Metro Atlanta home to several prostate cancer clinical trials

4/08/2019, Atlanta Business Chronicle, Health Care Quarterly

Today, more than 2.9 million men nationwide are living with prostate cancer, and millions more will develop the disease as they age. Prostate cancer also is attracting more research dollars and is the subject a growing number of clinical trials, many in metro Atlanta.

For men with the more deadly form of prostate cancer, these clinical trials at institutions such as Emory’s Winship Cancer Institute, Piedmont Cancer Institute, Grady Memorial, Atlanta Cancer Care in Conyers and others provide access to new and innovative approaches including new drugs, new drug combinations and other advancements.

“Prostate cancer is one of the most common cancer diagnoses in the United States and the number-one gender-specific cancer that affects men,” said Dr. Christopher Filson, assistant professor of urology at Emory University School of Medicine.

There were 164,690 new prostate cancer diagnoses in 2018, which is 9.5 percent of all cancer cases, according to the National Cancer Institute.

To be eligible for a clinical trial, men must meet the specific requirements of the study, including diagnosis of the disease and usually a specific medical and treatment history.

“We have a clinical trial program quite robust for folks who need radiation therapy,” said Dr. Vasily Assikis, a medical oncologist with Piedmont Cancer Institute, P.C. “We have a number of clinical trials for radiation therapy and we also have a very successful and robust program in management of advanced prostate cancer.”

Trials, such as those going on in Atlanta, have given physicians insights into what works best in treating the disease at different stages.

“Around 2015, we started using chemotherapy up front with patient diagnosed with metastatic prostate cancer,” said Dr. Mehmet Asim Bilen, associate medical director at Winship Cancer Institute of Emory University. “In addition to hormone deprivation therapy, we just start chemotherapy at the beginning.”

In some cases, men diagnosed with prostate cancer may not necessarily need treatment, said Filson, who said he involved with studies for some of these patients. “It’s called ‘active surveillance,’ and we participate in a multi-center trial with other universities such as Harvard and the University of Washington Seattle,” he said, “where we’re monitoring men and trying to see if there are certain blood or urine tests that can help figure out whether they develop or have more advanced types of prostate cancer that may need treatment.”

Winship Cancer Institute will participate in a trial to determine whether treatment with surgical removal of the prostate or radiation help patients with metastatic cancer. “The traditional way of managing men who have prostate cancer that has spread is to give therapy to the whole body, not necessarily remove the prostate or treat the prostate with radiation,” said Filson, adding that this large national trial will help determine which approach is more effective.

Another clinical trial at Winship is assessing the impact of educational programs in improving health outcomes. The trial studies how well an educational interview works in helping African American patients better understand treatment and side effects.

Other current studies focus on men who receive drug treatments for the whole body before surgery, to eliminate prostate cancer cells that may have spread. “If we knock out of small parts of cancer that got elsewhere before surgery and then remove the prostate,” said Filson, “is that more helpful for high risk patients?”

Men can tap into clinical trials through the National Cancer Institute website or by asking their personal physicians. But participation in studies reveals another example of the rural-versus-urban divide in health care: with nearly all trials located in large metro areas, men in rural areas seldom have access to them. “           There are some barriers to participation in cancer trials not just for prostate cancer, but in general for men who live in more rural areas of the state and are maybe of lower socio-economic status,” said Filson.

Funding for prostate cancer research also tends to lag behind other, more high-profile diseases. The National Cancer Institute allocated $233 million to prostate cancer compared to $545.1 million for breast cancer. The American Cancer Society funded grants totaling $64,325,725 for breast cancer and grants worth $28,934,712 for prostate cancer research.

However, prostate cancer is starting to get more attention, said Rudy Morgan, acting executive director and vice president of the Georgia Prostate Cancer Coalition. “The problem is the data, the numbers, the disease have always been there.”

Over the past decade, guidelines for prostate cancer screenings have changed dramatically, physicians said. Where once doctors always ordered PSA and digital rectal exams as part of their male patients’ physicals, data did not support their effectiveness. In fact, across the general population, these exams produced a high number of false positives, so they are not routinely performed today.

Risk Factors for Prostate Cancer

* Age: Chances of developing prostate cancer increase with age

* Family history: Father, grandfather, or brother had prostate cancer.

* Race: More common in African American (1 in 5) than Caucasian men

Source: National Cancer Institute

Randy Southerland

Contributing Writer

Atlanta Business Chronicle