Prostate cancer

In the last decade we witnessed science and medicine making giant leaps in the field of breast cancer treatment. The next decade the same trend is expected in the treatment of prostate cancer, which like breast cancer is sex specific and has become ubiquitous.

Most cancers are notoriously equal- opportunity killers. Some like breast and prostate cancer are confined to a particular sex. In the recent years we have seen the market being swamped by a deluge of new drugs for the treatment of advanced stage breast cancer. Unfortunately we are yet to see any such major breakthroughs in the treatment of prostate cancer. Though if detected at an early stage, prostate cancer can be quite benign and easily treated, but the cancer’s persistence for a long period can prove to be fatal. But this lack of any new drug may very well change soon.

A better grasp and understanding of the exact genesis of the disease, the associated biological factors have triggered an era of new drug development which is quite similar to the revolutionary era which saw the ushering in of Herceptin, the pioneer drug in the treatment of breast cancer. These innovative therapies which are currently undergoing clinical trials were at the foremost of every major discussion at the Congress of European Association of Urology which was held in Paris from February 24th – 28th.

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New Drugs

Some of the therapies mooted were quite outlandish, bordering on the realm of fantasy and science fiction, which included genetically engineered viruses that could actually the cancerous cells from the inside. However, there are a number of drugs which are currently at an advanced stage of development.

Cabazitaxel from the stable of French firm Sanofi is one such drug in the pipeline. It is closely linked to taxol, a drug which is primarily used for the treatment of ovarian and breast cancer. Its modus operandi is simple. It prevents the formation of certain structures called microtubules, responsible for pulling the chromosome apart in the cancerous cells. It received approval for commercial use in 2010 after the results of extensive clinical trials clearly suggested that the particular drug actually prolonged the life span of men where the prostate cancer is at an advanced stage.

A second drug, Abiraterone from the healthcare behemoth Johnson & Johnson, received approval in 2011 after its amazing efficacy against the disease was clearly established in a particular clinical trial. So amazing was the potency of the drug that the trial had to be stopped midway because it was deemed extremely unfair that the respondents in the control group were denied this medicine.

Abiraterne primarily works by stopping the activity of an enzyme, responsible for testosterone production. Most importantly its testosterone inhibiting action is spread to every tissue that is responsible for testosterone production. A common morphological alteration that is seen in cancerous prostate cells is their hypersensitivity to testosterone. In fact “Castration – Resistant” is a very commonly used terminology in the medical parlance, used to signify late stage prostate cancer as even such an extreme testosterone reduction measure cannot stem the cancer’s spread. But thankfully, Abiraterone, has been efficacious in this regard.

The only other proven viable approach in the treatment of late stage prostate cancer is the development of a vaccine. Sipuleucel –T is the vaccine in question, which unlike other preventive vaccines is a therapeutic one. Cultures of human dendritic cells,a part of our immune system, are used for its development. These cells if treated properly with fusion proteins can make the prostate susceptible to immune attack. A major impediment that could derail the vaccine’s development is the humongous cost associated, as the treatment for every man needs to be customized – using dendritic cells from the person’s own body. With the estimated cost running upto ten thousand dollars per course, it is highly unlikely any individual or government or any insurance organization will be willingly shell out such gargantuan sums.

Cost is indeed a major consideration. For the same reason Abiraterone was recently assessed to be extremely expensive in lieu of the additional years of life it confers. However, one must keep in mind that at the time of its discovery, Herceptin too was deemed expensive, but over the years because of economies of scale it has become a routine drug and the womankind has been massively benefitted. Hopefully, the new prostate cancer drugs will chart the same path as that of Herceptin and make men’s lives better.