Death rate jumps to fifth place! Prostate cancer metastasis "castration resistance" is more difficult! PARP inhibitors can extend survival, and "this gene" can pay for it
A mature man’s bone pain caused him to undergo surgery, but it turned out to be bone metastasis from the silent killer “prostate cancer”
According to the latest causes of death in Taiwan released by the Taiwan Ministry of Health and Welfare in June 2023, prostate cancer has jumped to fifth among the top ten cancers in terms of mortality, and the number of deaths has increased significantly by 8.3% compared with the previous year, reaching 65 It is one of the leading causes of death in Taiwanese people over the age of 18, and once metastasis occurs, the five-year survival rate may be less than 40%. It can be called the “silent killer of mature men.”
Dr. Ye Shaode, director of the Cancer Center of Taipei Medical University Hospital, said that up to 30% to 40% of Taiwanese prostate cancer patients have metastasis when they are first diagnosed, especially bone metastasis. There are no obvious symptoms in the early stages of prostate cancer. Many patients suffer from neck cancer. Or the back pain may be thought to be just a long bone spur, but after examination it is found that the tumor is compressing the spine. After further examination, it is discovered that it is prostate cancer bone metastasis.
Does prostate cancer metastasize as soon as it is discovered? Castration resistance increases risk of death
Dr. Ye Shaode pointed out that prostate cancer is extremely dependent on male hormones, and it is necessary to control the patient’s male hormones to extremely low levels through “castration therapy”. However, once prostate cancer metastasizes, whether to lymph nodes, bones, or even the liver or lungs, it usually recurs after 1 to 3 years and does not respond well to castration therapy, progressing to “metastatic castration resistance.” “Prostate cancer”, even if the treatment effect is good, the patient still has a high risk of dying from prostate cancer, and the mortality rate and malignancy are even less ideal.
“Metastatic castration-resistant prostate cancer does not only occur in the elderly. Nowadays, many patients who are only about 40 years old develop metastatic castration-resistant prostate cancer!” Dr. Ye Shaode said, among which young people have prostate cancer. One reason is related to heredity. The patients themselves may carry the hereditary oncogene “BRCA1” or “BRCA2”. Not only do they develop the disease at a younger age, but it also metastasizes faster than ordinary cancers. The threat to life caused by prostate cancer cannot be ignored. degree.
New breakthrough in the treatment of metastatic castration-resistant prostate cancer! Targeted drug PARP inhibitor extends survival
Dr. Ye Shaode explained that the diagnosis of prostate cancer is based on the calculation of the “Gleason score” (Gleason score) by biopsy and the PSA at the time of initial diagnosis to assess the malignancy and risk of metastasis. If prostate cancer has metastasized when diagnosed, the vast majority will progress to metastatic castration-resistant prostate cancer.
In the past, chemotherapy was the standard treatment for metastatic castration-resistant prostate cancer. Although radiation therapy can improve local pain, it does not help prolong the patient’s survival. Since then, a new generation of hormonal treatments has emerged to improve survival in metastatic prostate cancer. Dr. Ye Shaode said that the most important breakthrough in the treatment of metastatic castration-resistant prostate cancer in recent years is the targeted drug PARP inhibitor. For patients with BRCA1 or BRCA2 gene mutations, the therapeutic effect is higher than those without gene mutations. Several times, in phase III clinical trials, it was shown that the average survival advantage increased by more than 5-7 months, and when used in the first line in advance, effective survival exceeded 10 months. The treatment and survival benefits are quite obvious. It will also be included in health insurance from November 2023 and can be paid to patients with BRCA mutation genes.
PARP inhibitors are included in health insurance! How to treat prostate cancer without genetic mutation?
Dr. Ye Shaode explained that the drug mechanism of PARP inhibitors is called “synthetic lethality”. Cell DNA needs to be repaired through recombination of genes including BRCA1, BRCA2, etc. to maintain normality. Some patients are born with mutation defects in the repair genes. Or during the process of cell cancerization, DNA repair of cancer cells is transferred to the repair mechanism of PARP polymerase. Oral PARP inhibitors block the repair mechanism of abnormal cells by inhibiting PARP polymerase, thereby achieving the purpose of killing cancer cells.
What should I do if I develop metastatic castration-resistant prostate cancer and no BRCA gene mutation is detected? Dr. Ye Shaode said that oral PARP inhibitors can be used alone when there is a BRCA1 or BRCA2 mutation. However, clinical trials have proven that even if there is no BRCA1 or BRCA2 mutation, oral PARP inhibitors can be combined with a new generation of hormonal drugs and used for protection regardless of genotype. Adenocarcinoma can also prolong the survival of patients and improve their quality of life.
Dr. Ye Shaode reminded that the treatment of metastatic castration-resistant prostate cancer has made great progress. There are actually patients in Taiwan who received oral PARP inhibitor treatment, and the PSA index dropped significantly to less than 1 ng/mL, and the tumor metastasis Symptoms were also significantly relieved. Prostate cancer patients are urged to actively receive treatment and discuss with their doctors whether to undergo genetic testing to find the most appropriate treatment.
Is prostate cancer in Taiwan more malignant than in Europe and the United States? Doctors reveal 2 major cancer risk factors that should be screened for early
The prostate’s ranking among the top ten cancers in terms of mortality increases year by year. Does this mean that prostate cancer in Taiwan is more malignant than in Europe and the United States? Dr. Ye Shaode explained that early-stage prostate cancer has almost no symptoms. Men mistakenly believe that urination is smooth or there is no bone pain, so they ignore the risk of prostate cancer. As a result, up to 3-40% of Taiwanese people have metastatic prostate cancer when diagnosed. Sex or late.
Blood testing for PSA is currently the main screening method for prostate cancer. It is recommended that men aged 50 to 55 undergo at least one PSA screening or digital anal examination to help detect prostate cancer early. If the PSA index is abnormal, you can also consider undergoing prostate magnetic resonance imaging (MRI). The prostate imaging report and data scoring system can be used to analyze the risk of prostate cancer, which is more accurate than a simple PSA test.
Dr. Ye Shaode reminded that prostate cancer and prostate hypertrophy cannot be distinguished simply by symptoms. It is still recommended to seek treatment at a urology department as soon as possible when there are urinary problems. In addition, there is a clear family history of prostate cancer, such as the father himself suffering from metastatic or high-risk prostate cancer, or three or more (including three) third-degree blood relatives having any risk of prostate cancer. This is a family history with a high genetic risk. It is recommended to undergo the first prostate examination and PSA screening as early as 40-45 years old in order to increase the chance of early detection of prostate cancer.
References:
See the Ministry of Health and Welfare: “Statistical Results on Causes of Death in Taiwan in 2022”
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