Cancers, taken collectively, are the leading cause of death in Canada by a large margin, but the public has learned that not all cancers are created equal, and even the layman has begun to ask questions like “What stage?” and “Has it metastasized?” But with prostate cancer, the most commonly diagnosed cancer among Canadian men, even the scariest answers to these questions no longer necessarily equate to a death sentence.

“We’ve had tremendous success over the last four or five years with new options for treating patients who are at the latest stage of their disease, namely metastatic castration-resistant prostate cancer (mCRPC), which is ultimately the state of the disease which actually causes patients to die of prostate cancer,” says Dr. Fred Saad, Chief of Urology at the University of Montreal Hospital Centers. “Even in the metastatic stage, as long as people are still responding to hormone therapy, they don’t die. It’s when people stop responding and the cancer finds some way to survive in the absence of testosterone that people die of the disease. Until a few years ago, we really had no other options to prolong life at this stage other than chemotherapy.”

The new drugs that keep surprising doctors with their effectiveness

The biggest game changer for patients with mCRPC has been the advent of oral hormonal agents, drugs that can shut down the hormones that feed cancer cells even in castration-resistant cases. “It’s absolutely fantastic to have something that’s easy to tolerate, prolongs survival, improves quality of life, and relieves symptoms,” says Dr. Saad. “It’s close to miraculous. The only problem was that, at first, it was limited to patients who had already received chemotherapy.”

But as researchers and clinicians continue to study these drugs, new findings have confirmed that these drugs significantly improve survival and maintain quality of life even in asymptomatic patients in the earliest stages of mCRPC. And, vitally, research published just this year has shown that patients who receive the drugs still respond well to chemotherapy if the disease does progress.

“In 2015, we are realizing just how powerful these agents are and the importance of starting treatment early,” says Dr. Saad. “We’re talking about patients who have mCRPC, but just starting when we have the first evidence that they are metastatic and castration resistant, and not waiting until the patients start falling apart.”

"In the tug of war between effectiveness of treatment and quality of life, mCRPC is starting to look like one of the few cases where both teams are pulling in the same direction."

Quality over quantity

Starting treatment early, especially when it delays symptoms and the need for chemotherapy, is something that Canada’s new class of hyper-informed cancer patients are particularly invested in. They are understandably averse to treatments that will prevent them from living life on their own terms. “Patients more and more realize that quality of life is equally as important as, if not more important than, quantity of life,” says Dr. Saad.

In the tug of war between effectiveness of treatment and quality of life, mCRPC is starting to look like one of the few cases where both teams are pulling in the same direction. It flies in the face of our layman’s assumptions about cancer, and in this case, that’s very good news. “With all agents, we are looking for reductions in prostate-specific antigen (PSA), relief of symptoms, and measurable improvements in tumour size,” says Dr. Saad. “When we’ve got all three, that’s a trifecta. Amazingly, the drugs that are the easiest to tolerate are the ones giving us the best results for all three.”