Prostate Cancer

Prostate Cancer

Research advances over the last 40 years have helped to make prostate cancer one of the most treatable of all cancers. Today, nearly all men who are in otherwise good health live at least five years after a prostate cancer diagnosis, up from 65 percent in the 1970s.

However, important research challenges remain. Recent trials have questioned the value of routine PSA testing to screen for prostate cancer, and researchers continue to search for a screening test that can accurately detect high-risk cases of the disease. New treatments are urgently needed for men with advanced stages of the disease, for whom survival remains low. In addition, racial disparities in prostate cancer mortality point to the need for better knowledge of the biology of prostate cancer, and improved access to care for many with the disease.

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2015

Adding chemotherapy to hormone therapy helps men with metastatic prostate cancer live longer

Adding chemotherapy to hormone therapy helps men with metastatic prostate cancer live longer

A large, federally funded clinical trial shows that adding docetaxel (Taxotere) chemotherapy to standard initial hormone (androgen deprivation) therapy for advanced prostate cancer extends patients’ lives by more than a year, on average. This marks the first study to identify a strategy that prolongs survival for men with newly diagnosed metastatic prostate cancer. In 2016, a second large study affirmed that docetaxel extends survival in this setting.

2012

New treatment option for advanced prostate cancer

New treatment option for advanced prostate cancer

Enzalutamide (XTANDI) is proven to extend survival in men with advanced prostate cancer that persists despite all other standard treatments, including hormone therapy and chemotherapy. The drug is approved later in the year.

Enzalutamide works by blocking testosterone from binding to the androgen (male hormone) receptor, a process that would otherwise help fuel prostate cancer growth.

Experts caution against unnecessary PSA screenings for prostate cancer

Experts caution against unnecessary PSA screenings for prostate cancer

Debate continues on the value of prostate-specific antigen (PSA) testing for prostate cancer screening.

In May, the U.S. Preventative Services Task Force (USPSTF) recommends against PSA screening, concluding that it does little to reduce the number of deaths from prostate cancer and can lead to unnecessary biopsies and treatment.

Later that year, however, ASCO issues guidance recommending that physicians discuss the benefits and risks of PSA testing with their otherwise healthy male patients who have life expectancies of greater than 10 years. The guidance notes that PSA testing may still offer important benefits for this group of men, but that the risks outweigh the benefits for men with shorter life expectancies.

2010

New targeted drug approved for certain advanced prostate cancers

New targeted drug approved for certain advanced prostate cancers

FDA approves abiraterone acetate (Zytiga) in combination with the drug prednisone for patients with advanced prostate cancer whose disease progresses despite prior hormone therapy and standard chemotherapy with docetaxel. Abiraterone blocks the production of male sex hormones, including testosterone, which fuel prostate tumor growth. Since only one other agent, cabazitaxel (Jevtana), has been shown to prolong survival in this population of patients, the treatment represents a much-needed new option.

New drug for patients whose disease progresses despite other treatments

New drug for patients whose disease progresses despite other treatments

The FDA approves cabazitaxel (Jevtana), given together with the drug prednisone, for men with advanced stages of prostate cancer that has progressed despite prior hormone therapy and chemotherapy with a drug called docetaxel (Taxotere). The approval, the first for this group of patients who have few other options, was based on data showing cabazitaxel increases survival compared with standard mitoxantrone (Novantrone) chemotherapy in patients who have already received docetaxel treatment.

First-ever "therapeutic vaccine" for prostate cancer becomes available

First-ever "therapeutic vaccine" for prostate cancer becomes available

The FDA approves a therapeutic vaccine called Provenge for patients with advanced prostate cancer, based on studies showing that it modestly improves survival compared to use of a placebo. This new treatment option is designed to boost a patient's own immune system to fight their cancer. The potential impact of the treatment remains to be seen, however, as physicians and patients weigh its modest benefits with its high cost.

2009

Men urged to discuss routine PSA testing with doctors

Men urged to discuss routine PSA testing with doctors

Three large, randomized trials provide conflicting results on the use of PSA screening and lead experts to question whether this screening method translates into improved survival and actually saves men's lives. Initial results from two of the trials indicate that PSA testing has a minimal effect on overall survival and leads to the diagnosis and treatment of slow-growing cancers that are unlikely to be life-threatening. The third study finds that PSA testing every two years among men age 60 and older reduces the risk of prostate cancer death by 40 percent. Given the conflicting evidence, leading medical societies urge men to discuss the risks and benefits of screening with their doctors.

