34 JUNE 2017
Hunsicker’s non-profit, the
One-in-Six Foundation, eventually
gave funding to Dr. Denmeade’s lab.
Although Hunsicker died of prostate
cancer in 2010, his tenacity lives on.
“It was inspiring to me to keep him
in mind as we try to do all this stuff
to make a difference and not make a
profit,” Dr. Denmeade says.
Dr. Denmeade has invested
that money into a crazy idea that
flips conventional wisdom about
prostate cancer on its head.
Doctors have long looked to the
hormone testosterone as a piece
of the prostate cancer puzzle. Back
in the 1940s, Charles Huggins,
M.D., a professor at the University
of Chicago, found that he could
kill prostate cancer cells if he
blocked testosterone production.
Since then, oncologists have
used a testosterone-reducing
treatment known as androgen
deprivation therapy in men with
advanced prostate cancer. Kill
the T, kill the cancer – or so the
Health
theory goes, because the cancer
lives on androgen receptors that
testosterone binds to.
In the lab, however, Dr.
Denmeade’s team found that the
link between testosterone and
prostate cancer may be more
complex. When they exposed
testosterone-starved cancer cells to
a sudden high dose of T, the cancer
was suppressed. That T influx, it
seemed, might shock the cells and
break their DNA.
Now Dr. Denmeade’s team is
trying this method, known as
bipolar androgen therapy, in some
men with advanced prostate cancer.
Patients are injected with a “rapid
shock” of testosterone to spike
blood levels, which then taper off
over the course of a month.
Giving high doses of testosterone to
prostate cancer patients is novel, but
if it works, the benefits could be big.
Compared with treatments that cost
thousands of dollars, testosterone is
cheap and widely available.Prostate cancer is more
prevalent in men aged
between 60 and 74
Prostate enlargement, also known
as benign prostatic hypertrophy
(BPH), happens in almost all
men when they hit 50. BPH is
not cancer. Prostate cancer only
occurs when the rate of growth is
uncontrollable.WHAT YOU
NEED TO
KNOW ABOUT
PROSTATE
CANCER IN
MALAYSIAWe asked Dr. Sulaiman Tamanang
of the National Cancer Society
Malaysia to share his insightsThe incidence of prostate
cancer in Malaysia is
increasing...
You can blame awareness, but in
a good way, Dr. Sulaiman says.
More men are being tested for the
prostate-specific antigen (PSA). As
a result, more cases are detected,
contributing to the rise in numbers.... However, the death toll
has actually dropped
Regular testing for prostate
cancer has also meant early
detection, which prevents the
spread of cancer to other organs,
leading to a better survival rate,
Dr. Sulaiman says.Get a PSA test
Over-50s should include a PSA
test in their annual check-up.
Don’t be alarmed by symptoms
such as frequent urination, trouble
getting a urine stream and painful
ejaculation, Dr. Sulaiman advises.
They could just be symptoms of
BPH. It is always best to consult a
doctor when there are irregularities
in urination and ejaculation.In Dr. Denmeade’s first small
study, half the patients exhibited
dips in a common cancer marker,
and about a third had tumours
shrink. The patients were happy, and
some even regained sexual function.
As the next phase of research
begins (it should end next year),
Dr. Denmeade is trying to figure
out which patients respond best to
bipolar androgen therapy. It’s being
tested in 17 medical centres, but
it’s still too early to use the therapy
outside a study setting.
Even if it works, Dr. Denmeade’s
bipolar androgen therapy won’t
necessarily be a cure-all for prostate
cancer. “The disease is a whole bunch
of different cells,” says Eugene Kwon,
M.D., a professor of immunology
and urology at the Mayo Clinic.
Some are sensitive to chemo, some
to radiation, and some to hormone
therapy. “The cell manipulations
they’re exploring are a slice of the pie
when you talk about the spectrum of
prostate cancer,” he says. PHOTOGRAPHSISTOCKPHOTOSIDEBAR WORDSDENISE LIM“A lot of media says we
shouldn’t screen for or treat
prostate cancer, and that
you’re going to die with it,
not of it,” says Charles Ryan,
M.D., professor of urology.
“That’s just not true.”