POSTED: September 04, 2015

Advanced Prostate Cancer

In August’s Prostate Forum, we’re talking about advanced prostate cancer with Dr. Philip Kantoff and Dr. Himisha Beltran.

Read these conversations.

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Here’s Dr. Myers’s introduction to the issue:

In this issue, we’re featuring conversations with two investigators making major contributions to our understanding and treatment of advanced prostate cancer.

Dr. Philip Kantoff has long been one of the major clinical investigators involved in prostate cancer research and is now Director, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute. While our conversation with him covers a range of topics, I suspect two are of great interest to our readers.

The first issue involves the impact of statins on prostate cancer. As Kantoff points out, there are sound retrospective studies showing a correlation between statin use and improved effectiveness of hormonal therapy. We now have a potential mechanism for the effect of the statins. From multiple studies, we know that one way the cancer cells can resist hormonal treatment is to take up DHEA sulfate and convert it to dihydrotestosterone. Dr. Kantoff and his team have shown that statins reduce the uptake of DHEA sulfate by prostate cancer, eliminating one potential mechanism of hormone resistance. At this point, enough is known to design a Phase 3 clinical trial randomizing patients to hormonal therapy alone versus hormonal therapy plus a statin. While we await the results of such trials, it certainly makes sense to use statins for their approved purpose–to lower elevated cholesterol in patients in whom diet and exercise are not sufficient.

Both Dr. Kantoff and our second interviewe, Dr. Himisha Beltran, are both heavily involved in using gene sequencing to characterize the changes that can make advanced prostate cancer difficult to treat.

I am particularly interested in the work Dr. Beltran has done to characterize neuroendocrine prostate cancer. This is a form of prostate cancer that has traditionally been difficult to treat. Fortunately, this has been a relatively uncommon form of prostate cancer.

However, as the intensity of hormonal therapy has increased, the frequency of neuroendocrine prostate cancer has increased. In fact, in the laboratory, testosterone removal has been shown to foster the development of neuroendocrine prostate cancer. This is why Dr. Beltran’s work is so important as it has led to the discovery of new drug targets that may improve treatment of neuroendocrine prostate cancer.

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