In the not so far past, prostate cancer treatments had few options to extends ones life not much farther than 3 to 5 years once Metastatic. Today the new breakthroughs like Provenge, Zytiga,(abiraterone), Xtandi, (enzalutamide), Radium223, cabazitaxel and upcoming TOK-001 have provided us a much larger tool box to fight this cancer.
I have seen many men, (including myself) who has made in excess of 10 years with metastatic PCa by going “‘TORA- TORA- TORA” , (ATTACK-ATTACK-ATTACK”) on PCa cells. This is thanks to our ability now to understand and attack the various pathways that fuel and block PCa cell reproduction. We have learned a consolidation/maintenance strategy (as in acute leukemia) that will control minimal residual disease and prolong PCa remission (i.e., by keep the remaining cancer stem cells dormant).
So what makes a very slow growing cancer like PCa turn into a monster that becomes the second leading cancer causing morbidity in males? After many years of Hormone blockage by desensitizing the GnRH receptors, it indirectly downregulates the secretion of gonadotropins luteinizing hormone (LH) and follicle-stimulating hormone (FSH), leading to hypogonadism and thus a dramatic reduction in estradiol and testosterone levels. This works well for normally a handful of years thus reducing ones PSA and arresting the growth of PCa cells. A few PCa cells have the ability live through the bombardment of fuel deprivation and AR blockage tend to morph or transform into a much more dangerous form of PCa cancer called : a small cell, neuroendocrine, or ductal/endometrioid carcinoma. Unlike “standard” prostate adenocarcinoma, small cell tends to metastasize to “unusual” places – we are seeing much more of this since the advent of using abiraterone and/or enzalutamide –patients with liver, lung, and brain mets are becoming more common…. almost always with small cell characteristics. The reason is somewhat obvious: the adeno type is driven by T receptors, so if you are able to clamp down on those more, the cells that don’t respond to T-attack slowly become predominant. Soon to follow is CRPCa, (Castrate Resistant PCa) that allows none of the new breakthrough drugs to react by reduce ones PSa or arresting PCa growth!
I hope this helps your understanding of the progression of prostate cancer and the mechanisms that drive this horrible disease. It took (9) years for me to grasp how PCa can go along for several years, semi arrested and then blow up into an uncontrollable monster! I know many men who once found their rising PSA, attacked it by a Radical Prostatectomy or other corrective means and have become totally PCa free! The key to survival is catching it early brfore the PCa cells go “CTCs”, (Circulating Tumor Cells) and release their cells into ones blood stream.
Bottm line……….. Get your PSA checkups starting at age 40, be aggressive fighting PCa, learn what new breakthrough drugs work for you and most of all keep HOPE in you back pocket! Much thanks to Dr. Glode, Division of Medical Oncology, University of Colorado Hospital and Shi-Ming Tu MD. Professor, Department of GU Medical Oncology @ UT MD Anderson Cancer Center for their words of wisdom.
The New Denver Men’s Club
“Men Fighting Cancer To Win”