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‘Bring It Back to the Patients’ With Focus on Quality of Life in Prostate Cancer

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Dr. Stephanie Berg of Dana-Farber Cancer Institute and Harvard Medical School discusses the need to be mindful of quality of life when treating prostate cancer.

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For providers who are treating patients with prostate cancer, there has been a renewed emphasis in 2023 on remaining mindful of quality of life while delivering effective treatment options, one expert told CURE®.

“The biggest news so far, I would say, is that we've had really, and especially in prostate cancer, (more) focusing back on quality of life, we're really seeing a lot of new data coming out on how we can improve lives of our patients with cancer,” said Dr. Stephanie Berg. “I think in the field as a whole, we're really always shifting in how we can have cures and how we can treat cancer, but now I really bring it back to the patients and how we can really support them (while they are) on their cancer treatments.”

Berg is a medical oncologist for the Dana-Farber Cancer Institute’s Lank Center of Genitourinary Oncology and an instructor of medicine at Harvard Medical School in Boston.

For instance, when discussing the findings of the phase 3 EMARK trial, which resulted in the approval by the Food and Drug Administration (FDA) of Xtandi (enzalutamide) for the treatment of some patients with non-metastatic castration-sensitive prostate cancer (nmCSPC), Berg observed that in the trial, Xtandi was not shown to improve patients’ quality of life.

In particular, Berg noted this despite other encouraging results. After five years, metastasis-free survival was 87.3% for patients treated with Xtandi plus Lupron (leuprolide), 71.4% for those treated with Lupron and placebo and 80% with Xtandi alone.

“I think it's something to note, (that) when this trial had three different treatment arms, there really wasn't an improvement in quality of life, (researchers) just said there are no new safety or side effects noted,” Berg said. “But they didn't really say that men were maybe living better, they all kind of had the same symptoms, especially fatigue, which is a big one.”

LEARN MORE: Men’s Health News in the Cancer Space From 2023

In 2023, researchers found that stereotactic body radiotherapy that was guided by magnetic resonance imaging (MRI) significantly reduced moderate side effects and improved quality of life for patients with prostate cancer compared with radiotherapy guided by standard of care.

Elsewhere, data presented at the 2023 American Society of Clinical Oncology (ASCO) showed that patients who were cured of high-risk prostate cancer experienced a better quality of life after testosterone recovery following treatment with androgen deprivation therapy (ADT).

“Patients have a lot of choices when it comes to prostate cancer treatment; they can either undergo surgery or they can undergo radiation, they can undergo chemotherapy, or they can watch it,” Dr. Kiran Nandalur, a radiologist at Corewell Health in Grand Rapids, Michigan, told CURE® earlier this year. “So, for them, for patients with prostate cancer, when they make their choice of therapy, what they really want to consider (as) somewhat important is what are the potential complications are there, because they're likely going to live a full life, which is great.”

Berg advised that patients discuss quality of life and studies examining that facet of cancer care with their providers.

“I always recommend looking asking your doctor and looking out there because there have been so many things coming in about these studies and how patients perceive treatment,” Berg said. “And it's really shifting the field of how we're reporting data.”

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