men undergoing EBRT and those under active surveillance was not clinically relevant, at a difference of -4.3 points, they add.

Surgery was also more ly to cause urinary incontinence than either EBRT or active surveillance, especially in men who did not have urinary incontinence at baseline, the investigators note.

More men, at 14%, were also ly to report having either moderate or big problems with urinary leakage compared with the 5% to 6% of men in the other two treatment arms.

On the other hand, urinary irritative symptoms improved following surgery, whereas those symptoms showed little or no improvement in patients who received radiation or who were under active surveillance.

“Decline in bowel domain score was not common,” the study authors continue.

At 6 months, mean scores in bowel domains were significantly worse among men treated with EBRT than in the other two groups, but at 12 months, there was little difference between the three groups.

Only the radiation group showed decrements in hormonal function, but these patients had all received androgen deprivation therapy, so this was expected.

Health-related quality-of-life scores were not significantly different between the three treatment groups at study endpoint, investigators add.

“These findings may facilitate counselling regarding the comparative harms of contemporary treatments for prostate cancer,” researchers conclude.

Second Study

In the second study, Ronald Chen, MD, MPH, University of North Carolina at Chapel Hill, and multicenter colleagues followed 1141 men with newly diagnosed prostate cancer who were treated with radical prostatectomy, EBRT, brachytherapy, or active surveillance.

Scores for sexual, urinary, and bowel function at 24 months were all propensity-weighted, and the patients were stratified for baseline levels of function.

“At 3 and 12 months but not 24 months, patients who received external beam radiotherapy and brachytherapy had increased sexual dysfunction compared with active surveillance,” the study authors observe.

However, sexual function was more ly to deteriorate after surgery; more than half of the patients (57%) who had normal sexual function at baseline reported poor sexual function 24 months after undergoing prostatectomy.

This compares with 27.2% of the men treated with EBRT, 34.2% for those who received brachytherapy, and 25.2% for those who were under active surveillance. (Among those assigned to active surveillance, almost 19% received some form of treatment within 24 months.)

Only about 20% of the men who received brachytherapy and who had no obstructive or irritative urinary symptoms at baseline still had no symptoms 24 months after brachytherapy.

This was much lower than approximately half of men who underwent either surgery or radiation therapy and who reported no obstructive or irritative symptoms 24 months after treatment.

Only about a third of the men who had no problems with urinary incontinence prior to surgery still had good urinary control 2 years later.

This was again much lower than the proportion of men who retained good urinary control 24 months after EBRT (73%) and brachytherapy (65%).

Close to 43% of the men who had normal bowel function prior to radiation therapy maintained good bowel function at 2 years, as did some 47% of the men who underwent brachytherapy and 57% of the men who underwent either prostatectomy or active surveillance.

“Physicians can use these data to provide more individualized counselling of their patients regarding expected outcomes of patients with similar levels of baseline function,” the study authors reiterate.

Overall Outcomes

The findings from these two studies generally agree with each other, Dr Hamdy comments in the editorial.

Despite the fact that men involved in the current studies received more contemporary treatment options, he notes that the findings were “remarkably consistent” with those from the landmark ProtecT (Prostate Testing for Cancer and Treatment) study, which was published last year. Dr Hamdy was the principal investigator of that study.

The consistency of findings across all three studies shows “that all options carry risk of adverse effects that affect quality of life,” Dr Hamdy comments.

Given the fact that all treatments for prostate cancer have some adverse effects, Dr Hamdy suggests a way in which physicians can best use this information to help patients come to a decision regarding their treatment.

“First, each man can take time to assess carefully with his treating physician the risk of receiving treatment or active surveillance taking into account the tumor risk category and his general health,” Dr Hamdy advises.

Second, physicians need to review the main adverse effects that men might expect once they choose any one of the treatment options, at least in the short term: sexual function and urinary incontinence are worse after surgery and may persist over time; bowel problems are typically worse after radiation; and sexual dysfunction can be expected with androgen deprivation therapy.

Lastly, physicians need to remind men that even if they choose active surveillance and avoid adverse events initially, “there is a natural decline in urinary and sexual function symptoms over time,” Dr Hamdy points out, “and the adverse effects of radical treatments will be experienced when those treatments are received.”

How to “ProtecT” Men From Harm

In a separate opinion piece on findings from the ProtecT trial, Daniel Spratt, MD, University of Michigan, in Ann Arbor, argues that the “most powerful message” from ProtecT is how physicians can protect men from the adverse effects of radical therapy without jeopardizing oncologic outcomes.

