Prostate Cancer and the Importance of Avoiding Undertreatment

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In truth, prostate cancer is an umbrella term ascribed to heterogeneous disease states with varying expected prognoses. Over the years, there has been a growing justified recognition and impetus to avoid overtreatment, particularly for those who present with early-stage low grade (i.e., nonaggressive) disease. The goal is the treatment’s side effects should not be worse than the disease’s expected morbidity. On the other side of the pendulum, more recent research is now illustrating clearly that undertreatment of prostate cancer can negatively impact survival in many circumstances.

New York Cancer & Blood Specialists’ medical oncologist/hematologist, Dr. Jahan Aghalar, discusses the importance of early evaluation with a medical oncologist to conquer the disease. “We can help personalize effective and optimal therapies initially to combat prostate cancer, leading to improvements in long-term outcomes,” Dr. Aghalar said.

“In particular for those with metastatic cancer that is still sensitive to traditional hormone therapy (castrate-sensitive prostate cancer), recent research clearly illustrates the life-prolonging benefit of utilizing chemotherapy in addition to hormonal therapy early on. There are also three different novel hormonal agents that have been FDA approved and have been shown to improve survival compared to traditional primary hormonal therapy. Your physician can help you go over these options.”

Patients should also inquire about genetic sequencing at the time of their diagnosis. “Approximately 15% of patients with advanced-stage prostate cancer have an important genetic component to their disease affecting the DNA repair mechanisms,” Dr. Aghalar continued. “This has significant therapeutic implications as patients who are found to have such defects have an increased chance of significantly benefiting from a class of oral medications named PARP inhibitors.”

In addition, more extensive analysis using whole-genome sequencing (WGS)-based classification of tumors may be useful to improve the selection of patients for different targeted therapies via ongoing promising clinical trials at NYCBS. Lastly, genetic sequencing can also uncover crucial hereditary information which would affect future cancer risk to close relatives who may be harboring the same genetic defect.”