Understanding Prostate Cancer
- Comic strip “Dilbert” creator Scott Adams has been diagnosed with metastatic prostate cancer battle—something he’s been able to accept as he knows his prognosis cannot get better.
- It’s important to remember that despite a stage four cancer diagnosis, treatment advancements have made for patients to better manage and treat patients living with metastatic prostate cancer.
- Early detection of prostate is important as it can help reduce the risk of cancer spreading to other organs. Screening for prostate cancer generally involves a PSA (prostate-specific antigen) test and a digital rectal exam to feel the prostate gland. The prostate-specific antigen is a protein secreted by the prostate gland, large amounts of which can indicate prostate cancer.
- Though the PSA test is not always accurate and an elevated PSA test does not always mean you have prostate cancer, our experts maintain that these tests are helpful. Make sure to discuss your options with your doctors and decide what screening should look like for you.
- There are many different treatment options for both early and later-stage prostate cancer including active surveillance, watchful waiting, surgery, radiation, cryotherapy, hormone therapy, chemotherapy, immunotherapy and targeted therapy. The disease is one where doctors may have differing opinions on the best treatment path to take.
In fact, Adams admitted that Biden’s prognosis inspired him to come forward with his own diagnosis. The award-winning cartoonist shared the news on his YouTube show “Real Coffee With Scott Adams YouTube,” explaining, “I have the same cancer that Joe Biden has. I also have prostate cancer that has also spread to my bones, but I’ve had it longer than he’s had it, well longer than he’s admitted having it.
Read MoreRELATED: Metastatic Prostate Cancer Treatment is Improving
Adams also expressed he’s now come to terms with the disease and is making the most of the time he has.
“I’ve just sort of processed it, so it just sort of is what it is. Everybody has to die as far as I know and it’s kind of civilized that you know about how long you have so you can put your affairs together and make sure you’ve said your goodbyes and done all the things you need to do,” he said.
“So, if you had to if you had to pick a way to die, this one’s really painful … but it’s also kind of good that it gives you enough time while your brain is still working to wrap things up.”
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Adams also expressed how he waited for “the right time” to announce his diagnosis, telling his viewers, “I thought to myself, ‘You know what? I’m going to slide under his story and he’s going to take away a lot of the attention because, you know, [he’s the] ex-President.’
“It would just be a little bit easier for me to tag on to that.”
Fans took to Adams’ Instagram page to comment on his health news, with one writing, “Sorry for what you’re going through, Scott. I was just rereading your How to Fail book – it is a timeless classic. I send you prayers and good wishes from Ohio. Your work continues to influence me greatly.”
Another said, “Scott, I can’t express how sorry I am on hearing of your health diagnosis. I will be hoping for some kind of miracle for you as your writings and wit have been a bright spot in my life. I can’t thank you enough.”
“I Love and adore you. You changed my life forever. My heart is broken. I found out during my lunch at work & was weeping when I read it. Not many things you can count on in life, but you were one of them. You became part of my daily life. I am indebted to you for guidance, kindness, hope and life skills. Peace be with you,” commented a third fan.
Despite his diagnosis, the New York native, often takes to social media to share what he enjoy in life, including adorable photos of him spending time with his dog snickers.
Adams occasionally shares photos of himself working out at the gym on Instagram, as well as memories from vacations he’s enjoyed, and cups of coffee.
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Understanding Prostate Cancer
If you or a loved one has been diagnosed with prostate cancer, it’s important to remember that most types of prostate cancers are treatable. According to the National Cancer Institute, the five-year survival rate of prostate cancer in the U.S. is 97.9%. There is, however, a small number of men whose type of prostate cancer may become unresponsive to treatment, for example, when cancer cells develop a resistance hormone therapy, the treatment may no longer work.
Prostate cancer begins in the prostate the walnut-shaped gland located between the rectum and bladder that produces the fluid that nourishes sperm. Outside of skin cancers, prostate cancer is the most common cancer in American men with about one in eight men being diagnosed with this disease during his lifetime.
It’s important to remember a prostate cancer diagnosis is not always preceded by symptoms. And even when symptoms do occur, they can be inconsistent and hard to pinpoint.
Prostate Cancer: Symptoms & Diagnosis
“Prostate cancer is a very odd disease in that it doesn’t have a particular symptom,” Dr. Edwin Posadas, director of translational oncology and the medical director of the Urologic Oncology Program at Cedars-Sinai, previously told SurvivorNet.
After the Diagnosis: “What Did I Do Wrong?”
Still, it’s important to note changes in urinary function, like urinating more or less often or waking up at night to go more than usual, could be a sign of prostate cancer. So, even if you think there’s nothing to worry about, always talk to your doctor about changes to your health when they occur.
There are many different treatment options for both early and later-stage prostate cancer including active surveillance, watchful waiting, surgery, radiation, cryotherapy, hormone therapy, chemotherapy, immunotherapy and targeted therapy. The disease is one where doctors may have differing opinions on the best treatment path to take, so don’t hesitate to ask lots of questions and seek out multiple opinions.
