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.”http://www.mens-health.com.my 35Active Surveillance
For small or slow-growing tumors, active
surveillance may be the way to go. Doctors
carefully monitor your cancer with blood tests,
prostate exams, and follow-up biopsies. If the
cancer shows any signs of aggres sive ness,
then treatments are initiated.Radical Prostatectomy
Have your problematic prostate removed.
In the robotic-assisted form of the surgery,
a surgeon controls the instruments remotely
within the patient’s body. Complications after
any prostatectomy can include urinary problems
and erectile dysfunction.Radiation Therapy
Intensity modulated radiation therapy (IMRT)
delivers radiation to your prostate, avoiding the
surrounding structures. Then there’s proton
beam radiation which, like IMRT, also shoots at
particles with precision. Like surgery, radiation
can affect urinary and erectile function.Brachytherapy
Your doctor places small radioactive seeds
into your prostate. They emit radiation for a few
months before burning out. It’s a kind of internal
radiation therapy. It’s best for patients with
lower-risk tumours. It can also affect
urinary and erectile function.WHAT ARE YOUR OPTIONS?
“You have prostate cancer.” These are four words no man wants to hear, but if you do, your
next priority will be to pick a treatment. We asked Raj S. Pruthi, M.D., chair of urology at the
University of North Carolina, to weigh some common choicesGo on the Sauce
In a study in the American Journal of
Clinical Nutrition, men who ate more
than two servings of tomato sauce
a week had a lower risk of prostate
cancer than guys who ate less than a
serving per month. Certain compounds
in cooked tomatoes may shield DNA
strands from breakage.Drink Responsibly
New Finnish research finds that people
who swig three alcoholic drinks a week
or less have a lower risk of prostate
cancer than heavy drinkers. As you
metabolise alcohol, your body makes
carcinogenic molecules, which are
only okay in moderation.Finally Quit Smoking
As if you needed another reason
to give up the cigs, research finds
that smokers are more likely to die
of prostate cancer than those who
never smoked. One factor is that
carcinogens from tobacco smoke likely
promote the creation of tumours.Buy Into Beans
In a recent study in the British
Journal of Nutrition, men who ate
the most legumes (about 170g a
week) had half the prostate cancer
risk of those who ate the least.
When your gut digests the fibre in
beans, it decreases inflammation,
which may play a key role in tumour
development.4 WAYS TO
PROTECT YOUR
PROSTATEProstate cancer often comes with age,
bad genes, or just plain bad luck – but
it’s still possible to chip away at your
risk. Try these tactics1
2
3
4
Dr. Denmeade is cautiously
optimistic. “There’s a fine line
between hope and hype,” he says.
But if further research deems the
treatment a bust, he has more ideas.
This is an important mission:
a projected 161,360 American men
will be diagnosed with prostate
cancer this year. Most will survive
with treatment; some strategies are
described below. Within five years
of their diagnosis, however, up to 20
percent of patients will learn that
their cancer has spread beyond the
prostate and is defying treatment.
This is when prostate cancer turns
deadly. It will likely kill more than
26,000 men this year.
“There’s a lot of media out there
that says we shouldn’t screen for
prostate cancer, that we shouldn’t
treat prostate cancer, and that
you’re going to die with it, not of it.
That’s just not true,” says Charles
Ryan, M.D., a professor of urology
at UC San Francisco. “There are
plenty of men who suffer and diehorrible deaths from prostate
cancer. The key to understanding
the difference is collecting data and
making a risk-adapted decision.”
Fortunately, a slew of new
treatments are now available.
“There are things that didn’t
exist five years ago that are now
standards of care,” says Fred Saad,
M.D., director of prostate cancer
research at the Montreal Cancer
Institute. Men are living longer
and better lives even with late-
stage disease. For instance, the
cancer-fighting drugs abiraterone
acetate and enzalutamide were
approved by the FDA in 2011 and
2012, respectively. In 2013, the FDA
approved radium-223 dichloride,
a form of radiation therapy for
men whose cancer has spread to
their bones. For men with certain
genetic mutations, poly ADP-ribose
polymerase (PARP) inhibitors- designated a “breakthrough
therapy” by the FDA – can
preferentially kill cancer cells.
Some centres now have
imaging tests to track tumours
every few months and see
which treatments work.
Some offer genetic tests to
personalise treatment. After
all, not all prostate cancers
are the same. One tumor can
require a completely different
protocol than the next.
“We can go from one therapy
to another, so we’re constantly
trying to bring patients back
into remission,” Dr. Saad says.
In other words, men with
late-stage prostate cancer
have more reason than ever to
be optimistic. If a doctor tells
you that you’re out of options,
seek a second opinion, ideally
from a specialised centre for
prostate cancer. “It’s sad to
say,” Dr. Saad says, “but for
some people, their end of the
road is not necessarily the
same as at other centres that
are doing a lot of research.”WORDSMEGAN DITROLIO (4 WAYS); SARAH SANTOS (OPTIONS)PROP STYLINGANGELA CAMPOS/BERNSTEIN & ANDRIULLI(OPENING PAGE);MICHAEL BRANDON MYERS(ILLUSTRATION)