The conclusion to be drawn from the ProtecT study, as expressed in the accompanying editorial, was that the higher risk for metastases seen in the active surveillance arm of the study supports the use of active surveillance only in patients with a relatively short life expectancy.

“Rather than concluding that radical therapy is the best choice, I would argue that the logical answer would be to select the appropriate patients for active surveillance and to optimize active surveillance strategies to avoid the small (approximately 3.5%) absolute increased risk of distant metastasis seen in ProtecT,” Dr Spratt writes.

“Optimizing active surveillance will help to avoid or delay the often permanent adverse effects from radical treatment,” he reaffirms.

Dr Hamdy and Dr Barocas have disclosed no relevant financial relationships. Dr Chen has received grants and personal fees from Accuray and personal fees from Astellas and Medivation. Dr Spratt has served on an advisory board for Dendreon.

JAMA. Published online March 21, 2017. Study 1, Abstract; Study 2, Abstract; Editorial

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Epidemic of overtreatment of prostate cancer must stop

Prostate cancer treatment needs to be tailored

  • Dr. Otis Brawley says many men with prostate cancer get unnecessary treatment
  • In some cases, Brawley says, these treatments are known to be worthless and even harmful
  • Americans must learn that some cancers don't need their attention, he writes

Prostate cancer is a significant disease in the U.S. In 2014 alone, the American Cancer Society estimates, 233,000 men will be diagnosed and 29,480 will die of it.

This week, two important studies showing how prostate cancer is treated in the U.S. were published in the journal JAMA Internal Medicine.

The findings should cause those of us who treat prostate cancer and the organizations that advocate for prostate cancer awareness to take notice. These studies found that a large number of American men with prostate cancer get unnecessary and aggressive treatment. In some cases, these treatments are known to be worthless and even harmful.

One study more than 20 years long and involving more than 60,000 men diagnosed with cancer confined to the prostate found that initial treatment with anti-androgen hormonal therapies is common. This study also confirmed previous research showing that this treatment in this population does not prolong survival.

This is a therapy that is appropriate for a small, well-defined group of men with prostate cancer. It is an unnecessary and harmful treatment for the majority of Americans prescribed it.

The hormones used cause hot flashes, muscle weakness, osteoporosis and impotence in all who get it.

These drugs also raise a man's risk of diabetes, cardiovascular disease and death from cardiovascular disease.

A second study showed that there is significant variation in how physicians treat good-prognosis (low-grade, less aggressive) cancer confined to the prostate.

A substantial number get unnecessarily aggressive surgical or radiation therapies. These unnecessary therapies are also associated with significant harms.

They can cause urinary and bowel incontinence, sexual impotence and, in some cases, death.

A number of studies in the U.S. and Europe have shown that there is a type of prostate cancer that is localized to the prostate and of good prognosis, meaning it rarely progresses or causes harm if left alone.

All of the organizations that set treatment guidelines the scientific evidence recommend that men diagnosed with this type of cancer be carefully observed. These cancers can almost always be effectively treated if found to be progressing. With careful observation, the majority of men will never need treatment and can be spared the burdens of unnecessary therapy.

These low-risk forms of prostate cancer are commonly diagnosed through screening and commonly overtreated in the U.S.

Indeed, the massive problem of overtreatment and the resultant large number of harms to the population is part of the reason that a number of respected organizations such as the U.S.

Preventive Services Task Force and the American Academy of Family Physicians now recommend against routine prostate cancer screening.

I must note that while the data show that a large number of men receiving these treatments should not be getting them, these therapies are appropriate for a select group of men.

It is the physician's responsibility to tailor treatment to the patient and his cancer.

These two studies form a long list of patterns of care studies showing that a number of American physicians who treat prostate cancer are not fulfilling this responsibility.

Some will say that physicians are overtreating prostate cancer for profit. Although it is true that most American physicians get paid to treat patients and not to observe them, profit may not be a major motive.

In the case of hormonal prostate cancer therapies, a 2010 study actually demonstrated that their use consistently increased throughout the 1990s. Usage went down dramatically in 2003, when Medicare took much of the profit administering the treatment by reducing physician reimbursement for the drugs.

One of the studies published this week shows that there is still tremendous overuse of hormones years after the profit motive was removed.