Second (& Third) Opinions Matter When Deciding Between Surgery or Radiation
“I think it behooves the patient to have multiple discussions or second opinions, not only by the urologist who did the biopsy and diagnosed that man, but also with other surgeons and other radiation oncologist just to get a very circumspect view of what the treatment options are,” Dr. Jim Hu, a urologic oncologist at Weill Cornell Medicine, told SurvivorNet. “Oftentimes, I think patients need to understand that our health system is based a lot on fee-for-service medicine.
“And so therefore, a lot of physicians, I think, who are very well intentioned, will believe that their treatment is best for that particular man,” Dr. Hu added.
Prostate Cancer Screening Guidelines
It’s unclear if the benefits of prostate cancer screening outweigh the risks for most men. Nevertheless, screening can be life-saving, and it’s important to discuss the pros and cons of screening and your risk factors for the disease with your doctor.
The American Cancer Society (ACS) recommends “men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer” after “getting information about the uncertainties, risks, and potential benefits of prostate cancer screening.”
The ACS says the discussion about prostate cancer screening should take place at:
- Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
- Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father or brother) diagnosed with prostate cancer at an early age (younger than age 65).
- Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).
When Should I Get Tested for Prostate Cancer?
Prostate cancer screening methods look for possible signs of the disease, but they can’t determine for sure if you have cancer. A prostate biopsy is the only way to confirm if the patient has prostate cancer.
Screening generally involves a PSA (prostate-specific antigen) test and a digital rectal exam to feel the prostate gland. The prostate-specific antigen is a protein secreted by the prostate gland, large amounts of which can indicate prostate cancer.
It’s slightly uncomfortable but painless, and takes less than 30 seconds,” Dr. Posadas said of these methods. “The amount of information that is gained from that is tremendous, and it can be a life-and-death type decision that is made.”
Though the PSA test is not always accurate and an elevated PSA test does not always mean you have prostate cancer, our experts maintain that these tests are helpful. Make sure to discuss your options with your doctors and decide what screening should look like for you.
Surgery Isn’t Always the First Option; Some Choose ‘Active Surveillance’
It’s common for prostate cancer to grow very slowly. Some men, especially those who are older and those who have a low risk of the cancer spreading, may not need aggressive treatment, making active surveillance a viable option.
WATCH: People With Low-Risk Prostate Cancer Can Rely on Monitoring the Disease
Active surveillance means the doctor watches the cancer carefully for changes, with a PSA blood test every six months and a digital rectal exam about once a year. You may also get prostate biopsies and imaging tests every one to three years.
SurvivorNet experts stress active surveillance is not “watchful waiting.” Active surveillance is a treatment, and as the name implies, it is active. This path requires coordination between the patient and their healthcare team.
“[It’s] not just kind of check in once a year—hey, how are you doing—but actively have a physician check a PSA and do a rectal examination,” Dr. Posadas, told SurvivorNet.
“We can actually see some of the metabolic information within the cells through our next-generation imaging and find high-risk areas that are or are not changing in a patient to let us know, yeah, that cancer’s still sleeping. Let’s not bother– let’s not put that young man through the risk of losing his sexual quality of life or his urinary quality of life,” Dr. Posadas added.
Half of men who choose this approach will avoid unnecessary treatment and potential side effects.
But the other half of men do end up having treatment, whether as a personal decision to remove the cancer or to treat the disease as it progresses. Your doctor will determine if this is necessary based on the results of your ongoing tests.
Hormone Therapy and the New Treatments Available for Late-Stage Prostate Cancer
Hormone therapy is used when patients are unable to have cancer surgically removed because it has spread to other parts of the body.
Although hormone therapies do not cure stage 4 prostate cancer, they may help keep it from growing and spreading further.
“The traditional standard of care for metastatic prostate cancer is androgen (male sex hormone) deprivation therapy or hormone therapy,” explains Dr. Jeff Tosoian, a urologic oncologist.
Androgen deprivation therapy is a type of hormone therapy that works by inhibiting androgen production, including testosterone, or blocking androgen receptors, which can slow down tumor growth.
“Prostate cancer feeds off testosterone,” explains medical oncologist Dr. Mary O’Keeffe. “When you lower testosterone with androgen deprivation therapy, it’s no longer feeding the cancer.”
As metastatic prostate cancer progresses, the cancer cells can adapt and become resistant to therapy.
According to Dr. O’Keeffe, this is true for most cancer treatments. “You have some men that are on it for many years, and some men can progress in less than a year if they have a more aggressive type of cancer.”
