US Pharm. 2016;41(8):1.
Prostate cancer is the second most common cancer in men and, except for skin cancer, constitutes nearly one-quarter of all male cancers. The disease causes 8% of cancer-related deaths in men, placing it as the second leading cause of cancer death in men behind lung cancer. Moreover, the American Cancer Society predicts that some 190,000 new cases and more than 26,000 prostate cancer–related deaths will occur in the United States this year alone. No wonder this disease generates so many questions for pharmacists from patients confused about testing regimens.
The diagnostic tool of choice against this devastating disease is the prostate-specific antigen (PSA) test, developed in 1987. Certain populations are at greater risk for the disease: the rates in African American men, for example, are almost twice as high as those in white men, while more than a third of cases are diagnosed in men older than 75 years.
Given the widespread impact of prostate cancer, it is not surprising that it grabs headlines. Late last month, I noticed a new study that pushed out the surprising news that new cases of advanced prostate cancer in the U.S. had risen 72% over the past 10 years. Most alarming was a 92% increase in late-stage prostate cancer. Lead study researcher Edward M. Schaeffer, MD, PhD, chair of urology at Northwestern University’s Feinberg School of Medicine in Chicago, posits two possible reasons for the rise in advanced prostate cancer cases in the study: The disease may be becoming more aggressive, or the rise could be due to less screening. (In 2012, the U.S. Preventive Services Task Force recommended that men not be routinely screened for PSA.)
Soon after this study’s release, however, criticism surrounding its methodology ensued. The American Cancer Society’s chief medical officer, Otis W. Brawley, MD, characterized the study as “misguided epidemiology.” Dr. Brawley contended that the researchers could not rely solely on the absolute number of cases. The study authors acknowledged that the lack of rates limited their findings, adding nonetheless that because the number of patients in the study was large (800,000), the findings probably reflected national trends.
Whatever the precise scope of prostate cancer incidence, Dr. Schaeffer of Northwestern believes that for men with an average risk, screening should start at age 50 years. For men at increased risk, prostate cancer screening should start at age 40. Screening can stop when a man has less than 10 years of life expectancy, Dr. Schaeffer said. “If you screen, you can reduce the number of men who present with metastatic cancer, that’s what I believe,” he added.
Scientific controversies about disease scope aside, there is no doubt a need for innovative treatment tools. As covered in “Immunotherapy in Prostate Cancer” by Kiran Panesar, BPharmS (Hons), MRPharmS, RPh, CPh, in this month’s Health Systems edition of U.S. Pharmacist, a bevy of intriguing, immune response–related treatment modalities are in play. These include agents given in combination with traditional therapies that modulate T-cell activity and initiate an immune response able to kill tumor cells for an extended time following conventional therapy.
Vaccines show promise against prostate cancer, as Ms. Panesar reports. Therapeutic cancer vaccines induce tumor-specific immunity in patients with prostate cancer via a variety of delivery systems to boost an immune response. Viral vectors, she writes, can accept a large number of tumor antigens and immunomodulatory genes, rendering them effective against the disease.
In the world of complex combination immunologic therapies and complicated oral chemotherapy regimens, the role of the pharmacist continues to expand. Oral chemotherapy agents have novel toxicity profiles and require strict adherence, monitoring for drug interactions, and proper handling and disposal methods.
Clearly, pharmacists can provide medication therapy management services that could make a difference in battling this formidable foe. If this turned out not to be the case, now that would surprise me!