Prostate cancer is the most common cancer in men — about 1 in 8 U.S. men will be diagnosed with prostate cancer at some point.
Dakim Gaines, M.D., Ph.D.
Vanderbilt University Medical Center
“For prostate cancer patients, advancements like PSMA PET scans and SBRT are working to improve survival and quality of life for men across the world.”
In general, cancer is a disease that afflicts older people, and the average age at prostate cancer diagnosis is 66 years. As men approach their 50s (40s if a person has a strong family history or is African American), they should have a conversation with their doctors about screening for prostate cancer. Guidelines from the American Urological Association (AUA) and National Comprehensive Cancer Network (NCCN) recommend prostate specific antigen (PSA, blood test) screening every two years.[i]
Improved imaging
A new technology is helping to diagnose prostate cancer and is changing the way we treat it. In 2020, the FDA approved the first imaging tracer drug, 68Ga-PSMA-11, for positron emission tomography (PET) to detect prostate cancer-expressing prostate-specific membrane antigen (PSMA). In 2021, the FDA approved a second PET imaging tracer drug, piflufolastat F-18. Both are radioactive tracers that bind to prostate cancer cells to help visualize them.
This tracer is injected into the patient, and they then undergo a PET/CT scan. A radiologist reviews all the images and reports areas of the body that have high PSMA signals, consistent with prostate cancer.
Imaging with PSMA-PET is superior to traditional imaging methods, such as nuclear bone scan that only shows findings in the bones.[ii] This more accurate imaging can detect advanced and metastatic prostate cancer earlier than traditional imaging, which gives patients more options for tailored treatment.
The full potential of PSMA-PET imaging is under investigation. It is currently used to detect metastatic disease in patients with localized aggressive prostate cancer and cancer recurrence after previously local therapy, such as prostatectomy or prostate radiotherapy.
A new paradigm for disease management
Another recent advancement is the management of low burden metastatic (oligometastatic) prostate cancer. Oligometastatic cancer describes the early spreading stage of metastatic cancer before it is widely spread disease.
Oligometastatic cancer is a subset of stage 4 cancer, typically defined as up to 5 active metastases in the body. Previously, all patients with metastatic prostate cancer were managed with androgen deprivation therapy (ADT), a group of medications that lower the body’s testosterone to deprive the cancer of growth signal. ADT for metastatic disease is typically a lifelong treatment and can carry a host of undesirable side effects, such as weight gain, mood changes, hot flashes, and increased risk of heart disease and strokes.
However, recent clinical evidence has changed this treatment paradigm. The STAMPEDE trial showed radiation treatment of the primary cancer within the prostate provided patients with up to three bony sites a 12% increase in survival at three years.[iii]
Targeted deliveries
With enhanced imaging techniques like PSMA-PET scans, it is possible to detect metastatic sites earlier than traditional imaging and to target them with improved accuracy. Stereotactic body radiation therapy (SBRT) is a form of radiation therapy that uses very precise dose delivery to deliver high radiation doses to tumors and minimize radiation to the surrounding normal tissue.
Several phase 2 clinical trials have shown that targeting metastatic sites with SBRT has improved tumor control and increased overall survival in patients with oligometastatic prostate cancer.[iv], [v] These studies have also shown that targeting metastatic sites with SBRT can allow patients to delay starting ADT, thereby sparing side effects and maintaining their quality of life.
Larger clinical trials are underway to validate these findings, but this exciting data is already creating more treatment options for patients with prostate cancer.
The world of cancer care is rapidly evolving as new research emerges and new treatment techniques are developed. For prostate cancer patients, advancements like PSMA PET scans and SBRT are working to improve survival and quality of life for men across the world. Such progress is giving patients with prostate cancer hope that previously was difficult to find.
[i] Wei, John T., et al. “Early detection of prostate cancer: AUA/SUO Guideline Part I: Prostate Cancer Screening.” Journal of Urology, vol. 210, no. 1, 2023, pp. 46–53, https://doi.org/10.1097/ju.0000000000003491.
[ii] Dondi, Francesco, et al. “Bone scintigraphy versus PSMA-targeted pet/CT or PET/MRI in prostate cancer: Lessons learned from recent systematic reviews and meta-analyses.” Cancers, vol. 14, no. 18, 2022, p. 4470, https://doi.org/10.3390/cancers14184470.
[iii] Parker, Chris C., et al. “Radiotherapy to the prostate for men with metastatic prostate cancer in the UK and Switzerland: Long-term results from the Stampede Randomised Controlled Trial.” PLOS Medicine, vol. 19, no. 6, 2022, https://doi.org/10.1371/journal.pmed.1003998.
[iv] Phillips, Ryan, et al. “Outcomes of observation vs stereotactic ablative radiation for oligometastatic prostate cancer.” JAMA Oncology, vol. 6, no. 5, 2020, p. 650, https://doi.org/10.1001/jamaoncol.2020.0147.
[v] Palma, David A, et al. “Stereotactic ablative radiotherapy versus standard of care palliative treatment in patients with oligometastatic cancers (SABR-Comet): A randomised, phase 2, open-label trial.” The Lancet, vol. 393, no. 10185, 2019, pp. 2051–2058, https://doi.org/10.1016/s0140-6736(18)32487-5.