Prostate cancer: Race matters in diagnosis, treatment

Other than skin cancer, prostate cancer is the most common cancer in American men. That's why early detection is key.

Now, Duke University researchers say race plays an important role when it comes to risk and response to treatment.

Known as Hugh "Muddy Waters" Hargett on the football field back in college, this now grandfather had trouble tackling the diagnosis of prostate cancer.

"I couldn't eat. I probably lost about 45 or 50 pounds," he recalled.

"One in 9 men will be diagnosed with prostate cancer in their lifetime," Duke Cancer Institute Dr. Daniel George said.

An oncologist, George says that even though there's been a decrease in prostate cancer cases, too many lives are still being lost.

"Death from prostate cancer is at an all-time high: 29,000 deaths a year in the U.S.," he said.

He says African Americans are at a greater risk for developing the disease.

"And they are at a 2 ½ times greater risk of dying from prostate cancer," George said. "Should we be treating these patients differently?"

Researchers at Duke Cancer Institute studied both African American and Caucasian patients, treating both groups with a drug called abiraterone

"We saw a better response in the African American population than the Caucasian population," George said.

Now, they want to understand genetically why these patients do better.

"Can we use that information to treat them even earlier and maybe cure some of these guys?" George asked.

Hargett has been on the chemotherapy drug for two years and found out his cancer is in complete remission.

"It's a really fantastic response, and I'm very happy for you," George said. "Thank the Lord!"

Now, he believes it is possible to beat cancer, but he knows there are no guarantees.

"I'd never thought I'd be here today," Hargett said.

This new research is giving men at high risk hope for the future.

George says it's not the skin color that's important; it's the genes associated with skin color that can affect treatment response.

Hargett will continue to stay on the chemotherapy even though that study has concluded.

RESEARCH SUMMARY

PROSTATE CANCER: RACE MATTERS REPORT #2627

BACKGROUND: Every 17 minutes another American man dies from prostate cancer. That's a little more than 86 deaths per day and 31,620 this year. One in nine American men will have prostate cancer during his lifetime. Prostate cancer is the second leading cause of cancer death among American men and is the most commonly diagnosed. The American Cancer Society estimates in its Cancer Facts & Figures 2019 report that 174,650 men will be told they have prostate cancer in 2019. Currently there are nearly 3.1 million American men living with the disease. Early detection and advances in treatment are saving lives. Finding prostate cancer when it is still at an early stage offers the best hope for living cancer free for a long time. The most recent research shows the five-year survival rate for all men with prostate cancer is nearly 100 percent. The relative ten-year survival rate is 98 percent, and 96 percent for 15 years. (Source: https://zerocancer.org/learn/about-prostate-cancer/facts-statistics/)

DIAGNOSING PROSTATE CANCER: If a digital rectal exam or prostate-specific antigen test detects an abnormality, your doctor may recommend further testing to determine whether you have prostate cancer. A trans-rectal ultrasound will further evaluate your prostate. A small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to create a picture of your prostate gland. If initial test results suggest prostate cancer, your doctor may recommend a procedure to collect a sample of cells from your prostate (prostate biopsy). Prostate biopsy is often done using a thin needle that's inserted into the prostate to collect tissue. The tissue sample is analyzed in a lab to determine whether cancer cells are present. While still being developed worldwide, MRI fusion to assist in prostate biopsy and diagnosis is being used more and more. At Mayo Clinic, urologists and radiologists collaborate to leverage MRI fusion biopsy technology, yielding the best fusion imaging available for prostate cancer care. Mayo Clinic is also the first medical center in the United States approved by the Food and Drug Administration to prepare and administer C-11 choline PET scanning to help detect recurrent prostate cancer at its earliest stages. (Source: https://www.mayoclinic.org/diseases-conditions/prostate-cancer/diagnosis-treatment/drc-20353093)

NEW PROSTATE CANCER DRUG BREAKTHROUGH: A British trial has for the first time shown that state-of-the-art immunotherapy can be used to target prostate tumors. The study at the Royal Marsden Hospital in London found more than a third of men who had run out of existing options were still alive and one in ten had not seen their tumors grow after a year of taking Pembrolizumab, which targets a gateway and helps the immune system to attack cancer cells. For some in the group, the drug even caused their tumors to shrink. Funded by the Institute of Cancer Research, the team will now set out to identify the genes that will tell them which people are most likely to benefit from the drug. Previous trials using immunotherapy in prostate cancer have been unsuccessful but the latest research examined the genetics of the tumors and found particular groups of patients may benefit. While only five percent of men in the trial saw their tumors shrink or disappear after treatment, many of those had mutations in genes involved in repairing DNA. The researchers suggest these mutating cancer cells may be easy for the immune system to recognize and attack because they look different from healthy cells. Professor Johann de Bono, Director of the Drug Development Unit at The Institute of Cancer Research, said, "I have these men who are basically dying, with weeks to months to live, who we gave this drug to and had complete responses. Their cancers shrunk, disappeared actually, with minimal cancer left on scans." (Source: https://www.telegraph.co.uk/news/2018/06/02/prostate-cancer-breakthrough-new-drug-keeps-men-previously-untreatable/)