According to the NIH’s National Cancer Institute, about one in every eight men will be diagnosed with prostate cancer making it the most common cancer among men in the United States. Additionally, prostate cancer is the third most common cancer in the University of Cincinnati Cancer Center’s ten-county catchment area.

Prostate cancer usually grows very slowly, and detecting and treating it early has many benefits including extending life. Prostate cancer begins when cells in the prostate gland start to grow out of control. Almost all prostate cancers are adenocarcinomas, which means that it begins in prostate cells that make and release mucus and other fluids.

“The management of prostate cancer is an ever-changing field,” said Dr. Patil. “Almost every day, we notice improvements in diagnostic techniques and treatment modalities led by both technological and pharmacological innovations.”

Nilesh Patil, MD Member, Experimental Therapeutics Research Program University of Cincinnati Cancer Center Director of Robotic Urology, Department of Urology University of Cincinnati College of Medicine

There are eight types of standard treatment for those with prostate cancer:

• Active Surveillance
• Surgery
• Radiation Therapy
• Hormone Therapy
• Chemotherapy
• Targeted Focal Therapy
• Immunotherapy
• Bisphosphonate Therapy

Active surveillance, also referred to as watchful waiting, is a treatment used for older men who do not have signs or symptoms or have other medical conditions that are likely to affect their life span rather than prostate cancer itself. Active surveillance is also a form of treatment used to manage men with prostate cancer that is not very aggressive and unlikely to spread. This treatment involves closely monitoring a patient’s condition without giving any treatment until signs or symptoms appear or change.

Patients in good health whose tumor is in the prostate gland only may be treated with surgery to remove the tumor. This type of surgery is called radical prostatectomy with a pelvic lymphadenectomy. Radical prostatectomy is a surgical procedure that involves removing the prostate, surrounding tissue and seminal vesicles, and it can be robotically assisted, which is the most common and least invasive.

“Prostate cancer can be treated in multiple ways,” said Dr. Patil. “For some prostate cancers, less is more, so we manage them with active surveillance. For some aggressive prostate cancers, surgery and radiation therapy form the cornerstone of treatment with robotic surgery being the most common and least invasive, and radiation therapy being the other common avenue.”

Today, if surgery is recommended for a patient with prostate cancer, they could be a candidate for da Vinci Surgery, which is a highly effective and minimally invasive procedure that enables doctors to perform the most precise surgery available.

“There are many exciting technological advances available to treat prostate cancer right here,” said Dr. Patil. “For instance, we are the first healthcare system in Cincinnati to procure the latest DV5 version of the da Vinci Surgery robot.”

For most patients, da Vinci Surgery offers numerous potential benefits over open surgery including:

• Excellent cancer control.
• Faster return of urinary continence.
• Faster return of sexual function.
• Shorter hospital stay.
• Low level of pain.
• Less blood loss and transfusions.
• Lower risk of infection, complications.
• Faster recovery and return to normal activities.

Dr. Patil, an expert in prostate cancer, emphasizes the importance of a comprehensive approach to treatment, which is offered at the Cancer Center.

“Multiple treatment options exist for treating and managing prostate cancer while minimizing the side effects on men,” Dr. Patil explained. “Therefore, it is important to take opinions from institutes that offer all the options. High-volume cancer centers, like the University of Cincinnati Cancer Center, are designed to take care of patients with prostate cancer in a holistic fashion.”

“A multidisciplinary team comprised of a surgeon, radiation oncologist, medical oncologist, radiologist, nuclear medicine radiologist and pathologist provide consultation to patients who are referred to the Cancer Center,” Dr. Patil said. “Almost all forms of treatment options for prostate cancer are available right here on our medical campus, and we have multiple ongoing clinical trials to address the emerging problems we face in prostate cancer.”

The Clinical Trials Office at the University of Cincinnati Cancer Center manages oncology trials for the University of Cincinnati College of Medicine's clinical departments. There are numerous types of clinical trials, each with a different purpose: treatment, prevention, diagnostic, screening, quality of life and observational. The Clinical Trials Office conducts comprehensive research studies within all these categories, and the research professionals within the Office serve as key resources for patients, investigators and sponsors on cutting-edge clinical trials that advance science.

One such cutting-edge trial is the Saruparib (AZD5305) vs Placebo in Men with Metastatic Castration-Sensitive Prostate Cancer Receiving Physician's Choice New Hormonal Agents (EvoPAR-PR01) study, which focuses on patients with metastatic hormone-sensitive prostate cancer. The trial drug is in a class of drugs called PARP inhibitors, which have gained a well-established role in the management of prostate cancer over the last three years.

PARP is a protein in cells that helps the cancer cells repair damaged DNA. By blocking PARP, the cancer cells become more prone to dying. This can be particularly effective in a subset of men who have inherited disorders with genetic repair like BRCA mutations.

“One particularly exciting advantage of this PARP inhibitor is that, unlike the earlier-generation PARP inhibitors, it causes less side effects in the blood,” Dr. Franklin said. “Prostate cancer, unfortunately, affects an enormous number of men, and as we gain more powerful insights into the biology of prostate cancer, we look forward to using clinical trials like this one to help men live longer and healthier lives.

Robert Franklin, MD Member, Experimental Therapeutics Research Program University of Cincinnati Cancer Center Assistant Professor, Department of Internal Medicine University of Cincinnati College of Medicine

Learn more about the Phase III EvoPAR trial.