Combination therapy extends survival in metastatic prostate cancer
Prostate cancer generally grows slowly. Even if cancer cells unfortunately spread, patients can often coexist with the cancer if given appropriate treatment. Taking diffuse hormonal therapy-sensitive prostate cancer as an example, Consultant Urology Surgeon of Gleneagles Hong Kong Hospital, Dr. Lu Tingjie (specialist in urology), said that the latest international guidelines recommend the use of traditional hormonal therapy and a new generation of oral hormonal drugs (double combination therapy), or Coupled with chemotherapy (triple combination therapy) as standard treatment, the overall survival period is significantly longer than traditional treatment. Dr. Lu described that patients are generally inclined to accept new combination therapies. Currently, some social welfare organizations also provide assistance to patients with financial difficulties, and he hopes that patients will actively accept treatment.
Lu Tingjie, consultant urologist at Gleneagles Hong Kong Hospital, said that there has been a breakthrough in the treatment of diffuse prostate cancer and the results are encouraging. He hopes that patients will actively accept treatment and live with the cancer.
The third most common cancer among men in Hong Kong, but “long life” is not a dream
Prostate cancer, considered “the most painful thing for men”, is the third most common male cancer in Hong Kong. The number of newly diagnosed cases has been on the rise in the past 20 years. It is believed that this may be related to the aging of the population, the increase in average life expectancy and the increasing popularity of related screening. Dr. Lu said that age and family history are high-risk factors for prostate cancer. Epidemiological studies have also shown that high-fat diet, obesity and smoking may increase the risk of prostate cancer.
According to Dr. Lu’s clinical experience, most patients in Hong Kong are diagnosed in their 60s. However, prostate cancer generally grows slowly. If diagnosed and treated early, the chance of recurrence is low. Many patients can coexist with the cancer and even live a long life. , only to die from other long-term illnesses.
Symptoms are only obvious in the late stages. Diagnosis and treatment are based on high and low metastasis amount.
Prostate cancer is mainly classified into localized and diffuse. Early-stage prostate cancer may have no symptoms. In many cases, abnormal prostate cancer index is discovered through screening. The symptoms of advanced prostate cancer are more obvious, including hematuria, frequent urination, urinary retention, ureteral obstruction and even kidney failure. If it spreads to the bones, it can cause bone pain, fractures, anemia, and even spinal cord compression and paralysis of the lower body.
Dr. Lu analyzed that diffuse prostate cancer can be divided into high volume metastasis (high volume) and low volume metastasis (low volume) prostate cancer based on the location of metastasis and the number of cancer cells. If the patient is suitable for hormonal therapy (that is, no resistance has been produced), sex), it can be classified as hormone therapy sensitive prostate cancer.
International guidelines: dual and triple combination therapy as standard treatment
In the past, the treatment of diffuse hormonal therapy-sensitive prostate cancer was mainly traditional hormonal therapy. Dr. Lu said: “The latest international guidelines recommend adding a new generation of oral hormonal drugs (dual combination therapy) to traditional hormonal therapy, or in combination with Chemotherapy (triple combination therapy) as standard treatment can significantly prolong the overall survival of patients and reduce the mortality rate by about 25% – 30%. In the past, patients may develop drug resistance in about 2 years after receiving traditional hormonal therapy, but now it is postponed to that time. It may appear after about 4 to 5 years. “In addition, Dr. Lu mentioned that as long as the choice is appropriate, the side effects will not be significantly increased compared with traditional treatment, and the patient’s quality of life will not be greatly affected.
Dr. Lu described: “As long as they are properly selected, dual and triple combination therapies can significantly extend the overall survival of patients without significantly increasing side effects, which can be said to subvert the traditional treatment methods.”
Case: New combination therapy effectively and continuously controls the disease
Dr. Lu cited a case in his 70s who was diagnosed with diffuse hormone therapy-sensitive prostate cancer in 2022. The patient developed symptoms of hematuria and bone pain. After further examination, it was found that the prostate cancer index reached 300, which is a very high level. The cancer cells had spread to the bones and lymph nodes, indicating that it was a highly metastatic prostate cancer. After the patient was advised to receive dual combination therapy, the prostate cancer index dropped to less than 1 and the number of sites of spread was also reduced. Dr. Lu added: “The patient has been receiving dual combination therapy for two years after diagnosis, and his condition continues to be under control. On the other hand, if he only receives traditional treatment, resistance problems may occur after one year.”
Social welfare organizations provide financial support
Although dual and triple combination therapies are more effective than traditional treatments, some patients will inevitably worry about not being able to afford the medication, which may make them hesitant when choosing appropriate treatment. Fortunately, there are now social welfare organizations that provide drug subsidy programs for patients with financial difficulties. The programs are mainly divided into two types, including covering the patient’s drug costs for a certain course of treatment, or setting up a “capping” mechanism. When the patient pays a certain amount of drug costs, , the social welfare agency will bear the cost of the remaining course of treatment.
In fact, as long as prostate cancer is taken seriously, high-risk individuals undergo regular screening, seek medical advice early if symptoms occur, and receive appropriate treatment, prostate cancer will no longer be “the most painful thing for men.”
Information provided by Dr. Lu Tingjie, Specialist in Urology
The above health column is supported by Hong Kong Astellas Pharmaceutical Co., Ltd.
