An 87-year-old gentleman was diagnosed with metastatic prostate cancer. He presented with a very high PSA of more than 1600 (normal is <4). He had a bone scan which showed cancer spread to multiple bones. This is stage 4 prostate cancer.

Prostate cancer is the most common cancer among men. Approximately a quarter million men in the United States are diagnosed with prostate cancer each year. Most prostate cancers (89%) are found when the disease is in only the prostate and nearby organs. The five-year survival rate for them is nearly 100%. For people diagnosed with prostate cancer that has spread to other parts of the body, the five-year survival rate is 30%.

Since prostate cancer growth is driven by male sex hormones called androgens (the commonest is testosterone), lowering the levels of these hormones can help slow the growth of the cancer. This is usually accomplished by an injection given every few months by medicine like Lupron.

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My patient was started on such a drug. We usually also add another oral drug to the injections to improve survival. In his case, his cancer is extremely fast growing as measured by the Gleason score. His Gleason score was very high at 9 out of a total of 10. Unfortunately, he did not respond to these drugs well.

  His cancer was progressing. Ideally, he should get some chemotherapy. At the same time, he is 87 and wants to avoid chemotherapy as much as possible. This makes sense.

  I advised him about research. In the Florida Cancer Specialists Lecanto office, we do lots of research in different cancers. FCS offers patients access to more clinical trials than any private oncology practice in Florida. Our patients have access to groundbreaking therapies, in a community setting, and they may participate in national clinical research studies of drugs and treatment protocols. In the past five years, the most new cancer drugs approved for use in the U.S. were studied in clinical trials with FCS participation prior to approval.

My patient is started on a new drug called ARV-110. This drug has a novel mechanism of action. It degrades androgen receptors on cancer cells and so androgen (testosterone) cannot bind to the cancer cells and, thus, growth of cancer cells is stopped, leading to eventual death of cancer cells. This is a hormone therapy, but not yet available in the USA without clinical trial, as it is not yet FDA approved. My patient is started on this drug. He is tolerating it well and he has not had any significant toxicities.

This kind of advanced research helps cancer patients locally in our own county.

Dr. Sunil Gandhi is a hematologist and oncologist. He is the volunteer medical adviser of the Citrus Unit of American Cancer Society. Write to 521 N. Lecanto Highway, Lecanto, FL 34461, email sgandhi@tampabay.rr.com or call 352-746-0707.

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