Some will blame the epidemic of overtreatment on patient demand for aggressive cancer treatment. Patient preference does have a role in overtreatment, but the cooperation of the physician is still necessary to provide the unnecessary treatment.

It is the physician's responsibility to counsel the patient and even teach the patient what approaches are most appropriate. There is evidence that some physicians are able to convince patients to accept less aggressive evidence-based practices.

In one of the studies, author Karen Hoffman and her colleagues noted that younger American physicians were more ly to use observation according to accepted standards, and older doctors were more ly to be associated with more aggressive therapies. I also note that these patterns of overtreatment do not exist in Western Europe.

I believe the major reason for the epidemic of unnecessary therapy in America is that many Americans simply cannot accept that there are cancers that do not need treatment.

They have trouble accepting it because of all the messages heard over the years about the evils of cancer and all the devastation that we have seen from the disease.

Our emotional prejudice against the disease impairs our ability to approach cancer rationally and understand the diversity within the disease.

In some instances, unnecessary treatment of prostate cancer is curing some men who do not need to be cured, with significant detriment to their quality of life. The large number of “cured” makes aggressive treatment look good when one does not realize that many of the cured did not need to be cured.

For the doctor seeing individual patients and not examining data from large clinical studies, it is difficult to see and accept that our aggressive therapies could be more harmful than more conservative approaches observation.

This, even when the harms of some of these therapies are better proven than the benefits and some have even been proven ineffective. A few of the doctors guilty of overtreatment may not understand the number and quality of the studies showing that there are “good cancers.

” But most simply cannot accept the truth.

If we physicians claim to practice evidenced-based medicine, we must understand and respect the science and accept its findings. The science is very clear that there is some diagnosed prostate cancer that we can accurately predict as not needing treatment. These tumors are unly to progress, cause harm and kill.

The phenomenon of cancers that can be diagnosed but will never progress and cause harm is the end result of dramatic improvements in our diagnostic and imaging technologies.

The technical term for this phenomenon is “overdiagnosis.” It has been estimated that overdiagnosis occurs in half of all patients with prostate cancer, perhaps 30% to 40% of those with thyroid cancer, 10% to 30% of breast cancer patients and even some with screen detected lung cancer.

One of the challenges of modern medicine is to develop better abilities to distinguish the cancers that need treatment from those that do not. Ironically, these abilities are relatively well-developed for certain prostate cancers and simply not used in the U.S.

In the paper describing their findings, Hoffman and associates note that some doctors' treatment patterns are more appropriate than others. They suggest that public reporting of physicians' cancer management profiles might enable primary-care physicians and patients to make more informed decisions about selecting physicians to manage prostate cancer.

Such a system is unly to be created in the near future and would be cumbersome at best. Aggressive treatment is appropriate in certain cancers, and treatment really does need to be tailored to the individual patient.

I believe the patient needs to be empowered and have good open conversations about their cancer treatment with all their doctors, including their primary-care physician. This conversation should explore all options and discuss the published cancer treatment evidence-based guidelines and how they should apply. A second opinion from other physicians is always appropriate.

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What Is The Precision Medicine Revolution?

Prostate cancer treatment needs to be tailored

Welcome to the world of precision medicine.

That sounds futuristic, science fiction, or a cool exhibit, something that promises great things for tomorrow, something that’s not here yet.

But this is different.

We have new knowledge which has given us new targets for a smarter, more scientific approach that is helping all men with prostate cancer – but particularly those who need it most, men with metastatic prostate cancer.

Even a year ago, many of these men had to endure the discouraging trial-and-error process of finding drugs that work for them. We hate trial and error; it takes up valuable time and wears you down.

One day, there won’t be trial and error for prostate cancer drugs.

Thanks to research funded by the Prostate Cancer Foundation, we have new targets – genes we now know to look for – that have led to new tests, which point us to specific drugs.

Some of these drugs may not even be intended for prostate cancer, but for colon cancer or breast cancer; yet they are ly to work in your cancer if you have those same faulty genes, too.

One great thing about these drugs is that because they are gene-targeted, they don’t poison your body, make you vomit, deplete your white blood cells or hurt your bone marrow.

In the past, because chemotherapy was so harsh, doctors did something that seems kind of odd now: they waited until nothing else worked before they gave it.

This meant that by the time a man with metastatic prostate cancer got chemo, he was already very sick, and his cancer was very advanced.

