Observing the Evolving Prostate Cancer Landscape and Hopes for the Future

When Maha H. Hussain, MD, was beginning her career in the genitourinary [GU] oncology field, resources were limited in terms of funding. Since then, this field has evolved with government and pharmaceutical companies investing in these research practices.

In a recent conversation with CancerNetwork^® for Breaking Barriers: Women in Oncology, Hussain, a Genevieve E. Teuton Professor of Medicine at Northwestern Medicine, highlighted that it was not only funding that had increased but treatment options and survival outcomes.

Hussain was joined by her mentee and fellow colleague Sarah E. Fenton, MD, PhD, an assistant professor of Medicine at Northwestern Medicine. Although Fenton is just beginning her career, she focused on what she is excited to see in the future of prostate cancer care.

Transcript:

Hussain: I think [the GU oncology field] has evolved dramatically. In the old days, nobody wanted to work on prostate cancer, bladder cancer, or kidney cancer. Our major source of treatments and funding was from the National Cancer Institute [NCI], and the cooperative groups did a great job in terms of leading efforts to evaluate different agent strategies like the Intermittent trial [SWOG-9346; NCT00002651], which was a [3040]-patient trial. The reality of it is these were our efforts at the time. I’m delighted to say now that the whole field has changed significantly.

Aside from the usual federal and international nonprofit entities, we now have pharmaceutical companies partnering with us on the different trials and different strategies that we’re working on. I do think the field has moved quite a bit. When I entered the field, for the patients with metastatic castration-resistant prostate cancer, the median survival was 9 months, and for patients with metastatic hormone-sensitive prostate cancer, their median survival was about 2.5 years or just under 3 years. Now we’ve moved it to a different space where it’s almost tripled in terms of the outcome of survivals. Many men are living much longer. I’m hoping that at some point, many of them will hopefully be cured with better treatment strategies, better imaging, and so on.

Fenton: A lot of the progress that we’ve made has come through therapy intensification, earlier therapy initiation, and using more modalities that use different mechanisms at the same time to control the disease more aggressively at the outset. I’m thinking most of prostate [cancer], but we’ve seen great progress in bladder and renal [cancers], as well, not even to mention testicular [cancer]. All these outcomes are improving. The space that I would love to see patients moving into is getting great control before they’re able to come off treatment either permanently because we’ve started to cure these patients—these men and women with these diagnoses—or get good control and then allow a treatment-free interval. Although as Hussain [mentioned], intermittent therapy has previously been a little bit dicey. That is where I hope we’re headed. We’re seeing these great improvements in outcomes. I want to see that continue to improve. It would be great if we could increase our ability to cure these patients, as we’ve seen in testicular [cancer].

Reference

Hussain M, Tangen CM, Berry DL, et al. Intermittent versus continuous androgen deprivation in prostate cancer. N Engl J Med. 2013;368(14):1314-1325. doi:10.1056/NEJMoa1212299