As the Republic of Korea enters a super-aged society, the importance of managing prostate cancer (prostatic cancer) is increasing. According to data released this year by the Korea Central Cancer Registry, as of 2023 prostate cancer has overtaken lung cancer to become the most common cancer among men. Prostate cancer is difficult to detect early because its initial symptoms are not distinct. However, advances in diagnostic technologies and therapeutics have recently enabled personalized treatment that takes into account individual patient characteristics and disease status, significantly improving treatment outcomes. Professor Chung Byung-chang of the Department of Urology at Samsung Medical Center discussed in detail the latest treatment strategies for prostate cancer.

―Prostate cancer is now the most common cancer among men. What are the reasons for this?

“In actual clinical practice, the increase in prostate cancer patients is clearly evident. The number of patients has risen not only in large tertiary hospitals but across general hospitals, leading to increases in the numbers of biopsies, surgeries, and diagnoses. The main causes of prostate cancer can largely be attributed to population aging and the westernization of dietary habits. Prostate cancer is common in Western countries, and previously in Japan, as the country became more westernized, prostate cancer increased sharply to the point that it became the number one cancer in men. A similar trend is now seen in Korea due to changes in eating habits toward a Western style and the growth of the elderly population.”

―What are the characteristics of prostate cancer, and what should patients be particularly aware of?

“Compared with other cancers, prostate cancer progresses relatively slowly and treatment outcomes are favorable, but once metastasis begins, the 5-year survival rate drops to 50%. Therefore, early detection is of paramount importance. Prostate cancer can be detected early with a simple blood test called PSA (prostate-specific antigen), and if identified at an early stage and treated, a cure can be expected. Early detection clearly improves survival rates, and because early screening is not difficult, regular PSA tests are recommended for adult men aged 50 and over. However, PSA is a screening test, not a definitive diagnostic tool, so if abnormalities are found in the PSA test, a biopsy should be performed and appropriate treatment should be initiated according to the diagnosis.”

―There is talk of a new drug for hormone-sensitive metastatic prostate cancer. What is it?

“For several decades, the standard treatment for metastatic prostate cancer has been androgen deprivation therapy (ADT). However, even with ADT, over time the disease tended to progress to a ‘castration-resistant stage’ in which cancer cells resume growth. Once the disease enters the castration-resistant stage, there have been few effective treatment options, and many patients have died within 1 to 1.5 years, which is why prostate cancer used to be regarded as a highly lethal cancer. Subsequently, more potent second-generation oral androgen receptor inhibitors (ARi) were developed, significantly improving treatment outcomes. However, these therapies have also been associated with adverse events such as general fatigue, asthenia, and skin rash. The most recently developed ARi, darolutamide, is known to provide a similar survival benefit to existing second-generation agents while minimizing such side effects.”

―There is now a wider range of ARi therapies. Besides efficacy, what should be considered when selecting a treatment?

“Quality of life is just as important as treatment outcomes. In particular, because prostate cancer requires long-term treatment and management, reducing the burden of adverse events is crucial. In some patients, ARi therapies can cause nervous system-related side effects such as generalized weakness, depression, and headache. Fortunately, the latest agent, darolutamide, is designed not to cross the blood–brain barrier, which reduces risks associated with the central nervous system and thereby lowers the risk of falls in elderly patients.”

―When prescribing doublet or triplet combination therapy with ARi for patients, what are the treatment strategies?

“Triplet therapy is an intensive regimen that adds an ARi and a chemotherapeutic agent (docetaxel) to conventional ADT. While its efficacy is strong, the inclusion of chemotherapy also increases the burden of side effects. Therefore, the choice between doublet and triplet therapy is made after comprehensively considering the patient’s metastatic sites and extent of disease, overall condition, and treatment history. For example, lymph node metastasis is regarded as a relatively indolent form of spread, whereas metastasis to the liver, bone, or throughout the body is classified as having a poor prognosis. Metastatic burden is also categorized as high or low volume based on the number (degree) of metastatic lesions. Triplet therapy is considered for patients with extensive metastases or poor prognostic factors. For patients with limited metastases or poor general condition, doublet therapy is selected, thereby providing individualized, tailored treatment.”

―How should the treatment environment for prostate cancer evolve going forward?

“The earlier prostate cancer is detected, the higher the cure rate and the lower the treatment burden and cost. Yet it is most regrettable that early detection through PSA testing is still insufficient. In regions with limited access to screening, there are indeed many cases in which patients are diagnosed late with advanced or metastatic prostate cancer. Therefore, it is hoped that PSA testing will be incorporated into the national screening program and that screening will begin in rural areas. Expanding patient access to the latest therapies is also important. For new drugs whose efficacy and safety have been verified but are not yet reimbursed, it is hoped that national health insurance coverage will be granted. This would enable domestic patients to receive global standard treatments and, in turn, significantly improve the overall treatment environment for prostate cancer in Korea. In particular, because these therapies can be used safely in elderly patients and those with comorbidities, benefits would extend to a broader spectrum of patients. Ultimately, if the overall environment from screening to treatment is improved, more patients will experience better survival and quality of life, and, furthermore, cures will become a realistic expectation for many.”

Popular News