In this issue, we focus on the interaction of bone with prostate cancer, as well as treatment for this cancer.
In the first interview, Dr. Shore reviews the propensity of prostate cancer to bone and how that impacts treatment as well as clinical outcome. He also discusses available treatment approaches for the bone loss caused by hormonal therapy.
In the second interview, Dr Tward discusses a clinical trial he is conducting that seeks to control bone metastatic prostate cancer. In this trial, men with five or fewer bone metastases have these lesions treated with external beam radiation. In addition to the bone lesions that can be seen on scan, patients may have other bone metastases still too small to see. In this trial, those lesions are treated with Radium 223 (Xofigo). How does this trial differ from the standard treatment for men with bone metastatic prostate cancer? The standard approach would be to use hormonal therapy with or without radiation to the bone metastases. Thus, this trial tests whether Xofigo (radium-223) can replace hormonal therapy. Xofogo (radium-223) is much better tolerated than hormonal therapy and the result would be an improvement in quality of life.
In the third interview, Dr. Denmeade discusses his clinical trial of bone marrow transplantation in prostate cancer. The thinking behind this trial is quite clever. The goal of the trial is to replace the patient’s immune system with one better able to control prostate cancer. To this end, the bone marrow donor would be a female, usually a daughter. The immune system of the female donor would never have encountered prostate tissue, normal or malignant. It is hoped that this would increase the odds of an immune response to the cancer. As an added twist, testosterone levels are held low during transplantation and early engraftment to keep production of prostate antigens to a minimum. Then testosterone levels are restored and this will trigger production of prostate antigens and thus, hopefully, a clinically meaningful cancer immune response. While bone marrow transplantation is cumbersome, expensive and associated with significant side effects, if successful, this trial would be a potential game changer
Finally, we have a short interview with Darryl Mittledorf, representing MaleCare about their new booklet on prostate cancer and African Americans.
Charles E. Myers, Jr., MD