Expert Connections: Hereditary Prostate Cancer - Episode 5
Nicholas J. Vogelzang, M.D., FASCO, FACP: When a patient is diagnosed with prostate cancer, as there was today, I saw a patient of Japanese ancestry. He was young, only 65 years old, it had spread out, and it was prostate cancer. The first thing I wanted to do is get his genetic testing. There’s a 25% chance that he’ll have an abnormality. He didn’t have any family history. His mother had a brain tumor. I don’t know what that means as far as his genetics are concerned. He’s already been on the hormone treatment, and that has caused him to be miserable.
The hormone treatments caused hot flashing, muscle loss, and poor quality of life. He is eager to get off the hormone treatment, but if he cannot get off the hormone treatment and the cancer gets worse, then my choices, if he has the BRCA mutation, would either be chemotherapy or PARP [poly ADP ribose polymerase] inhibitors. Genetic testing will determine which one I will choose depending on the mutation he has. If he has a BRCA1 or a BRCA2, he could get either one. If he has a CHEK2 or a PALB or a RAD51 genetic abnormality, then he’ll have to get olaparib. But that aside, the quality of life on these PARP inhibitors is good.
The quality of life is somewhat better than it is on chemotherapy. There is no hair loss, at least not generally. There can be some mild nausea, fatigue, arthritis, etc. You’ll follow the patients carefully. The worst thing that happens is the anemia, and if they get anemic, then many times you must hold off, back down, reduce the dose a little bit, or delay. On rare occasions you have to give them a blood transfusion. But that is rare. Usually, just by holding the medicine for a short period, the blood counts come up and they’re back feeling well again. It can be a very dramatic effect when pain is present, and the patient has already had chemotherapy.
Sometime these drugs work within days and the pain melts away. It can be encouraging to the patient. And as a result they’re optimistic, and their quality of life improves. These are broad estimates. Each patient will differ. Each side effect will affect their quality of life to some extent. Generally, the drugs have a high level of retention of a good quality of life. That would be the best thing I can say.
Transcript Edited for Clarity