PCF Scientific Retreat Top Stories for Patients: New Methods and Overcoming Disparities

PCF held the 28th Annual Scientific Retreat virtually over 4 days in late 2021. Once again, researchers, industry partners, clinicians, patient advocates, and others were able to join from anywhere in the world to discuss the latest findings in prostate cancer research, treatment, and survivorship. PCF’s Dr. Andrea Miyahira has identified the top stories for patients.

Using VA Prostate Cancer Data to Improve Clinical Trials
Tito Fojo, MD, PhD
Columbia University and the James J. Peters VAMC

What this means for patients: Dr. Fojo and colleagues have developed a new method called “g,” to calculate tumor growth rate. G strongly predicts overall survival, the current “gold standard” outcome in clinical trials. G may eventually be used in several ways to accelerate trials and the development of new treatments.

Currently, the criteria for measuring disease response versus progression in prostate cancer is based on changes in tumors on scans. PSA responses are also used, but are not considered valid by the FDA to determine the efficacy of new treatments. Dr. Fojo and colleagues have developed a novel method to calculate tumor regression and growth that is more accurate and informative than standard methods.

This new approach, called “g,” is calculated from PSA levels over time. The research team found that g strongly predicts overall survival, and thus may act as a “surrogate biomarker” for making treatment decisions and evaluating the efficacy of a new treatment. (In other words, g may provide information earlier about how well a treatment works, rather than waiting many years for survival data.) They also evaluated the use of g as a marker in a large study of Veterans who were switched from abiraterone to enzalutamide or vice versa. How to identify which patients should remain on a therapy vs. switch to another is an important question. 

Using existing data, g can be used to reduce the size of, or even eliminate, control arms. G could also be used to inform decisions about new treatments under development, and make decisions with small numbers of patients, including those with rare cancers or rare mutations. The FDA has requested further studies to evaluate g for use in clinical trials.

Prostate Cancer Disparities: What We Know, and What We Can Do
Brandon Mahal, MD
University of Miami

What this means for patients: Prostate cancer disparities result, in large part, from unequal access to care. Additional research on biology and genetic factors remains to be done. Solutions must be multi-pronged, including: increasing access to insurance and clinical trials, and actively engaging diverse communities.

African Americans are over 75% more likely than Caucasians to be diagnosed with prostate cancer, and more than twice as likely to die from it. We know that genetics plays some role, but the impact of social and economic inequalities is better defined. One such factor is medical insurance: Mahal and colleagues have reported that among uninsured men with prostate cancer, Black men were much more likely to go untreated (28%) vs. Caucasian men (16%). Knowing about gene mutations in a tumor can help save lives, but research studies include relatively fewer people of non-European ancestry. Moreover, Black men tend to get this type of tumor testing later in their treatment course. 

Solutions to disparities require research in diverse populations, and outreach programs to bring care delivery and cutting-edge science to diverse communities. Patients and communities must be engaged as research partners rather than subjects. These approaches should incorporate transparency, education, acknowledgment of the history of racism, and a diverse oncology workforce.

Written by Prostate Cancer Foundation. PCF is the world’s leading philanthropic organization dedicated to funding life-saving prostate cancer research. Since it was founded in 1993, PCF has funded more than 2,200 research projects at 245 leading cancer centers in 28 countries around the world. For more information, go to www.pcf.org or call 1-800-757-CURE.