– Modern anti-androgen tablets are very effective – at virtually every stage of treatment they can slow down the disease, extend life and are very well tolerated. We are talking with Dr. Iwona Skoneczna, PhD, about new hormone therapies still not fully available to Poles.
Doctor, prostate cancer has been taking a bloody toll on the mortality rate of Polish men for years. One of the reasons is “male resistance”, i.e. fear of a urologist, and the other is limited access to modern therapies. What do Polish patients miss the most?
The survival and mortality rates in neoplasms depend on many factors, but in general it can be said that the most important factor is the stage of disease advancement at the time of diagnosis and the ability to efficiently apply, usually multidisciplinary, treatment. The pandemic added objective diagnostic problems to the situation in which most men had to be persuaded to undergo urological examination.
I would like to repeat once again that early prostate cancer does not cause any symptoms and if we do not try to check whether we do not have it ourselves, it may surprise us and generate metastases before we know it. Another important element leading to good treatment results, especially in advanced prostate cancer, is access to modern therapies. Here too, despite improvements, much more could be done.
A breakthrough in the treatment of prostate cancer is to be modern antiandrogens – how do they work?
We have known for over 50 years that the growth of prostate cancer depends on the presence of male hormones, mainly testosterone. Androgen receptors in the cancer cells capture androgens and the cancer grows faster. The first treatment is still to lower your testosterone levels. Over time, however, this effect wears off, and cancer cells either produce their own androgens or begin to multiply independently.
It turns out, however, that then the androgen receptor can be permanently blocked and the tumor growth slowed down again. Modern anti-androgen tablets have such an effect, they are very effective, because at virtually every stage of treatment they can slow down the disease, extend life and are very well tolerated.
Which patients will benefit most from the new hormone therapies?
In oncology, we try to identify markers of early relapse in order to be able to effectively counteract the development of resistant clones as soon as possible. In prostate cancer treated with surgery or radiation therapy, rising PSA becomes an early sign of relapse. If PSA continues to increase despite the decrease in testosterone, especially when it doubles in less than 10 months, and we do not yet see metastases in control imaging tests (tomography and bone scintigraphy), according to medical knowledge, it is time to use new hormonal drugs (apalutamide , darolutamide or enzalutamide). When given to patients at this stage, they delay the onset of metastasis by about 2 years and add about a year to overall survival.
What is the advantage of the new oral hormone treatment over chemotherapy?
It is difficult to compare intravenous chemotherapy with next-generation oral hormone therapy. Both treatments are beneficial and it is best to take advantage of both. It is advisable to discuss the treatment plan with the oncologist, both for the present and for the future. In the case of aggressive symptomatic disease, chemotherapy is often offered as the first treatment, while in minimal asymptomatic disease, we can start with hormone therapy.
What criteria must a patient meet to qualify for new methods of prostate cancer treatment in Poland?
Modern hormone therapy for prostate cancer in the stage of resistance to testosterone lowering is available only to patients who meet the qualification criteria for the so-called drug programs. For today, these are indications that only include people with confirmed metastases, we are waiting for the moment when we will be able to delay the appearance of metastases using these drugs.
How does the availability of modern therapies look like in other European Union countries?
In most EU countries, new hormonal drugs are available at an earlier stage of treatment than in Poland.
Why in your opinion are the new treatments for prostate cancer not reimbursed and is there any chance for a change in the near future?
I cannot find an answer to the first question, and to the second: I hope so.