By Bernie Riley
Head of Telenursing and Supportive Care Programs, PCFA
The last 10 years have seen massive leaps in the treatment of prostate cancer, and it's exciting to see there is more to come.
The push to find a cure remains the central focus of many across the globe and it is hard to believe that just 15 years ago, there were very few treatments for prostate cancer beyond surgery, radiotherapy, chemotherapy and hormone therapy.
Alongside this, there have great advances in the understanding of managing prostate cancer effects and the impacts of treatments.
Let's take a look at some of the advancements in treatment to be announced over the last year.
In the past year, men with metastatic prostate cancer gained PBS subsidized access to two such medications, Nubeqa (Darolutamide) and Erlyand (apalutamide).
Both of these drugs work with standard hormone therapies injections to suppress testosterone and reduce the drive for prostate cancer cells to grow and spread.
These tablet-based therapies are funded on the Pharmaceutical Benefits Scheme (PBS) for different stages of advanced prostate cancer and give new hope to men and their families.
Men diagnosed with metastatic disease (cancer which has spread beyond the prostate region) either at initial diagnosis or after initial treatment by surgery and/or radiotherapy may be eligible for Erlyand when cancer has spread beyond the local prostate region to bones, organs or lymph nodes outside the pelvis.
The tablets come from a class of drugs called Androgen Receptor Signaling Inhibitors (ARSI).
Simply put, they aim to prevent testosterone from linking with its usual receiver on the prostate cancer cell, thus slowing further growth. Nubeqa, Xtandi (enzalutamide) and Erlyand do this by blocking testosterone from connecting to the prostate cancer cell receptor (receiver).
Zytiga (abiraterone) and Yonsa (abiraterone and methylprednisolone) work by preventing a protein from making testosterone in the testicles, adrenal glands and prostate cancer tumours Zytiga has been available on the PBS for a few years for men's with cancer that has become resistant to initial hormone injection therapy (ADT) commonly referred to as metastatic castrate resistant prostate cancer (mCRPC). Yonsa is a new formulation of abiraterone and a steroid combined together in one tablet and is PBS listed as an alternative to Zytiga and other ARSI's in mCRPC.
Normally, BRCA genes help stop abnormal cells from growing and repair damage to cells. Mutations (faults in the gene) to BRCA 1 and 2 genes enable growth and repair of cancer cells.
The newly PBS subsidized Lynparza (Olaparib) targets particular proteins which repair these abnormal cancer cells, leading to prostate cancer cell death.
Listing on the PBS
The PBS listing of the medications listed above means that eligible patients will pay just $30 (general patients) or $6.90 (concessional patients) for each cycle of treatment, rather than more than $30,000-60,000 per year without this subsidy.
At last count there are 65 clinical trials recruiting in Australia aiming to improve the chances of Australian men surviving and tackling prostate cancer.
Every trial aims to improve men's chance of not only living longer but also improving their quality of life.
With each of these trials and new medication listings new hope springs.
For many, that means being around to blow out more birthday candles, celebrate more anniversaries, see children get married and grandkids spring to life - and for others it means more time, new relationships, travels and experiences.
