Prostate cancer treatment has changed a lot in recent years. What one expert calls a previously “boring space” has become one of the most exciting areas in cancer care. 

These advances are coming at the right time. Doctors expect a 40% increase in prostate cancer cases over the next five years due to an aging population.

“This is a really exciting time with regards to prostate cancer,” says radiation oncologist Michael Baine, MD, PhD, who practices at the Fred & Pamela Buffett Cancer Center – Nebraska Medical Center. “When I started here seven years ago, it seemed like nothing had changed in prostate cancer for 20 years.”

That’s no longer true. Dr. Baine notes that the field now sees “two to four practice-changing things happening every single year.” These developments focus on two main goals: 

• Better cure rates.
• Easier treatment for patients.

Targeted therapy brings radiation directly to cancer cells

One of the biggest advances involves PSMA-directed treatment. PSMA stands for prostate-specific membrane antigen. This protein is found mostly on prostate cancer cells. Scientists have created therapies that attach to this protein and deliver radiation right to cancer cells.

“There are several therapies now that basically have an antibody that attaches to that protein, that PSMA, and then we use a little radioactive tag that can bring radiation directly to that cancer cell,” Dr. Baine explains.

This method is highly precise. “Depending on what the radioactive tag is, sometimes radiation will only go as far as one to two cells’ distance. So, it can be very specific to where the cancer is,” he says.

Right now, this treatment is only available for patients with advanced cancer that can’t be cured. But researchers are studying whether it could help patients with earlier cancer who might benefit from upfront treatment.

Making treatment shorter and easier

Another major focus is reducing the time patients spend in treatment. Regular radiation therapy for prostate cancer usually requires 28 treatments. Researchers are working to cut this down to just five treatments while keeping the same results.

“We’ll hopefully end up making this  more accessible, especially for patients in rural areas, and a lot easier for patients, even in more urban settings like Omaha,” Dr. Baine says. “They will receive these treatments and not have their everyday lives impacted as much, coming every day for weeks on end.”

For patients who need radiation therapy after prostate surgery, known as “salvage radiation therapy,” Nebraska Medicine and UNMC researchers are studying ways to reduce treatments from almost 40 sessions to as few as 25. This reduction comes from using better imaging to find exactly where cancer may be hiding.

“Now that we have scans that allow us to better identify where the cancer might be, we can use a lower dose of radiation everywhere in the pelvis and then focus on that one area of cancer that we identify on the scans,” Dr. Baine explains.

Better access to high-dose treatment

Many cancer centers can only offer external beam radiation. This limits their ability to deliver the highest doses of radiation that improve cure rates. But new techniques are changing this problem.

Large studies called FLAME and HYPO-flame have shown promising results. Using advanced imaging to locate cancer within the prostate allows doctors to increase radiation doses to specific areas using external beam methods. This approach doesn’t require extra treatments. It just means more radiation during each regular session.

“The data shows that by doing that type of escalation, with an external beam approach, can increase cure rates by 10%, 15%, 20%,” Dr. Baine says.

This development is especially important for patients treated at centers without specialized brachytherapy. That’s where radioactive seeds are placed directly into the prostate to treat cancer.

The role of treatment planning experts

Behind these treatment advances is sophisticated planning. Specialists called dosimetrists work with doctors to create custom radiation plans for each patient. These experts make sure radiation hits cancer cells while protecting healthy tissue.

“We have six dosimetrists here, and they are all absolutely phenomenal,” Dr. Baine says. “I don’t think there is another team of dosimetrists in the country that is better than the one that we have.”

The Fred & Pamela Buffett Cancer Center, the state’s only NCI-designated cancer center, provides access to this level of expertise.

Reason for hope

The combination of an aging population and better screening means many more men will face prostate cancer in coming years. The good news: treatment options keep getting better.

“Having these improved treatments means more patients can be treated, reducing the burden on the health care system, and in a way that doesn’t derail their normal life,” Dr. Baine says. “We see where things are going with prostate cancer treatment and we’re succeeding in meeting it head on.”

Current cure rates already reach impressive levels. They’re 95% or higher in some cases, and at least 75% in most situations. As these new treatments become standard care, those numbers should keep improving. At the same time, the treatment process will get easier for patients and their families.

The change from a “cookie cutter recipe” approach to personalized, precise treatment represents a big shift in cancer care. For the thousands of men who will face prostate cancer in coming years, these advances offer hope for effective treatment with less disruption to their daily lives.