The problem may be patients who do not show up for examination with alarming symptoms during the COVID-19 epidemic. They will appear at later stages, so we can still see an increase in deaths from prostate cancer, says the doctor. Jakub Kuharz, clinical oncologist at the Urinary Tract Cancer Clinic, NIO-PIB.
Katarzyna Pinkos, Wprost: Prostate cancer is the most common cancer in men today. The number of cases in Poland is on the rise, but it is worrying that the number of deaths is also on the rise. Why is this happening?
doctor hab. Jakub Kukharts: The number of cases is growing not only in Poland. We live longer, so there is time for cancer to develop, including prostate cancer in men. Age is one of the main risk factors. Prostate cancer is also detected more frequently because more diagnostic tests are performed. Increasingly, the disease is diagnosed in patients accidentally when it does not cause symptoms, for example, in connection with a PSA test or for other reasons, they turn to a urologist.
It is good that today prostate cancer is detected earlier.
Certainly. In addition, prostate cancer is mainly a disease of elderly patients. It can be found, for example, in an 80- or 90-year-old person. Often in this case, it does not need to be treated. The patient may have other diseases that are much more important than his own, for example, the cardiovascular system. In some patients, prostate cancer is a clinically “silent” disease, does not cause symptoms, does not shorten life. Quite often at these elderly patients the “smoldering” disease is observed.
At the other extreme are patients who initially come to us with a very advanced disease. Often these are young patients. There are even men under 50. In their case, prostate cancer is much more aggressive and requires intensive treatment.
Why does this cancer appear so early in some men and is it so aggressive?
Genetic factors certainly play a role. There are certain genetic disorders - so-called disorders in DNA repair genes - that predispose to prostate cancer. It is more common in young men. The most common mutations in the BRCA1 and BRCA2 genes are associated with the risk of developing breast cancer, ovarian cancer in women, and prostate cancer in men. It is very important to remember about genetic testing as it has implications for treatment. If it is a so-called germline, congenital mutation, this is a signal that the family should also be tested for such genetic disorders.
When prostate cancer is detected at an early stage, the urologist is mainly involved in its treatment. And when does the oncologist start treatment? How does an oncologist look at prostate cancer?
In general, the treatment of cancer patients should always be carried out by a multidisciplinary team. In the case of prostate cancer, this team should always include a urologist, a radiation oncologist and a clinical oncologist. Oncologists mainly deal with patients with metastases, with changes in distant organs.
How many patients with advanced prostate cancer?
In the case of new diagnoses, this is a small percentage - about 10-15 percent. These patients certainly require a multidisciplinary approach. However, most of the patients who come to us are patients after some form of radical treatment, that is, after radiation therapy or surgery, who have developed a relapse.
Despite early diagnosis, is treatment not always effective enough to prevent metastasis?
Unfortunately, yes: a feature of malignant tumors is that often, despite radical treatment, the disease recurs.
How do you assess the current therapeutic options for advanced prostate cancer? They have changed a lot in recent months.
They have changed a lot since March 2023. We can definitely treat patients in a more modern way. I mean some important changes. Firstly, this is the possibility of using abiraterone acetate in combination with chemotherapy in patients with primary metastatic prostate cancer. This drug has been moved from the drug program to the chemotherapy catalog. The cost of cabazitaxel, which we use after unsuccessful chemotherapy with docetaxel, is also reimbursed. Equally important is access to apalutamide, a modern hormonal drug for the treatment of metastatic, castration-sensitive prostate cancer. However, there are some limitations here. It is also important to offset the cost of olaparib, a PARP inhibitor that can be used in patients with BRCA1/2 disorders.
Is it possible to treat advanced prostate cancer in Poland in accordance with the recommendations of international and Polish scientific societies?
In principle yes, although the greater the choice of therapy, the more we can tailor treatment to the needs of patients; then it’s more personal. In many cases, treatment should be selected taking into account comorbidities, patient preferences regarding the form of therapy, contraindications, interactions with chronically used drugs.
Also on the horizon is a new radioisotope therapy, Lu-177; is a new concept, effective after the use of other treatments. However, the therapy is extremely expensive, but there is a global problem with the availability of the drug.
What we still lack is the possibility of using abiraterone acetate in patients with so-called high-risk groups undergoing radical radiotherapy. Overall, however, the recent improvement in treatment options for advanced prostate cancer has been tremendous. I can treat patients in a modern way. I don’t feel the way I used to when a patient with advanced prostate cancer came to me, when I knew that he needed to be given a certain medicine, but could not prescribe it. Today at 90-95 percent. patients can choose the optimal treatment. The Ministry of Health has done a lot to improve access to treatment. However, it will be some time before we see the effect of modern treatments.
When a patient with advanced prostate cancer comes to you today, what are your options for optimal treatment? Can we say that this is a chronic disease?
I can definitely tell the patient that he will receive world class treatment.
It is known that there is a certain group of patients in whom prostate cancer will progress aggressively, our solutions will be ineffective or ineffective, but such patients are in the minority. It is imperative to forget the belief that cancer is short-lived and - I don’t like that word - is a “sentence”. Today it doesn’t look like this.
Still, the diagnosis of “cancer” causes great fear …
I always recommend the patient to visit a loved one. I am even surprised when patients ask if they can come with their wife; I believe that this is the best solution when there is one or even two accompanying persons with the patient. First, the patient is less afraid; secondly, about 30% of the information is remembered during the visit. what the doctor says, and even less in the great stress of hearing an oncological diagnosis. Besides, patients don’t always want to tell us everything; it happens that someone from the family will give us important information. It is very important to be with someone.
What do you think can be improved in the treatment of prostate cancer?
I think that the problem may still be in patients who did not report worrisome symptoms during the COVID-19 epidemic. They will report later stages, so we may yet see an increase in mortality.
We are seeing a big increase in the incidence of prostate cancer, of course, it is important that patients are quickly diagnosed and consulted by a team of specialists - in a very wide range.
Source: Wprost
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