New developments in Prostate Cancer Dr Jo Bowen Consultant Oncologist Worcestershire Royal Hospital

Key areas of Prostate cancer research: Making the diagnosis Improving outcomes of radical treatment New treatments for patients with advanced disease

Prostate Cancer diagnosis: Diagnosis of prostate cancer is made by carrying out a prostate biopsy This is usually carried out because: the patient has new suspicious symptoms the prostate feels abnormal PSA blood test is raised

Prostate Cancer diagnosis: PSA sensitivity is low when the levels are only slightly raised Only one in five biopsies will show cancer in this situation Research is ongoing looking for more accurate ways of predicting the presence of cancer

Urine PCA 3 test: prostate cancer diagnosis New urine test looking at the amount of a prostate cancer gene product in the urine The greater the amount, the higher the chance of prostate cancer being present May become a useful additional test when deciding on initial or repeat biopsies

Radical Radiotherapy for prostate cancer Aims of research in radiotherapy: Improve effectiveness Reduce side effects

Improving Effectiveness: Increasing dose Changing daily dose/ length of treatment Addition of other treatment modalities New hormone treatments Chemotherapy Targeted agents

Reducing side effects Reducing dose to nearby organs: - Intensity modulated radiotherapy (IMRT) - Increasing accuracy of patient positioning

New treatments for advanced prostate cancer The majority of prostate cancers are stimulated by the male hormone testosterone Mainstay of treatment for advanced prostate cancer is removing this stimulus usually by suppressing the production of testosterone

Advanced prostate cancer In time the prostate cancer can start to progress without the stimulation of male hormones Chemotherapy is effective in improving quality and length of life Urgent need for effective treaments at this stage

Process of new drug development: Laboratory development - drug companies Small trials primarily to look for side effects Studies to look for activity against the cancer Much larger ‘randomised’ studies to confirm expected effectiveness and side effects

Hormone therapy: Abiraterone New drug that prevents the synthesis of male hormones Current studies have looked at patients who have already had chemotherapy and the results are encouraging Larger trials have now completed recruiting patients and the results are awaited Studies are also looking to see if this drug can improve the effectivness of radiotherapy

Chemotherapy: Cabazitaxel New chemotherapy drug Recent large trial has shown activity in patients who have already had standard chemotherapy with improved response rates and survival

Targeted agents: Bevacuzimab - Antibody that inhibits the blood supply to the tumour Ipilimumab (MDX-010) - Antibody that stimulates the immune system to fight the cancer cells