For that small percentage of men with prostate cancer who are not cured by surgery or radiation, the outlook has been dismal. Recent drug development has resulted in somewhat better outlooks, but death is inevitable. Some of the newer approaches have been discussed in a prior post. Now comes the next revolution. Modern genetic testing has come to prostate cancer. Two approaches stand out.
First, a substantial minority of men with prostate cancer will harbor a germ-line mutation, meaning that every cell in the body has a genetic mutation inherited from one parent. One thinks about this with breast cancer (the BRCA family of mutations) or colon cancer (the mismatch repair gene family of mutations); however, one or the other of these mutations can be seen with prostate cancer. If present treatment with so-called PARP inhibitors should be highly effective. Not enough men have been treated to give percentages but this approach is very promising.
Next, men with the mismatch repair gene are also candidates for therapy with a highly effective new class of drugs, so-called PD-1 inhibitors. These drugs, such as Pembrolizumab, have caused very prolonged remissions — possibly cures — in people with metastatic melanoma and lung cancer. As with PARP inhibitors, there are not enough data to predict long-term outcome, but the outlook is much more promising than it used to be. Stay tuned….