Source: Flickr user Marlene Rybka.
According to the World Health Organization, cancer is among the leading causes of worldwide death, killing 8.2 million people in 2012. Perhaps more worrisome, WHO anticipates that the number of global cancer cases diagnosed on an annual basis will increase from 14 million as of 2012 to 22 million within the next two decades.
Within the United States no cancer is diagnosed more commonly than prostate cancer. According to the American Cancer Society, close to 239,000 men were expected to be diagnosed with prostate cancer in the U.S. in 2013, of which nearly 30,000 were expected to pass away directly as a result of the disease. Although there are far more deadly cancers on an annual basis, prostate cancer clearly represents a serious threat to the well-being of a significant percentage of the male population.
Five states where prostate cancer incidence is the highest
Despite already being the most-diagnosed cancer on an annual basis, prostate cancer also tends to occur more frequently in a few U.S. states than others. Based on data from the Centers for Disease Control and Prevention, the five states where prostate cancer is most prevalent are:
- Louisiana (161.1 incidences per 100,000 men)
- New Jersey (155.8)
- Michigan (156.4)
- Utah (154.4)
- New York (154)
Age-adjusted prostate cancer incidence rate per 100,000 men. Source: Centers for Disease Control and Prevention.
By comparison, the national rate of prostate cancer occurrence is a considerably lower 128.3 incidences per 100,000 men.
Why do these states demonstrate such abnormally high levels of prostate cancer cases? That's an answer that is unfortunately eluding researchers at the moment. However, just because researchers can't specifically predict who will and won't get prostate cancer, they do have a general idea of what risk factors rank high up on the list. These risks include a persons' family history/genetics, whether or not they smoke and/or are obese, and their age, for example.
Source: Flickr user Wonderlane.
The tide is turning
Prostate cancer is clearly a scary and terrible diagnosis, but the fact remains that the tide could be turning in patients' favor thanks to improved education regarding the risk factors associated with the disease, as well as improved pharmaceutical products aimed at improving patients' overall survival and quality of life.
As evidence of this I'd point to the American Cancer Society's five-year survival data on prostate cancer which has improved from just 68% in 1975-1977 to almost 100% (depending on stage of diagnosis) as of 2002-2008. In other words, progress is being made and we're thankfully beginning to see the fruits of that labor.
These drugs are making a difference
In earlier stages of prostate cancer either a watch-and-wait approach or hormone therapy can be used to help abate cancer growth. However, where we're rightly witnessing the bulk of research from pharmaceutical companies is with regard to treating more advanced stages of the disease.
Perhaps no drug has improved patients' overall quality of life recently more than Medivation (MDVN) and Astellas Pharma's (ALPMY 0.74%) Xtandi. Xtandi is unique in that it was initially approved three months ahead of its decision date by the Food and Drug Administration, somewhat of a rarity in the drug development world. The impetus for its initial approval in 2012 was a 4.8 month improvement in median overall survival to 18.4 months. That may not sound like a lot, but considering that few options existed even five years ago to treat advanced-stage prostate cancer this is a great step in the right direction.
Also encouraging, Xtandi received a label expansion to treat metastatic castration-resistant prostate cancer in a pre-chemotherapy setting earlier this month. In its PREVAIL study, which led to the approval, overall survival rose 29% compared to the placebo, while radiographic progression-free survival improved 81%.
Johnson & Johnson's (JNJ -1.15%) Zytiga is another key player that's helping to improve patient's lives. Approved in both pre-chemo and post-chemo settings, Zytiga was shown in both studies to improve patients' median overall survival by close to five months relative to the placebo.
In sum, we've seen some very encouraging new therapies hit the market since 2011. The most encouraging therapies may be yet to come, however.
Source: Flickr user Justin Ried.
The next-generation of prostate cancer therapies
Although it's early in development, I'm personally encouraged by the development of various cancer immunotherapies aimed at treating prostate cancer.
Cancer immunotherapies work by retraining your immune system to recognize cancer cells and to attack those cells in order to slow or stop cancer proliferation. Because prostate cancer can become metastatic, an immunotherapeutic solution could be a smart way of fighting cancer growth throughout a patients' body, while also focusing on the originating tumor.
One experimental therapy in particular that I believe may hold a lot of promise is NewLink Genetics' (NLNK) phase 1 study involving HyperAcute Prostate. NewLink's therapy involves utilizing 30 million to 500 million of a patients' prostate cancer cells and genetically modifying them to express alpha-gal carbohydrates, a carbohydrate that humans are immune to. Once these prostate cancer cells are injected into the patient they stimulate a response by the patients' immune system which then targets prostate cancer cells, hopefully containing prostate cancer proliferation. Of course, it's a phase 1 study, so any potential drug reaching the market is probably still a long ways off, even if it succeeds.
Here's what really matters
Even though we've witnessed our fair share of disappointments with regard to treating late-stage prostate cancer in recent months, the advancement in patient survival and quality of life over the past four decades is tangible and real. But, just because survival rates for prostate cancer are encouraging relative to a number of other cancer types, it doesn't mean in any way that researchers' work is anywhere near done. My hope is that we can look back a decade from now and move that 15-year survival rate even closer to 100% and make significant strides in improving both survival and quality of life for patients with advanced prostate cancer.