Now, because precision testing can give us a glimpse several years into the future, we know which men are ly to have their cancer come back, and we’re not waiting around for that. When it comes to treating cancer cells, sooner is better than later.

It’s not your father’s prostate cancer anymore.

We’re not done yet, not by a long shot. There’s much more work to do. Already, the death rate is half of what it used to be 20 years ago. Many men who have metastatic prostate cancer are not going to die of it; with these new approaches, we are putting them into long remissions.

Our goal is cure, and we’re not there yet. But we can see it; it’s not just some vague hope, not wishful thinking. We’re getting there, thanks to precision medicine. This is why we have raised and pushed $630 million dollars into research over the last two decades: to stop men from dying of prostate cancer.

Precision Drugs: If you have advanced prostate cancer and conventional hormonal therapy is no longer working, you might be helped by enzalutamide or abiraterone – but you might not. Now, instead of spending thousands of dollars and enduring months of trial and error, you can find out ahead of time if you should take one of these drugs.

A simple blood test is just becoming widely available. It targets AR-V7, a particular androgen receptor variant (basically, AR-V7 allows the cancer to create an antidote to these drugs, canceling out their effects). If you are AR-V7 negative, then abiraterone or enzalutamide can put you into remission.

If you are AR-V7 positive, then you will do better with another form of treatment.

I believe that every man should be asking his oncologist, “What’s my AR-V7 status?” You need to help drive your treatment. This is so new, your oncologist may not know about it.

Precision Diagnosis. We call this clonotyping: basically, your cancer is one dot on the big data map of prostate cancer, and exactly where you are depends on the specific genes that are mutated in your cancer.

We now know that you don’t just have prostate cancer: you have a very particular type of it – one of over 27 different kinds (scientists call them clones) of prostate cancer. This is not as crucial to understand if you have localized, low- or intermediate-risk disease.

But it is very important to understand if you have high-risk or advanced disease. Just as we all have different fingerprints, cancer has different fingerprints, too – except these fingerprints are genetic.

The genes that are mutated in your piece of the prostate cancer jigsaw puzzle are most ly different from the genes involved in the prostate cancer of the man sitting next to you in the doctor’s waiting room.

Your cancer is literally programmed differently from that guy’s; it’s driven by slightly different software, because the DNA code is different.

This means that when it comes to advanced or high-risk prostate cancer, we know that the treatment that works on one man’s cancer may not work on yours, and now we know why. So we shouldn’t treat you both the same. We need custom-tailored treatment, and that begins with custom-tailored diagnosis.

To show you where we’re headed, it’s the difference between buying a suit off the rack and getting one crafted by an expert tailor: precision medicine is individualized. You need custom-tailored treatment, and that begins with custom-tailored diagnosis.

The old way – and by this I mean what we did even six months ago – was to treat the average. This means that if 100 men got treatment, some would benefit, and the rest would have cancer that keeps right on growing. We did our best to give patients odds, because all we could do was estimate that they might be in the group of men who are helped by a particular drug.

The new way, precision medicine, means treating the right patient with the right disease at the right time with the right amount of drug. It’s about understanding the genes. This approach works: 25 years ago, everyone who got HIV died of AIDS. Now, nobody has to die of AIDS, because we have medicines to treat it.

Even the smallest genetic variant in that disease is so well-defined, we know what medicine will work best.

We shouldn’t be treating prostate cancer; we should be treating you. Precision medicine also means that your prostate cancer may have more in common with colon cancer, or breast cancer, than with some other man’s prostate cancer, because you may share the same genetic mutations.

Precision testing. There is a new blood test called the Cascade Genetic Test that could change your life. Your doctor may not know about it; it’s that new.

But if you have metastatic prostate cancer, or your father had it, you should know about it; so should your sons and daughters, and your grandchildren.

The “cascade” part of the test is the domino effect to the next generations; that’s the part that will save lives and stop the cycle of lethal cancer from bad genes. A patient recently asked, “Why didn’t my urologist tell me?” Because it’s very new.

This test, developed by PCF-funded research, tells you if you have a mutation in one of 16 genes called “DNA damage-repair” genes.

These genes are little mechanics; their job is to fix problems in the DNA. When they break down, errors don’t get fixed, and over time, this can lead to cancer.

Some of these genes are pretty famous: BRCA1 and BRCA2 are well-known causes of breast and ovarian cancer.

