News Center

Prostate cancer is the second-leading cause of cancer-related death in American men, and even deadlier among African American men, who are diagnosed younger and at increased risk for the disease compared to white or Hispanic men. Risk also increases with age and in those with a family history of prostate or other heritable cancers, including breast, ovarian, pancreatic and colon cancer. Men should have a discussion with their physician about prostate cancer screening so that cancer can be diagnosed at an early stage.

About three-fourths of prostate cancer patients are diagnosed before the disease spreads beyond the prostate. In this stage, most tumors are treatable and curable, though in 20-30% of patients, prostate cancer can come back after initial treatment. In a minority of patients, prostate cancer is diagnosed in an advanced stage, when it has already spread to other parts of the body. For those patients, a cure is unlikely and oncology providers focus on treatment to better control the cancer.

Until recently, the standard treatment for advanced prostate cancer care primarily consisted of different kinds of hormone suppression therapy and chemotherapy. Unfortunately, most patients will become resistant to this therapy over time after an initial response. Several new treatment options introduced in recent years show promise in controlling the cancer for patients whose disease has progressed following standard therapy. Those drugs take a new approach, targeting certain proteins in prostate cancer cells.

Asit Paul, M.D., Ph.D.

We spoke to Asit Paul, M.D., Ph.D., a medical oncologist and co-leader of the Urologic Oncology Disease Working Group at VCU Massey Comprehensive Cancer Center, to find out more about the latest innovations in advanced prostate cancer treatment.

PARP inhibitors

One new class of drug, known as PARP inhibitors, targets altered or defective DNA-repairing genes. These genes, such as BRCA and others, are inherited from family or in some cases acquired after birth. PARP inhibitors prevent these genes from repairing DNA damage in cancer cells, allowing those cancer cells to die.

Genetic testing for prostate cancer is currently recommended not only to identify individuals who are at risk of inheriting these genes, but also those who will benefit from this new class of drugs. Olaparib, rucaparib, niraparib and talazoparib are examples of PARP inhibitors. The FDA also recently approved a combination of a PARP inhibitor with potent hormone-suppressing drugs, which is available for patients with advanced prostate cancer who carry those altered genes and whose disease progressed after initial therapy.

PSMA-targeted therapy

Another new drug targets a protein called prostate specific membrane antigen (PSMA), which is found in abundance in prostate cancer cells. When this PSMA-targeted agent — bound to a radioactive tracer — is injected into a patient, it selectively delivers radioactivity to kill prostate cancer cells.

The same PSMA-targeting method is used for an advanced imaging technique known as PSMA PET, in which a radiotracer is injected into the body and attaches to tumor cells, making prostate cancer visible in an image. For patients to qualify for this treatment, their prostate cancer must be visible through PSMA-PET and continue to spread despite being treated with hormone therapy and chemotherapy.

Like these new agents, a number of other novel and exciting therapies are being tested in clinical trials for advanced prostate cancer in many centers around the country, including at Massey. These are expected to change the treatment landscape and prognosis of advanced prostate cancer in the near future.

Written by Annie Harris