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Last week, the National Cancer Institute and the Men’s Health Network co-hosted a Twitter chat on prostate cancer. The discussion focused on the future of treatments for the disease, and VCU Massey Cancer Center hematologist-oncologist Asit Paul, M.D., Ph.D., with nurse practitioner Gwen Parker, M.S., FNP-C weighed in as the moderator posed a series of questions. Below is a recap of the chat. Some of the responses have been slightly altered to provide context that could not fit into the original 140-character tweets. Be sure to follow @VCUMassey on Twitter to keep up with Massey’s latest groundbreaking research and clinical trials, learn about patient and caregiver resources and find out about volunteer and philanthropic opportunities while connecting with others who share similar interests and life experiences.

How prevalent is prostate cancer?
Every year approximately 220,000 men will be diagnosed and about 30,000 will die from the disease.

How is prostate cancer treatment changing?
Data suggests that up-front chemo with hormonal therapy is effective in high-volume metastatic disease. Radium 223 is an option for symptomatic bone disease. Active research is ongoing for immunotherapy with vaccines and checkpoint inhibitors for metastatic disease. New hormonal agents such as enzalutamide and abiraterone are effective means of treating metastatic castrate-resistant disease. Availability of new MRI/TRUS directed biopsies has improved the diagnostic yield and accuracy.

What are the current options for treating early stage prostate cancer?
Options include active surveillance, surgery and radiation based on risk stratification. Active surveillance is appropriate for low-risk disease with limited life expectancy. Risk stratification is done based on PSA Gleason Score and staging. Early-stage metastatic cancer doesn't always require active treatment but should be monitored closely.

How should clinicians/patients approach selecting the best treatment for them?
Treatment should chosen based on risk stratification. For example, a Gleason score of 7 or more, a PSA more than 10, and advanced stages are considered high risk. When PSA is considered, not a single PSA value other than increasing trend and quick doubling time should be assessed. Massey has a multidisciplinary team dedicated to helping prostate cancer patients decide the best course of cancer treatment.

What are the current options for treating advanced prostate cancer?
Treatment options for advanced prostate cancer include chemo and hormonal therapy and new hormonal treatments with enzalutamide and abiraterone. Clinical trials should always be considered and are always an option no matter the disease stage. Provenge is appropriate for patients with minimal symptomatic disease. New studies are assessing hereditary prostate cancer, so talk to your doctor if you have a strong family history of prostate cancer.

What are targeted therapies and what targeted therapies are being used to treat prostate cancer?
Targeted therapies are directed to a molecular defect in the cancer. Current clinical trials are exploring multiple targets, but there are so many targets, it's just a question of finding the appropriate one that is clinically effective. For metastatic castrate-resistant disease, secondary hormonal manipulation continues to be a good option before and after chemotherapy.

Are immunotherapies being used or studied for the treatment of prostate cancer?
Provenge is approved as a vaccine for minimally symptomatic non-visceral disease. Prostvac, another vaccine, is actively being tested in clinical trials. We strongly encourage patients to explore clinical trials when they talk with their oncologist. View ongoing trials at Massey here.

What are the most important research challenges moving forward?
One of the biggest challenges is that there are limited options for refractory progressive metastatic prostate cancer. There are limited options for second- or third-line chemotherapies after progression. Additional biomarkers (other than PSA) are needed to assess the treatment response. The role of chemotherapy in hormone-sensitive prostate cancer is being explored in the STAMPEDE (Systemic Therapy in Advancing or Metastatic Prostate cancer: Evaluation of Drug Efficacy) trial.

Where can I go to get more information?
The best resources for prostate cancer patients include the Massey website, the National Cancer Institute and the National Comprehensive Cancer Network websites. Always talk to your doctor if you have any questions or concerns about what is right for you.

Written by: Melissa Mitchell