Another is a gene called WNT. It’s mutated in 100 percent of colon cancers and a target in more than 25 percent of ovarian cancers that are chemotherapy-resistant. If you have a faulty WNT gene, then what makes most sense is a drug that has WNT as its bullseye.

Still another gene is called PTEN, and it is mutated in more than 40 percent of all lethal breast cancers, more than 60 percent of lethal ovarian and uterine cancers, and 40 percent of brain tumors.

PTEN is the emergency brake on a car; if it doesn’t work, you’re in trouble.

Now, imagine that car is parked on a hill: just as the car rolls downhill and picks up speed, so does cancer start growing unchecked without this gene.

So what we need – and are actively working on – are PTEN-targeting drugs that act a caltrop.

This is an ancient, highly effective weapon, used by the Romans to deter chariots and still used today in the form of spike strips that puncture your tires if you go the wrong way.

If the brake is off and the car is rolling, this will slow it down and eventually stop it. When – not if – these drugs become available, they will not only help men with prostate cancer, but many men and women with different cancers, as well.

Now, a PTEN-targeting drug is not going to help a man with a faulty BRCA1 gene; but a drug olaparib or rucaparib – both of which target BRCA1 – could help that man get his cancer into remission.

Have you heard of an “orphan disease?” That’s what we’re dealing with here. Orphan diseases affect just a few people compared to heavy-hitters, diseases lung cancer or diabetes that affect millions.

They tend to languish when it comes to funding for research and treatment.

But if those orphan diseases could be combined somehow, the numbers of people affected would really go up, and the pharmaceutical industry would have a lot more incentive to develop drugs to treat them.

We now know that advanced prostate cancer is a bunch of orphan diseases.

Here’s another example: 3 percent of men with metastatic prostate cancer have a mutated MMR gene. A young PCF-funded investigator named Julie Graff has had amazing results in some men with metastatic prostate cancer using a drug called pembrolizumab, which is in a new class of drugs called checkpoint inhibitors.

These drugs help the immune system recognize cancer as the enemy, and use the body’s own powerful T cells to kill the cancer. Specifically, pembrolizumab is a “PD-1” inhibitor, and is approved by the FDA to treat melanoma.

Melanoma is not prostate cancer, but some people in both categories have precisely the same MMR mutation, and for them, pembrolizumab produces results that have been called miraculous.

In some men, the cancer that lit up their scans when the study started either shrank significantly or disappeared entirely just a few months later. Their PSA dropped dramatically – from more than 2,000 down to 0. They stopped taking pain medication.

Graff’s protocol is laid out. If you have the right genetic mutation for this study, you should be able to get this drug, and you shouldn’t have to fly to Oregon, where she is, to get it. It’s not chemo.

No one has ever seen metastases in the liver disappear this – yet they really do, and you can see the images for yourself here.

Over the next few months, as soon as it’s available, we will have information on hospitals that are offering these drugs in clinical trials. This is precision oncology.

Precision family genetics. Another PCF-funded investigator, Dr. Heather Cheng, has started a program at the Fred Hutchinson Cancer Research Center in Seattle, Washington that is the first of its kind in the country.

She is offering treatment the genetics of your cancer.

If it involves a gene ( the ones we talked about above) that might be carried by your sons and daughters, she offers them genetic counseling – so your daughter can get high-risk screening for breast and ovarian cancer if she needs it.

Every man treated for prostate cancer there will have custom-tailored treatment an understanding of the genes that need to be targeted to make him better. Reach out to Seattle Cancer Care Alliance (URL: to inquire. We hope to see similar programs starting at centers of excellence around the country.

Precision biopsy. Pathologists can’t get this kind of genetic information just from looking at prostate biopsy tissue under a microscope and determining the Gleason grade.

So just as it’s not your father’s prostate cancer treatment anymore, it’s not his biopsy, either. Pathologists today look at the DNA of prostate cancer cells.

We are also working toward what we call a “liquid biopsy,” where pathologists can isolate some prostate cancer cells that are circulating in the blood and look at that DNA, as well.

Precision patients as partners. Everything I’m talking about right now is not going to become widespread without men and their families driving the standard of care. There is a frontier, a leading edge of medicine, and that’s what you need to be seeking. Ask your doctor for the AR-V7 test.

Ask your doctor for the Cascade Genetic test. Ask your doctor if you are eligible for a clinical trial of a checkpoint inhibitor. This is all so new. But we have turned a corner on prostate cancer, and there’s no going back. We’ve seen it with HIV.