Radiation after surgery or hormone therapy improves survival

Radiation after surgery or hormone therapy improves survival

Findings from a long-running clinical trial show that radiation therapy after surgery (known as adjuvant radiation) reduces the risk that prostate cancer will spread and increases survival time by nearly 30 percent in men with early-stage disease. A separate study finds that adding external beam radiation treatment to standard hormone therapy in prostate cancer that has spread to the surrounding areas can reduce the risk of death by more than 40 percent.

2008

Advanced prostate cancers respond to new treatments in early studies

Advanced prostate cancers respond to new treatments in early studies

Two new targeted drugs appear promising in early studies among patients with advanced stages of prostate cancer. In one study, a drug called abiraterone acetate (Zytiga) reduced levels of prostate-specific antigen (PSA) by up to 90 percent in men who no longer responded to hormone therapy. A second trial shows that adding the drug custirsen to standard chemotherapy significantly reduced PSA and pain levels, compared to an alternative combination. (Custirsen is designed to make prostate cancer cells more sensitive to chemotherapy.) In 2011, the FDA approves abiraterone acetate, in combination with prednisone, for men whose advanced prostate cancer progresses despite other therapies, including docetaxel (Taxotere) chemotherapy.

New blood test helps predict prostate cancer outcomes

New blood test helps predict prostate cancer outcomes

The FDA approves the CellSearch test for predicting survival and monitoring the impact of treatment in men with advanced prostate cancer. The test counts circulating epithelial cells in the blood and can be used to help doctors make more informed decisions about the best treatments for individual patients. Research continues to determine the most appropriate use of the test in everyday practice.

Potential prostate cancer-associated virus identified

2005

High-dose radiation helps men avoid cancer recurrence

High-dose radiation helps men avoid cancer recurrence

Studies find that men with localized prostate cancer who receive radiation treatment at a higher dose than was traditionally provided are less likely to have their cancer recur than men who receive conventional radiation. The high-dose approach is made possible by technological advances that allow doctors to precisely target more radiation to the tumor, while sparing healthy tissue.

2004

New chemotherapy for hard-to-treat prostate cancers

2003

First drugs proven effective for reducing prostate cancer risk

First drugs proven effective for reducing prostate cancer risk

Two large trials report that finasteride (Proscar) and dutasteride (Avodart) reduce the risk of developing prostate cancer by up to 25 percent, compared to placebo. However, debate persists about the optimal use of these drugs for prostate cancer prevention. Key issues of controversy include whether these agents increase aggressiveness of tumors that do arise, and whether they only inhibit less aggressive tumors that would not have been dangerous without treatment in the first place.

1997

Adding hormone therapy to radiation improves prostate cancer survival

1996

New treatment for prostate cancer that resists hormone therapy

1994

Watchful waiting introduced for men with early prostate cancer

Watchful waiting introduced for men with early prostate cancer

Prostate cancer often grows very slowly, and many tumors that are discovered in an early stage will never grow to the point of being life-threatening. To help avoid unnecessary treatments, doctors begin to practice watchful waiting (also called active surveillance), in which treatment is delayed or replaced by frequent exams and PSA testing for men with early-stage disease. This approach helps them identify patients whose cancer is more aggressive and requires treatment, while sparing others from the complications of unnecessary treatment.

1990

Laparoscopic prostate cancer surgery introduced

Laparoscopic prostate cancer surgery introduced

Laparoscopic prostatectomy involves removing the prostate through multiple small incisions and a telescoping camera device. The approach reduces the recovery time and complications of surgery, compared to traditional "open surgery" through a single large incision. While laparoscopic prostatectomy has become common practice, randomized trials are still needed to show conclusively that this minimally invasive technique provides the same long-term effectiveness as traditional open surgery.

