Matthew Cooperberg, MD, MPH, Assistant Professor of Urology; Epidemiology & Biostatistics, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, discusses the imminent stage migration that is likely to occur as new therapies become available expressly for metastatic prostate cancer.
The boundary between M0 (no metastasis) and M1 (metastatic) prostate cancer is arbitrary and depends heavily on the methods used to detect metastasis. In fact, Cooperberg stresses, most patients with M0 prostate cancer likely have microscopic metastasis that cannot be detected by standard bone scans.
These stages have remained unchanged to date because therapeutic options were limited. However, recent advances have brought an abundance of effective treatments into this space, providing incentive to pursue more advanced diagnostic approaches, such as fluorine-based PET scans.
This stage migration will not be without consequences, Cooperberg notes. While the agent sipuleucel-T (Provenge) has a fixed cost, other treatments can be given for an open-ended timeframe. Beginning these therapies earlier, and ultimately providing them for a longer period of time, may dramatically impact costs.
Since its approval in 1998 to treat metastatic breast cancer, the anti-HER2 monoclonal antibody trastuzumab has dramatically expanded life expectancy and improved quality of life for women diagnosed with HER2-positive disease.