Two newer androgen deprivation therapies for late-stage prostate cancer include:
Xtandi (enzalutamide)
- FDA-approved to treat non-metastatic (nmCRPC) and metastatic castration-resistant prostate cancer (mCRPC) and metastatic castration-sensitive prostate cancer (mCSPC)
- It’s a once-daily oral pill that can be taken with or without food
- The most common side effects include fatigue, weakness, hot flashes, back pain, joint pain, changes in bowel habits, high blood pressure (hypertension), and decreased appetite
Erleada (apalutamide)
- FDA-approved to treat metastatic castrate-sensitive prostate cancer (mCRPC)
- It’s a once-daily pill taken by mouth
- The most common side effects include rash, hot flashes, high blood pressure, itching, and joint pain
Targeted Cancer Therapy Options
Targeted therapy is a developing treatment option for prostate cancer. Unlike cytotoxic chemotherapy, which also damages healthy cells as it attacks cancer, targeted therapies interfere with specific molecular pathways.
These drugs can target and destroy specific cancer cells with fewer side effects than traditional chemotherapy.
Targeted therapy has three major mechanisms of action:
- Blocking the growth factor that encourages tumor cells to grow
- Interfering with the synthesis or function of DNA
- Disrupting cell signaling pathways essential for the survival and growth of cancer cells
Pluvicto is part of a newer class of targeted cancer therapies called radioligand therapies (RLTs). It delivers a small but powerful dose of radiation directly to prostate cancer cells that express a protein known as PSMA (prostate-specific membrane antigen). This protein is found on most prostate cancer cells but not on normal tissues — making it a valuable target for treatment.
Before receiving Pluvicto, patients must undergo a PSMA PET scan using an approved imaging agent, such as Locametz, to confirm that their cancer cells express PSMA.
This treatment is now approved for men with mCRPC — which means the cancer has spread beyond the prostate and is no longer responding to hormone therapy — who have already been treated with one ARPI (like abiraterone or enzalutamide) and who are not yet ready for chemotherapy.
Other Treatment Options
There are an array of treatment paths someone with stage four prostate cancer may choose to take, each with their own risks and benefits.
Here is a breakdown of the options:
- Chemo: The goal of this therapy is not to cure prostate cancer but rather to slow its growth and reduce symptoms.
- Radiation Therapy: This therapy uses high-energy rays or particles that are focused on prostate cancer cells to damage or destroy them. This treatment is effective for helping to ease symptoms related to prostate cancer, but it’s not used as a cure.
- Surgery: Surgery isn’t common in late-stage prostate cancer. However, sometimes, doctors may surgically remove the testicles (called an orchiectomy or surgical castration) in order to stop the production of testosterone.
- Clinical trials: Clinical trials are being conducted for many types of advanced prostate cancer. Participation can give patients access to new drugs and treatments.
- Cancer vaccine: Provenge, an immunotherapy treatment given over the course of one month, is the first FDA-approved vaccine for metastatic castration-resistant prostate cancer (mCRPC). It helps the patient’s immune system attack prostate cancer cells that have been growing and dividing throughout the body. Common side effects include fatigue, chills, fever, back pain, nausea, joint pain, and headaches.
WATCH: Genetic testing can help doctors tailor advanced prostate cancer treatments
Each of these treatment options involves careful considerations, including the patient’s age, past health history, and current health status.
Bone Therapy
Adams’ metastatic prostate cancer has spread to his bones. Metastatic cancer can destroy bone tissue and release substances that cause additional bone damage.
Doctors often manage bone loss with treatment to stop or slow bone destruction (such as bisphosphonate drugs), reduce pain, and prevent fractures.
New drugs available to prevent bone loss and fractures in those whose cancer has already spread to the bones include Xgeva (denosumab), which is FDA-approved for preventing skeletal complications in men with advanced prostate cancer who are at high risk for fracture.
It’s an injection given under the skin every four weeks. The most common side effects include shortness of breath, fatigue, nausea, and low phosphate levels in your blood.
Coping With Emotions After Cancer
After a cancer diagnosis, patients often are consumed with emotions, and managing them all can be a daunting task.
“People have a range of emotions when they’re diagnosed with cancer,” Psychiatrist Dr. Lori Plutchik previously told SurvivorNet. “And they can include fear, anger … and these emotions tend to be fluid.”
“They can recede and return based on where someone is in the process. Going through a cancer diagnosis is just the beginning of a complicated, complicated process,” she added.
According to Mental Health America, “56% of adults with a mental illness receive no treatment, and over 27 million individuals experiencing a mental illness are going untreated.”
While millions of people have unmet mental health needs, the need for mental health resources is even greater among cancer patients and their families.
What is Positive Psychology & How Can it Help Cancer Survivors?
Research published in Epidemiology and Psychiatric Sciences found that “35 to 40 percent of cancer patients have a diagnosable psychiatric disorder,” and the number of people experiencing mental health challenges is “higher among cancer patients with advanced stages of cancer and in palliative care settings.”
According to Dr. Asher Aladjem, a physician psychiatrist at NYU Langone’s Perlmutter Cancer Center, addressing your symptoms one by one with a mental health professional can go a long way in making treatment a more tolerable experience.
“Patients need to know they’re entitled to get the whole spectrum of services, and the mental health service is a very important one, I think,” Dr. Aladiem tells SurvivorNet.
Contributing: SurvivorNet Staff
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