While every year about 30,000 men die of prostate cancer in the United States, the most common cause of death in men with prostate cancer is heart disease. That's because not all prostate cancers are the same. Some are slow-growing while others are very aggressive.
The University of Michigan Comprehensive Cancer Center has started a new clinic focused on men with the fast-growing type of cancer. This kind of high risk disease is thought to possess a high likelihood of causing harm.
"These men will likely need more than one treatment because we know these types of cancers tend to recur. Patients with aggressive cancer need extra attention and a high level of care, including genetic information and a consensus opinion from different experts," says Ganesh Palapattu, M.D., FACS, director of urologic oncology and director of the new high-risk prostate cancer clinic at the U-M Comprehensive Cancer Center.
The clinic brings together experts in urology, medical oncology, radiation oncology and pathology. All of these specialists review cases together, discussing each patient's unique factors and agreeing on the best treatment plan. Patients also receive free cancer genome sequencing along with several recently introduced predictive genetic tests. Clinical trials are offered when appropriate.
For patient Jeffrey Roberge, 49, the idea of all the experts working to a consensus opinion helped make the process easier. Roberge was diagnosed with prostate cancer in August 2012. His cancer had not spread but was at high risk to do so. Roberge underwent surgery in January and has had regular PSA tests since - all of which have come back negative for cancer.
"It's daunting when you're not a professional and you don't understand all the options. When you have several doctors giving you their shared opinion, it makes it easier to help you make your own decision," Roberge says. "I didn't feel like I was floating around on my own trying to figure it out. We were all moving through the process together. That's comforting."
The high-risk prostate cancer clinic also offers survivorship services, including a team of social workers and other health care providers who help patients and their families deal with the challenges that go along with a cancer diagnosis.
As evidence grows that no two cancers are the same, doctors are more and more focusing on precision medicine, in which the particular genes, proteins or other markers in an individual's tumor tell doctors what kind of drug might be more effective - and what might be less effective. It allows patients to avoid drugs that are not likely to work for them.
"While prostate tumors may look the same from one patient to the next under a microscope, they may behave quite differently. This kind of behavior is driven largely by the genetics, the DNA sequencing of the cancer. Information about this DNA sequence or genetic sequence can be helpful in the future as we tailor therapy for a patient if the cancer recurs or comes back again after initial therapy," Palapattu says.
"We treat patients, not diseases. Our goal is to offer individualized treatment plans focused on each individual," he adds.
What is high-risk prostate cancer?
Doctors start with the results of blood tests and biopsies to guide the classification of high-risk prostate cancer. The key is that these are tumors likely to return or spread and cause poor outcomes.
Some of the markers that come into play include:
• Gleason score (8 or more)
• PSA score (20 or more)
• Advanced stage (T3 or higher)
• Relapse after prior surgery or radiation therapy