January 21, 2021

The Niche

Trusted stem cell blog & resources

Updated: Do Vulcans Get Prostate Cancer and get surgery for it?

It’s been a big couple months of headlines in the news for prostate cancer. I’m a prostate cancer survivor and cancer biologist so I spend probably more than my share of time thinking about prostate cancer and from a number of angles. A few days ago I got a test result suggesting I’m still in long-term remission so I’m happy, but prostate cancer is on my mind.

Another big headline came out today suggesting prostate cancer surgery for men diagnosed with the disease may in many cases be unnecessary or harmful.

Let me help you make sense of all the prostate cancer news.

Let’s try to be as logical as Spock from Star Trek. 

Prostate cancer seems almost an inevitable fate for men in America and for many other men around the world if you live long enough, but a significant fraction of the cancers are not life threatening.

Others, unfortunately such as the cancer I had surgery for 2 1/2 years ago (read my cancer “coming out” post here), are to the contrary very serious.

No watchful waiting for these.

Many questions remain about prostate cancer….

  • How good are we at telling the difference between relatively tame cancers and the tiger-like cancers that eventually kill a substantial fraction of those who have them?
  • What’s the best way to detect the cancers that are dangerous?
  • How can we best help men with prostate cancer?
  • What about those men whose cancer has recurred?

These questions are just a handful of the many important ones out there and it can be confusing.

What’s the scoop on the latest headlines?

First there was the bombshell that the federal task force recommended that all PSA testing be stopped. They claimed that PSA testing did more harm than good. Most rational people who are well-educated about prostate cancer that I have talked to in the biomedical community think the task force made a huge mistake. As I put it, they threw the baby out with the bathwater. It is not time to abandon PSA testing, but rather a prime opportunity to refine it and adopt a more logical system of testing. Bottom line, I think men should still get tested but guided by something similar to the new guidelines that I’ve proposed. At risk men such as those with a first degree relative who has had prostate cancer (e.g. my two brothers), especially at a young age, should get tested.

Second, we heard promising news that J&J’s drug Zytiga (Abiraterone) worked so well in a trial that the trial was stopped so all men could receive the treatment. Very encouraging news. Zytiga works by inhibiting production of testosterone. It is intended to be used for so called hormone resistant prostate cancer (which is the form of prostate cancer that kills men) for which older drugs no longer work. Zytiga has shown promise both for treatment of men with prostate cancer prior to their surgery (shrinks tumor before removing prostate) AND later in the course of the disease. Bottom line, Zytiga is just one of numerous new prostate cancer drugs in the pipeline so the fact that it works well is good news. Fans of another prostate cancer therapy, Provenge, which involves the use of immune cells and costs $100K, have nit-picked at issues related to Zytiga, but overall I think Zytiga is much more promising personally.

Third, it was reported that taking breaks from hormone-deprivation therapy may increase mortality. Let me explain. One of the weapons against prostate cancer is treatment of patients with drugs that block production of testosterone because testosterone is like fuel for prostate cancer. However, inevitably cancers find a way to become resistant to the anti-testosterone therapy. Nonetheless hormone deprivation is an important tool and can keep cancer at bay for years. One such drug is called Lupron. The catch is that Lupron has very nasty side effects.

My father, who had prostate cancer at age 58 and then had a recurrence about a couple decades later, took Lupron for a time. He hated it. Most men do hate Lupron and hence the impetus for wanting to take a break now and then from getting the hormone deprivation therapy. Now scientists report that taking such breaks, which helps alleviate the nasty side effects of the drug, has a cost: men taking breaks from hormone deprivation therapy are more likely to have their cancer be worse. Bottom line, this is not unexpected, but is still bad news that if men want the max benefit from anti-hormone therapies they are going to have to put up with the side effects without breaks.

Fourth, today a study was reported in the NY Times and published in the NEJM that suggested for many men prostate cancer surgery may be unnecessary or harmful. What does this mean? The study was a small one looking at 731 men with prostate cancer, but it suggests that for men with apparently lower risk prostate cancer and lower PSA levels that prostate surgery (prostatectomy) may not be beneficial. However, there were benefits of surgery to men with higher PSA levels at diagnosis (10ng/ml or higher) and the findings suggesting little benefit of surgery did not apply to men with apparently higher risk cancer. In addition fewer men who got surgery overall died during the 15 year study, but the difference was not statistically significant.

OK, so what would Spock make of all this?

I think he’d be favor of continuing PSA testing, but in a more logical manner. Don’t throw out the PSA testing system entirely, but rather make it better and more logical.

I believe he’d be encouraged by the news on the drug front and he’d advocate taking no breaks from hormone deprivation even if the side effects are nasty.

Spock would be in favor of more study of the benefits and risks of prostate cancer surgery before drawing a conclusion, but perhaps would encourage more watchful waiting amongst men who have apparently lower risk cancer.

Maybe Spock could invent a way to beam cancer out of the body!

Note, a version of this piece was originally published by me at Science2.0

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