The mission of PCF is to reduce the death and suffering from prostate cancer. I often wonder about what would be a good analogy for the mission. As one travels through the world of medical research organizations, patient groups, and even the general media we hear words like “war on cancer” “moonshot” “Manhattan project” to describe a problem to be conquered or a battle to be won.
All have a common thread – a bold, multi-faceted project aimed at a singular, well-defined, and easily communicable objective – place a human on the moon, develop the atomic bomb, win the war. While laudable, many of these analogies point to a far-off singular event – one that we will know is happening when we see it. On the flipside, such analogies undervalue incremental benefits. Let me ask it this way, if we focus only on a future cure, do we effectively ignore the hundreds of thousands of American men living with the disease today – over a million men worldwide?
Fifty years have passed since President Nixon declared “War” on cancer. Few would argue that we are still fighting it. But what will it mean to “win” the war on prostate cancer? Consider this list of a few outcomes that might qualify:
- Nobody ever gets it.
- Those who get it have zero chance of dying of it.
- Those who get it can control it, live a normal lifespan, and death from it is highly unlikely, but they need treatment, and treatment does not alter their daily life to a great extent.
- Those who get it can control it, live a normal lifespan, and death from it is highly unlikely, but they need treatment, even if there is considerable cost and side effects.
- Anybody who gets access to treatment can live longer than they would have a few years ago.
Right now, at best, we are at #5. Those with access to good care are in #4, #3 and even in some cases #2 ( consider a patient with one focus of Gleason 3+3=6 prostate cancer – a disease so indolent there is legitimate debate about no longer calling it cancer).
Yet in the US we are still losing over 30,000 men to the disease every year. So let’s just consider this a starting point and think of the list above as the hierarchy of our approach.
PCF should have audacious goals but need to be realistic about what can be achieved in the short, medium, and long term. So, to start, let’s ask the question – what more can we at the Prostate Cancer Foundation do to move us from #5 to #4? Can we get to a point where we can assure a man diagnosed with prostate cancer that he is likely to live out a normal lifespan, without the risk of his survival being compromised by the disease? That would be a successful incremental outcome.
But to start, let us talk about #5. It involves access to treatment more than about major scientific discoveries.
I’ll use the example of docetaxel use in metastatic prostate cancer. This is a treatment that is not new and has been validated in several large well designed clinical trials as a means to decrease the risk of death from this disease over time. Although today there are other options besides docetaxel in the front line management of the disease, docetaxel has a number of key advantages:
- A mere six doses of the drug is sufficient to substantially reduce the likelihood of dying from prostate cancer.
- It is generally well tolerated, even by older patients ( especially when we compare it to chemotherapies that are administered for other cancers)
- It is generic and relatively inexpensive, especially for the patient himself.
I’m not writing this as an advertisement for docetaxel, but I am suggesting that simple implementation of the standard of this care for all eligible patients is one fairly generous step towards reducing the death and suffering from prostate cancer.
So why bring this up? It’s a standard treatment and everybody must be getting it so let us focus our efforts on solving the next problem, right? Not so fast. Prior to starting at PCF, Steve Freedland and I from Cedars-Sinai worked with a team and recently co-authored a paper evaluating the proportion of patients with metastatic prostate cancer who receive docetaxel chemotherapy as a part of their treatment ( among other treatments). To our surprise, we found, based on national insurance claims data, that the number is <10%.1
Millions of dollars were spent studying this treatment in thousands of men and the results are unequivocal – docetaxel improves survival. It is a settled argument. Yet, in the real world, 90% aren’t getting this. This is a source of frustration – but also a great opportunity for us at PCF.
Many of the world’s top cancer biologists and translational scientists are engaged in our efforts. They use sophisticated techniques and dive deeper into cancer cells, their genetics, and their epigenetics. Their work yields tremendous insights and promises the development of more effective therapies and diagnostics that describe this complex disease and its multiple faces. We will support them further as they dive deeper and push us towards the top of this pyramid.
But at the same time we, as an organization, can help ensure that those who face the disease today face it with the full complement of effective strategies to deal with it – which includes therapies, technologies, and most importantly, informed and knowledgeable treatment teams.
I would much rather spend our precious research dollars on discovering more ways we can target the biology of prostate cancer that will allow us to be at #2 or even #1 on the cure hierarchy detailed above. With that said, getting more patients to receive proven therapies might be a higher yield way, in the short run, to lead to an immediate reduction in the death and suffering from the disease. Fortunately, we don’t need labs to do this. But we do need their rooftops – because that’s where we need to be shouting from as we learn new results.
So what can PCF do about this? It's actually pretty simple – we can communicate. We can be a reliable source of thoughtful analysis as to new findings and how they affect the current and future treatment landscape. We can be a place clinicians and patients go to put research in context, find community and incorporate it into their treatment. In short, we can ensure that the PCF is the world’s public square for reliable prostate cancer communication, education, and interpretation. In doing that, we can help the treatment teams deliver more effective therapies and capitalize on this standard. And by the way, that standard of care is evolving right before us, with the pending implementation of results from the PEACE and ARASENS studies with abiraterone and darolutamide, respectively, chemotherapy will be paired with these drugs, and outcomes are even better.
As we build the next version of PCF we will tie our research efforts to educational and communications efforts – through pcf.org, urotoday.com, and cancerpatientvoices.com to do this. Research progress only matters if someone is on the other end of the line to receive and implement the information.
Written by: Charles J. Ryan, MD is the President and Chief Executive Officer of The Prostate Cancer Foundation (PCF), the world’s leading philanthropic organization dedicated to funding life-saving prostate cancer research. Charles (Chuck) J. Ryan is an internationally recognized genitourinary (GU) oncologist with expertise in the biology and treatment of advanced prostate cancer. Dr. Ryan joins the PCF from the University of Minnesota, Minneapolis, where he served as Director of the Hematology, Oncology, and Transplantation Division in the Department of Medicine. He also served as Associate Director for Clinical Research in the Masonic Cancer Center and held the B.J. Kennedy Chair in Clinical Medical Oncology. Prior to moving to the University of Minnesota, he was on the faculty of the University of California, San Francisco, where he served as Program Leader for Genitourinary Medical Oncology and held the title of Thomas Perkins Distinguished Professor in Cancer Research. Dr. Ryan earned his medical degree from the University of Wisconsin Medical School and a BA in Philosophy, magna cum laude from Marquette University. He trained at the University of Wisconsin Hospital and Clinics, serving as Chief Resident, and at Memorial Sloan Kettering Cancer Center in New York.
References:
1. Ryan C., Xuehua K., Lafeuille M-H., Management of Patients with Metastatic Castration-Sensitive Prostate Cancer in the Real-World Setting in the United States. The Journal of urology. 2021; 206(6):1420-1429