Answers provided by Brendan Curti, M.D., oncologist and prostate cancer researcher, Providence Cancer Center.
Q. Why is prostate cancer receiving so much attention lately?
Well, in part because it’s a very common diagnosis: it’s estimated that 189,000 men are now diagnosed with this problem every year in the United States. I think part of it is also because some well-known people like Bob Dole and Colin Powell have been diagnosed recently, thus creating more awareness.
Men with prostate cancer as a group have been traditionally less activist than women with breast cancer, and I think they’ve learned something from the breast cancer community and are now starting to increase the awareness of this very important health problem.
Q. What’s the average age that men are diagnosed with prostate cancer?
It’s actually been changing. There’s been a trend that more men in their 40s, 50s and 60s are diagnosed with this disease – traditionally it’s a diagnosis for men in their 70s and older. We’re learning that there’s a strong hereditary component to prostate cancer, and that may be why men are being diagnosed at earlier ages and with more aggressive disease.
Q. Is prostate cancer prone to spread, or metastasize, and how does that affect the patient?
When doctors use the term “metastatic,” it implies that the cancer has left the place where it started and spread to other areas in the body. In the case of prostate cancer, the favorite places for the cancer cells to travel are the lymph glands and also the bone.
Metastatic disease affects a high percentage of men with prostate cancer: roughly 40 percent or so of men with this condition will have it spread outside the prostate. That’s why a very active area of research here at Providence Cancer Center is to stimulate the function of the immune system in order to fight the cancer.
Q. How does immunotherapy work?
Because the currently available medicines we have do not cure prostate cancer when it’s metastatic, there is a real and ongoing need for new ideas and new research. There are some very exciting areas that we’re working on, using our knowledge of the immune system to fight the cancer. In addition, there are a number of different strategies using vaccines – special medications to boost the immune system or even reboot or reset the immune system in preparation for a vaccine.
Let me explain the philosophy behind immunology: The immune system has a way of remembering foreign proteins and a way of responding to that over time. It is thought that to have an effective immune response, it’s not enough for the immune system just to see that there is a problem: it has to respond to it and then be ready if that problem arises again. We try to promote the memory function of the immune system to remember that there’s something bad going on and then to react to it when the cells start to divide and grow elsewhere in the body.
Other places are pursuing other approaches, but we feel that immunotherapy holds the greatest benefit for a specific attack on the cancer and hopefully will spare the body the side effects of other medicines that are less specific in the fight against the prostate cancer. We have devoted a talented group of researchers to develop new immunotherapy. There are very few places that do the sort of immunotherapy research that we do here at Providence.
Q. Do you see new hope for men with prostate cancer? Hope that maybe you didn’t have five to ten years ago?
In years past, men with prostate cancer often just got pain medication to treat the consequences of the spread of the cancer to their bone. We now have ways to intervene, including not only the newer generation of the hormone-blocking medications, but new chemotherapies. We also have medications that have certainly altered the course of the cancer as well as helping to provide comfort for these patients. So, yes, I would say that there is more hope that we can alter the course of this disease, certainly more hope that we can control its symptoms, and I think ultimately hope that we can use the power of the immune system to fight the cancer.
Dr. Curti is part of the prostate cancer research team at Providence Cancer Center's Robert W. Franz Cancer Research Center in the Earle A. Chiles Research Institute on the campus of Providence Portland Medical Center.
February 2004
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