I'm Dr. Nancy Dawson. I'm the Director of the GU Medical Oncology Program at MedStar Georgetown Lombardi Comprehensive Cancer Center.
How did you get involved in the work that you do for urologic cancers?
I was in the Army for 20 years. And when I was very early in my training, it's when men with prostate cancer were first entering clinical trials for prostate cancer. And so I was what's called a fellow in oncology, and they started to send these consultations up to oncology and say, "Please treat this patient on a particular clinical trial. Per the guidelines, they've been assigned to chemotherapy."
And the next thing you know, every single patient who had prostate cancer ended up in my clinic. So the next thing you know, I was the person who did prostate cancer. You should know that back then, and we're talking 1982, medical oncologists weren't even treating prostate cancer. And we really didn't have any therapies for prostate cancer. We had removal of the testicles, giving them estrogen, maybe giving them some prednisone. We didn't even have a standard test that we do, the PSA test. That actually came into development while I was in training. So we didn't have anything back then.
Why is getting screened for prostate cancer important for all men?
Well, prostate cancer is similar to actually a lot of cancers in that the early detection is going to give you an earlier disease and a more curable disease. So the only way you're going to usually cure prostate cancer is to get detected when it's still confined to your prostate. And unfortunately, people think that you have symptoms when you have early disease. You don't. So if you're waiting to get symptoms, you've waited too long. So that's why you have to screen early before you have any symptoms, and regularly, so that you can catch it when we can cure it.
What are the current guidelines for prostate cancer screenings?
Well, it always seems to be changing, to be honest. But I would say that in general, we look at all men should start screening no later than age 50, and should be screened once a year. Men who are at higher risk for prostate cancer, such as African American men, or men who have a first degree relative with prostate cancer, their father or their brother, they have a higher risk, and so they should be screened earlier. Most people say around 45.
What are current treatment options for advanced prostate cancer?
As I was saying earlier, when I was early in my training, we had almost nothing. But now if a man comes in with advanced, and we're talking metastatic prostate cancer, the standard is actually to either give them two or three different therapies. They will get a drug to lower their testosterone, which is the major androgen that men make from their testicles, and then they will also be given a second drug that will block the ability of any other androgens in your body from stimulating the prostate cancer. So you do have androgens made by your adrenal glands that's sitting over your kidneys. Most recently, if you have what's called high volume disease, which is a lot of prostate cancer in many bones, or in an organ such as your lung or your liver, we will add chemotherapy for six cycles, as we call it, short period, to actually give you the highest chance of having your cancer respond and respond for the longest time.
Where can immunotherapies such as Provenge fit into a patient's treatment plan, and who are good candidates?
Provenge is used for men who have what we call castrate-resistant prostate cancer. So that's cancer that has initially responded to drugs that lower your testosterone level, but is now progressing. And so we call that castrate-resistant, and it's approved for men who have minimum symptoms, which is defined as not requiring narcotics. And they need to have disease that's usually in bone and lymph nodes. Usually when it's in another organ, such as your liver, usually Provenge is not the appropriate therapy.
Can you explain the research on Provenge treatment outcomes in Black men compared to men of other racial groups?
So there was a trial done, a registry trial called PROCEED (PROVENGE Registry for the Observation, Collection, and Evaluation of Experience Data), which was done when Provenge was early in its approval, and actually it was requested by the FDA. They wanted to see what would happen if they treated a large number of men on Provenge, just to make sure that there were no additional safety issues or concerned. So about 2000 men were enrolled in this registry trial. And in that trial, they found that African American men had a better overall survival. So for the whole group, their survival was about 10 months longer. And for men who had lower PSA levels, sort of a little earlier castrate-resistant disease, their improved survival was about two years longer.
It's not known why African American men had a better survival, but there are several other scenarios that we know about where African American men actually do better, so we're not all exactly the same in terms of what genetic things might be wrong when we develop prostate cancer. We are different. And in the case of Provenge, African American men did have a better overall survival on this trial, and this in fact is a trial that Euvon was enrolled in.
What advice do you have for patients diagnosed with advanced prostate cancer?
You need to turn to various resources that are available. There are actually many resources, including prostate cancer support groups like Man-to-Man and Us TOO, there are numerous potential support areas to turn to. But I think you need to identify doctors that have expertise in prostate cancer, and then you need to find somebody that you're a good fit with, who you can trust, who you're willing to follow their advice. I think one of the problems, and this is true whether you're talking about having a diagnosis of cancer or any other illness that you'll be seeking help for, you need to have confidence in your doctor, you need to believe that they have your best interest, and you need to be willing to follow their advice on how to best manage your cancer or whatever illness you have.
We often try to be our own doctors. That's not necessarily in your best interest, and that's why it's important that you find someone you can work with, who you'll listen to and whose advice you'll follow. That's not to say don't do your own research. Bring the information that you've found to that doctor or to other doctors, and discuss it with them. Tell them what you found, tell them what you're thinking of doing, what alternative therapies, and have a discussion with them so you can have a shared decision.
How can clinical trials fit into a prostate cancer patient's treatment plan?
Every advancement that we have in the treatment of prostate cancer exists because men enrolled on clinical trials. Whether you're talking about Provenge, triplet chemotherapy, hormonal therapy, all the second-line therapies, all the novel new therapies. No matter what treatment you're talking about that's resulted in men living longer with a better quality of life, is a result of a clinical trial. So if men don't enroll in clinical trials, we cannot move forward and advance how we best care for men with advanced prostate cancer.
There's a poster on the door in my clinic that says, "Ask your doctor if there's a clinical trial for you." And so I would tell men that if they're trying to decide how to treat their prostate cancer that's advanced, that they should ask their doctor if there's a clinical trial for them. There are websites you can go to like ClinicalTrials.gov. We have a local one I'm very proud of called gumdroptrials.org, where you can find out what clinical trials are available for you just by answering a few simple questions, and then it will give you information about it, and then take that information to your doctor, and see if they agree that that might be something you should consider.