Resolving the Prostate Cancer Dilemma

For immediate release: September 09, 2014

Greenebaum Cancer Center researchers are improving diagnostic and treatment options to reduce or eliminate drastic side effects in men treated for prostate cancer

Prostate cancer is the second most common cancer and the second leading cause of cancer death in American men. It can be an extremely aggressive disease, and, in these cases, it’s critical to catch and treat it early. But for the majority of men diagnosed with prostate cancer, living with the side effects of treatment–including impotence and incontinence–are worse than living with the disease itself.

This is because most men diagnosed with prostate cancer have a non-aggressive form of the disease, with tumors that grow very slowly–so slowly, in fact, that these men could live the rest of their lives without cancer-related complications and die from other causes. But since current methods of differentiating between aggressive and non-aggressive cancer at diagnosis are limited, many men with low- or intermediate-risk prostate cancer either have their prostate removed surgically or undergo full-prostate irradiation. While these treatments are highly successful, the side effects can take a huge toll on a man’s quality of life.

“Right now, we don’t have any way to prevent or treat the side effects. It’s the unfortunate price that patients pay for treatment,” says Zeljko Vujaskovic, MD, PhD, professor of radiation oncology and director of the Division of Translational Radiation Sciences at the University of Maryland’s Department of Radiation Oncology. “It’s a major concern for patients, because the disease itself is highly curable. Considering people are living longer, and the overall health of older people is getting better, the impact of side effects is becoming even more of an issue.”

Prostate cancer is, indeed, a highly-curable disease–according to the American Cancer Society, the 15-year relative survival rate for all stages of prostate cancer is 94 percent. However, due to physicians’ inability to differentiate aggressive cancer from non-aggressive, they treat the majority of cases, putting those patients at risk for impotence and/or incontinence.

Researchers at the University of Maryland Marlene and Stewart Greenebaum Cancer Center are developing more sophisticated diagnosis techniques and treatment options to enable doctors to differentiate low- from high-risk disease and deliver more targeted treatments. The goal is to minimize or eliminate side effects in men who do not necessarily need the more aggressive treatments that come with greater side effects.

Mohummad Minhaj Siddiqui, MD, assistant professor at the University of Maryland School of Medicine and a urologic surgeon with the UM Greenebaum Cancer Center, is exploring different ways to identify aggressive cancer. In the lab, he’s looking at metabolic pathways for prostate cancer cells and determining disease type–aggressive or non-aggressive–based on the metabolism of the cells.

In the clinic, he is testing more advanced methods for identifying and diagnosing aggressive disease than are currently available. Right now, prostate cancer screening is done through a prostate-specific antigen (PSA) test, which measures the level of PSA in a man’s blood. PSA is often elevated if a man has prostate cancer, but a number of other factors can impact the level of PSA, so the test isn’t always a true indicator of prostate cancer. If the levels are elevated, a random biopsy of the prostate is done, meaning several tissue samples are taken and assessed. If cancer is found in any of the samples, the entire prostate is treated. Dr. Siddiqui is looking at ways to improve prostate cancer screening.

“Prostate is the only cancer in the body that we historically weren’t able to reliably screen for through imaging. It’s been a real disadvantage in our ability to accurately diagnose and track treatment progress,” says Dr. Siddiqui. “With recent advances in MRI imaging, we are now better able to pinpoint the location and size of a tumor. This allows doctors to determine how and if to treat the cancer, and could open the door for more targeted treatments.”

This is exactly what Dr. Siddiqui will seek to do in an upcoming clinical trial. He will use new imaging technology, called MRI/ultrasound fusion, to identify and biopsy only questionable areas within the prostate. If the disease isn’t wide-spread, he will use focal brachytherapy–implanted radioactive seeds–to irradiate only the tumor, sparing the surrounding tissue. For patients with early-stage or non-aggressive cancer, this option would help avoid the side effects associated with gland removal or whole gland irradiation.

While Dr. Siddiqui’s research seeks to improve diagnosis and treatment of prostate cancer, Dr. Vujaskovic and his team are working to reduce the side effects of radiation treatment using drug therapies to counteract the long-term effects of radiation on the prostate and surrounding tissues. These therapies include radioprotectors, which would be given to patients before radiation exposure; radiation mitigators, which would be given after treatment; and therapeutic interventions that could help to lessen or prevent symptoms from radiation treatment side effects, such as impotence.

“We are exploring all of these approaches with drugs, with the goal of moving some of them into the clinic, to use with patients, in the next year or so,” says Dr. Vujaskovic.

Collectively, Greenebaum Cancer Center researchers aim to not only improve prostate cancer diagnosis and treatment, but also ease some of the stress that patients feel when deciding if and when to undergo treatment.

“We’ve developed extremely effective treatments for prostate cancer,” says Dr. Siddiqui. “Now we need to take advantage of new technology and refine our practices so that men can go into treatment with confidence that they can be cured without the life-altering side effects.”