Dan George, M.D., is a medical oncologist and director of Duke Cancer Institute Genitourinary Oncology. He and his colleagues at Duke are continually working to offer better treatment options to men with prostate cancer.
What is the outlook for men with prostate cancer?
Today we are able to help men continue to live with prostate cancer for years beyond what we’ve historically been able to do. Even for patients with metastatic disease, we can offer a sequence of therapies that in many cases can stop the cancer from progressing and can maintain quality of life for years.
What are the therapies that can help men with metastatic disease?
Prostate cancer is different from many other cancers in its dependency on testosterone. Traditionally, therapies that suppress testosterone production by the testicles have been a mainstay of treatment for advanced disease. But recently it has been shown that prostate cancer can progress despite low testicular testosterone because the tumor is either able to make its own testosterone or turn on the testosterone receptor in the tumor.
Since 2011, a new generation of therapies have been approved that target testosterone production anywhere in the body, particularly in the tumor itself. These drugs—abiraterone acetate and enzalutamide—have drastically improved the survival of men with metastatic, castration-resistant prostate cancer.
Can men with earlier-stage disease take these therapies?
Currently those two therapies are approved only for men with metastatic disease. However, at Duke, through clinical trials, we are studying these new therapies to understand how well they will work in men with earlier stage disease, how they work in combination with other therapies, and whether some patients will benefit more than others.
What are you doing to understand health disparities in prostate cancer?
We are studying why rates of prostate cancer are higher among African-American men than white men, and why more African-American men die from the disease. We are investigating the genetic differences underlying this disparity, which may help us direct therapy based on genetics.
We are also studying whether race, genetic differences, or both affect response to hormonal therapy.