Prof. Michael Marberger, MD: Advances in Advanced Prostate Cancer from EMCC 2011

Prof. Michael Marberger, MD, FRCS discusses the highlights in advanced prostate cancer therapy treatments at the 2011 European Multidisciplinary Cancer Conference in Stockholm.

The Group Room at the 2011 European Multidisciplinary Cancer Conference was made possible, in part, by:

 

VIDEO TRANSCRIPT

Selma Schimmel, Founder & CEO, Vital Options International:

This is Selma Schimmel at the Multidisciplinary Cancer Congress 2011 in Stockholm. Thank you Professor Doctor Marberger for taking time to talk to us here in Stockholm about some of your impressions and thoughts about what’s happening in the area of prostate cancer, and also advanced prostate cancer.

Prof. Michael Marberger, MD, FRCS, Professor & Chairman, Dept. of Urology, University of Vienna:

Well we’re seeing exciting development where we have been seeing it in the last five years. Our clinical problem and advanced prostate cancer is the failure of androgen deprivation which is the first line treatment and up till about five years ago that basically meant that we were running out of options. There were some variations of the treatment but basically it was only about five years ago that we really had new approaches – first was chemotherapy, cytotoxic therapy, which has been shown to promote or to extend life, survival. It hasn’t been as successful in palliation, which is an important issue in patients who have had the disease for ten, fifteen years and has gone through all phases of it. But now we are beginning to see a number of drugs, which are basically a modification – some of them, at least – a hormonal therapy which seem to be able to influence the androgen receptor, which is still the turning point in keeping the tumor going.

Selma Schimmel:

What about an early stage of prostate cancer at this point?

Prof. Michael Marberger:

Well early stage prostate cancer is a big issue for urologists because I would say 80% of the patients we see come in – let’s call it a localized cancer stage. And our big issue there is are we treating cancer that needs to be treated and are we treating it sufficiently depending on its aggressiveness? And these are some of our main interests right now. We feel that we have become much better at selecting cancers that need treatment, active surveillance for tumors with a low tendency to progress is an accepted treatment. It’s not no treatment, it is active surveillance about 30% of these patients will ultimately have localized treatment. But one out of seven patients ultimately fails curative treatment and goes into phase where he needs some other form of treatment.

Selma Schimmel:

And up until this point you really haven’t been limited because you’ve had chemotherapy which now has – for the advanced cancer patient – at least there are new options that we can offer these men.

Prof. Michael Marberger:

Well there are some other issues in there too. I mean prostate cancer is a cancer of the aging men, and even patients that have progressive disease only about half of them die from their prostate cancer. The others die of something else because they’re over 85. So not every patient that has progress prostate cancer really dies from this disease and therefore the treatment we apply has to be adapted to the individual situations. And but now – like you said – we have real alternatives, and the way it looks they are less invasive and less toxic alternatives than what we had before.

Selma Schimmel:

What are the associated side effects associated with these new drugs.

Prof. Michael Marberger:

Well it depends on what drugs we’re looking at. If we take those which are – let’s call them most imminent, or have already been approved – it’s mainly drugs that’s still impact the hormonal control of the cancer, and the side effects are there but they are not very significant compared to for example, alternatives for cytotoxic therapy first line, second line, third line cytotoxic therapy. What is also important for very old men is that it can be done by oral treatment, it can be done in outpatient basis, he does not have to modify his lifestyle, which many of them do and the problems in treating patients with chemotherapy now for 15 years. The toxicity in old men – men that are usually older than what we see in our standard studies, which this treatment is based on – is considerably higher.

Selma Schimmel:

Professor Marberger, what is in the pipeline? Where do you see the future of prostate cancer in current research?

Prof. Michael Marberger:

Well right now it definitely is in what we’ve learned over the last couple of years is that the androgen receptor is not cut out by androgen depravation or castration. We know that there are a number of ways this androgen receptor adapts and still promotes the androgen-driven mechanism in prostate cancer. And we have developed new approaches in interfering with this mechanism, and so we have a newer form second line of hormonal therapy which is coming up now, which seems to be very attractive. One of the problems we are facing now in clinical practices is that the ones we are talking about have already been approved after failure of chemotherapy, which is a logical problem because in order to be approved they have to show a survival advantage and patients that have not reached the castrate resistant phase, or what’s called the end-phase just have a long life expectancy, and to prove that there is an extension of survival takes a longer period of time. So the trials are not there yet for that group of patients which is a big group, but already for castrate resistant prostate cancer that failed chemotherapy they have been shown to both improve survival and this is probably even more important, give validation.

Selma Schimmel:

Do you anticipate that at some point some of these new therapies that you are using in the advanced setting will move towards the earlier disease setting?

Prof. Michael Marberger:

Well yes, definitely so but it has to be proven by the appropriate trials. Trials are all under way, but it will take a longer period of time.

Selma Schimmel:

And the last question I have, I find it interesting because it varies so much by country in Europe. You come from Austria, what is the useage of PSA versus digital rectal exam. Where are we as far as screening in your country?

Prof. Michael Marberger:

Well digital rectal exam has really lost a lot of its significance, I would say, in the early move to detection prostate cancer with PSA is the standard. Like I said in Austria, well over 60% of all men over 50 have had at least one PSA test in their life, and I think this is where it’s going to go all over Europe. In fact, I think Europe is a lot more homogeneous than it was five years ago.

Selma Schimmel:

Thank you very much. I appreciate you taking time to speak with us.

Prof. Michael Marberger:

Thank you.

END OF VIDEO

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