We are seeing amazing results in metastatic prostate cancer, and in other metastatic cancers. We have momentum.

You are an essential part of this. It is crucial that we have men with prostate cancer willing to help other men with prostate cancer: sharing your stories, sharing the latest news about treatments and research – so they can ask their doctors whether it will be right for them.

What kind of prostate cancer do you have? Let’s figure it out and go from there.

Welcome to precision medicine.


Artificial intelligence could help tailor game-changing prostate cancer treatment

Prostate cancer treatment needs to be tailored

CLEVELAND — Rates of prostate cancer have long been higher among African American men than white men, and new artificial intelligence research from a biomedical engineering professor at Case Western Reserve University could help tailor treatment to account for cellular differences between black and white prostate cancer patients.

“We've always tended to look at the tumor,” said Anant Madabhushi, a biomedical engineering professor at Case Western Reserve University and research scientist at Louis Stokes Cleveland VA Medical Center. “We've always thought that's where the money is.”

PHOTO: Anant Madabhushi is a professor of biomedical engineering at Case Western Reserve University.

In newly-published research, Madabhushi and other researchers used artificial intelligence to look at slides of cell tissue, focusing on the tissue outside the tumor.

“One of the big questions that we’ve been looking at is trying to understand whether men who have had surgery for prostate cancer need additional treatment following the surgery,” Madabhushi said.

Outside the tumor is where the researchers found cellular differences.

“The appearance of the disease is actually different between black men and white men,” Madabhushi said.

For most men, prostate removal gets rid of the cancer, but Madabhushi said for about 20 percent, that may not work. Those men “might have metastasis, might have spread of the disease.” He said black men not only get prostate cancer at higher rates, but their cases are often more aggressive as well.

His research could help create different models for black patients and white patients, using each to figure out who might see a recurrence of prostate cancer or whose cancer might be more aggressive, without basing it all on a model of white patients.

“This is really changing the rubric, the paradigm that has been sort of the status quo thus far,” Madabhushi said.

While AI isn’t perfect, Madabhushi said it’s a tool scientists and physicians can use to help people receive better treatment that is tailored to them.

“AI is susceptible and prone to biases, and very often those biases are really coming in, it’s not really the AI itself, it’s really us,” Madabhushi said. “It’s the data scientists, it’s the computational scientists who are training these AI algorithms.”

AI learns what’s presented to it, so Madabhushi said if it learns from material that is mostly from white patients, it’s not able to account for biological differences in black men.

In this case, though, used as a tool by humans, artificial intelligence found something humans didn’t find.

“This is really changing the rubric, the paradigm that has been sort of the status quo thus far, which is, you know, taking standard models that unfortunately have been trained on a plurality of Caucasian American men,” Madabhushi said.

Madabhushi said he hopes this research will spread globally, since this method does not involve destroying tissue and is low-cost, involving only an algorithm, electricity and the internet.

The research Madabhushi and other collaborators conducted is being supported by about $3.2 million in U.S. Department of Defense grants, according to a release from CWRU.

A patient’s perspective

These days, Reverend Dogba Bass is the pastor at Aldersgate United Methodist Church in Warrensville Heights. But ten years ago, he was diagnosed with prostate cancer, the same disease that killed his uncle in the mid-1990s.

“We didn’t get any screening or anything that because we just thought it was an anomaly,” Bass said.

Bass’s brother was diagnosed with prostate cancer in 2008.

“I was diagnosed in 2010,” Bass said. “Then we kinda figured, ‘Wow, this must be in our family.’”

PHOTO: Reverend Dogba Bass was diagnosed with prostate cancer in 2010.

Both Bass and his brother recovered after having their prostates removed.

“By God's grace, I didn't need to do any radiation or any chemotherapy,” Bass said, noting that his brother did not either.

Bass said he’s changed his diet since surgery and has tried to exercise and lose weight. He goes to the doctor every six months and said his readings are clean.

When it comes to treatment for cancer, Bass knows it’s not always simple. He was optimistic about the research showing cellular differences between black and white patients.

“Early detection would definitely be tremendously enhanced,” Bass said of the research. “And more people would be cured.”

He called the research a “game-changer” and said he hopes it could be applied broadly to other illnesses and help better allocate resources and treatment.

“I believe that there’ll be some sense of advocacy, that we will need to do better, we need to try a little harder, because one size doesn't fit all,” Bass said.