1987

New prostate cancer subtype identified

New prostate cancer subtype identified

Researchers identify a specific sub-set of prostate tumors known as neuroendocrine tumors (also called small-cell tumors). Subsequent research shows that neuroendocrine cancers grow and react to treatment differently than adenocarcinomas, the more common form of prostate cancer. They are more difficult to detect and they tend to spread to soft tissue rather than bone, but are generally responsive to chemotherapy. Today, doctors can identify these tumors by their genetic signature and tailor treatment accordingly.

1986

FDA approves PSA test for prostate cancer screening

FDA approves PSA test for prostate cancer screening

The FDA approves the first PSA (prostate-specific antigen) test to screen for prostate cancer in men aged 50 and older. PSA is a protein produced by cells in the prostate gland, and is often elevated in men with prostate cancer. Widespread use of PSA testing leads to a significant jump in early-stage prostate cancer diagnoses, sparking a debate that continues today about whether such screening improves survival or simply leads to over-diagnosis and treatment of cancers that would never have become life-threatening.

1982

Early hormone therapy drugs introduced

Early hormone therapy drugs introduced

Studies demonstrate the effectiveness of treatments known as luteinizing hormone receptor hormone antagonists (LHRHa therapy). These drugs – the first of which is approved by the FDA three years later – chemically reduce the production of testosterone and are used to slow the growth of prostate cancer, which is fueled by male sex hormones. The new approach is reversible, and thus preferable to the other options available at the time, including surgical removal of the testicles. Hormone therapy is now a standard approach for treating the disease.

New surgical approach helps preserve sexual and urinary function

1981

CT scanning proves useful for staging of prostate cancer

CT scanning proves useful for staging of prostate cancer

Following the introduction of computed tomography (CT) in the 1970s, studies begin showing that the new imaging technology can be used to determine the stage of a patient's prostate cancer without invasive techniques. CT scanning later proves useful to guide surgery and radiation therapy, and to help determine the optimal placement of radioactive "seeds" for patients who undergo a radiation treatment known as brachytherapy.

1980

New tools enable detection of early-stage prostate cancer

New tools enable detection of early-stage prostate cancer

Doctors begin using prostate ultrasound – in which sound waves are used to generate an image of the prostate – to detect abnormalities that may signal cancer. Together with a type of biopsy, in which a thin, hollow needle is used to extract prostate tissue for testing, doctors are far more able to detect the earliest stages of prostate cancer.

1974

Modern system for "staging" prostate cancer is introduced

Modern system for "staging" prostate cancer is introduced

The newly-created Gleason scoring system provides a uniform way for doctors to classify men's tumors by stage (low aggressiveness to high aggressiveness) and select appropriate treatments accordingly. The system is based on how prostate tumor cells look under a microscope on a scale of 1 through 5 (a low score indicates that cells look less malignant). This useful staging system has been updated and refined in recent decades, based on greater understanding about the disease's development and growth.

1971

Early prostate cancer screening regimen introduced

Early prostate cancer screening regimen introduced

Studies show that screening with annual rectal exams, followed by surgery to remove the prostate in men who are found to have cancer, enables men with the disease to live as long, on average, as those without cancer. However, such treatment comes at the expense of urinary continence and sexual function.

1970

Radioactive "seeds" proven effective for prostate tumors

Radioactive "seeds" proven effective for prostate tumors

A highly focused approach to radiation treatment, called brachytherapy, is shown to extend the lives of patients with prostate cancer, compared to surgical removal of the prostate and surrounding tissue. In this approach, tiny radioactive sources or "seeds" are implanted directly into the prostate gland. These seeds deliver a high dose of radiation directly to the tumor, while leaving healthy tissue beyond the prostate relatively unaffected, ushering in more focused alternatives to standard external beam radiation.

1966

First standard chemotherapy regimens for prostate cancer

1943

Discovery that hormones can stop cancer growth

Discovery that hormones can stop cancer growth

Dr. Charles Huggins and colleagues make key discoveries on the role of hormones in prostate cancer growth. Huggins is the first to demonstrate that bilateral orchiectomy (surgery to remove the testicles) and treating men with the hormone estrogen lowers testosterone levels and causes prostate tumors to shrink. Today, hormone therapy (also known as androgen ablation) is widely used to treat prostate cancer and consists of hormone injections, rather than surgery, to stop the production of testosterone in the testicles. This research earned Huggins a Nobel Prize in 1966.