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The impact of prostate cancer

In 2020, Luka and ~473,000 others in Europe, were diagnosed with prostate cancer.[1] Luka now faces a devastating reality of tiredness, fatigue, and pain.[2] On top of this, the terrifying risk of progression and metastases looms over.[3]

The patient described is fictional and has been used for illustrative purposes only.

The prostate is a walnut shaped gland in the pelvis of men[4]

The prostate is approximately 3 cm long and weighs 20 grams.[4] It produces approximately a third of the total seminal fluid.[4]

Prostate cancer can be divided into three types depending on the extent of its progression:[5]

Localised

Tumour limited to the prostate[5]

Locally-advanced

Tumour has spread outside the prostate to nearby structures or lymph nodes[5]

Metastatic

Tumour has spread to other parts of the body outside the prostate[5]

Within 5 years of diagnosis, 10–20% of patients with prostate cancer progress to castration-resistant prostate cancer (CRPC)[6]

Prostate

Prostate cancer begins as hormone sensitive prostate cancer (HSPC), this is where men have never recieved and/or are sensitive to androgen deprivation therapy (ADT)[7]

Over time, resistance to ADT develops, and the cancer progresses to CRPC[6]

Tumours can become castrate-resistant through:[8]
  • Androgen receptor gene mutations
  • Activation of different signal transduction pathways in CRPC cells 
  • Increased expression of androgen receptors

Risk factors of prostate cancer are varied[9] and include:

Age

Prostate cancer is common among elderly males. The risk increases in white men over 50 years of age who have no family history of prostate cancer and in black men over the age of 40 or men with a familial history of prostate cancer.[9]

Family history

It’s estimated that 20% of patients with prostate cancer have a family history of the disease. Genes known to play a role include HPC1, HPC2, MSR1, BRCA1, and BRCA2.[9]

Ethnicity

Variants on chromosome 8q24 associated with prostate cancer are more commonly reported in African American men.[9] What’s more, African American men often display a more aggressive form of the disease.[9]

Chronic or recurrent prostatitis

A significant positive relationship between prostate cancer and prostatitis, which is defined as inflammation of the prostate gland, has been demonstrated.[10]

Being overweight

Obesity is linked to advanced and aggressive prostate cancer.[9]

Diet

Diet can be associated with a higher risk.[9] For example, studies have shown a positive correlation between prostate mortality and per capita intake of meat, fat, and dairy products.[9]

Smoking

Some cohort studies have documented a two to three times higher risk in smokers of more than a pack a day compared with non-smokers.[9] Smokers have been shown to have a two-fold increased risk of death from prostate cancer, compared to non-smokers.[9]

Lack of exercise

Exercise is thought to be one of the easiest modifiable risk factors for prostate cancer.[9]

BRCA1; breast cancer gene-1, BRCA2, breast cancer gene-2. HPC1; hereditary prostate cancer-1,HPC2; hereditary prostate cancer-2, MSR1; macrophage scavenger receptor 1.

Prostate cancer is the most commonly cancer diagnosed in European men[1]

In 2020, ~473,000 men were diagnosed with prostate cancer in Europe,[1] and more than 108,000 died.[11]

Currently, 3 million men in Europe are living with prostate cancer, and that number is set to rise due to the aging population.[12] The average age for a prostate cancer diagnosis is 66,[9] and projections suggest by 2060 there will be an increase of 32 million men over the age of 65.[12]

Estimated age standardised mortality rates for prostate cancer in Europe in 2020, in males of all ages[13]

Map showing the number of prostate cancer deaths in Europe in 2020

Adapted from International Agency for Research on Cancer/World Health Organization, 2020.[13]

Diagnosis of prostate cancer can be performed through various methods, including:

A prostate-specific antigen (PSA) test[4][5]

which is a blood test highly sensitive to detecting a growth in the prostate tissue[14]

A digital rectal examination (DRE)

which is a manual exam where the doctor feels the prostate gland for signs of cancer.[5] This is especially useful for prostate cancers in the peripheral zone[4]

Transrectal ultrasound-guided (TRUS) prostate tissue biopsies

which is the use of ultrasound through the wall of the rectum to guide the needle for biopsies[4][5]

Transperineal biopsies

which is the use of ultrasound through the skin of the scrotum and anus to guide the needle for biopsies[5][15]

There are often no early symptoms of prostate cancer[12]

Tiredness and fatigue are the major physical manifestations of prostate cancer.[2] Other common symptoms can include:[5]

Difficulties urinating


Blood in urine or semen


Erectile dysfunction


Hip, back, chest, or bone pain


Weakness or numbness in the legs or feet


Loss of bladder or bowel control


Compared to patients with non-metastatic disease, patients with metastatic prostate cancer face reduced quality of life and increased mortality[2][5]

Those with metastatic disease face a ~70% reduced 5-year survival rate compared to those with localised or locally-advanced disease.[5]

In one study, ~56% of patients had detectable metastases at diagnosis.[16] A PSA doubling time of less than 10 months puts patients at high risk of disease progression.[17]

Metastatic prostate cancer has a devastating impact for patients, both physically and mentally.[2]

The most common sites of metastasis are the bone (78%), followed by liver (37%), and lung (30%).[18] However, the distribution of metastases can vary between countries: with liver metastases being infrequent in England and France (both 19%), but much more frequent in Germany, Italy and Spain (46%, 47%, and 32%, respectively).[18]

At Janssen Oncology, we are working tirelessly so that the words “you have prostate cancer”, will be less terrifying for patients to hear and less distressing for healthcare professionals to say.

To achieve this, we’re continuously working to make your days better, so you can make your patients’ days better.

Prostate cancer restricts everyday life for patients and has physical as well as emotional impacts[2]

According to the Janssen Oncology EMEA survey “Prostate Cancer: Living Not Just Surviving”:[2]

of prostate cancer patients feel that they are unable to do the activities they used to enjoy before their diagnosis

of patients who experience a negative physical impact as a result of their disease say it is linked to tiredness and fatigue

of patients describe intimacy with a partner as the activity most significantly restricted by prostate cancer

At Janssen Oncology, we consistently integrate patients’ perspectives into everything we do, to create solutions that make a truly meaningful difference

We know that the precious time cancer leaves patients with is often tainted by the physical and emotional burden of their disease. We are dedicated to improving quality of life, to ensure patients can maximise the time they have left. To address this, we are working to develop new treatments and innovative endpoints for our clinical trials, such as metastasis-free survival.[19]

Prostate cancer restricts everyday life for patients.[2] Patients, their families, and the entire oncology community deserve meaningful change.

At Janssen Oncology, our purpose is to make cancer a manageable and, ultimately, curable condition. That’s why we’re working tirelessly to help you give your patients with prostate cancer the right treatment, at the right time, so they can have better days ahead.

The choice of treatment for prostate cancer depends on many factors, including: tumour stage at diagnosis, tumour aggressiveness, medical history, comorbidities, family history, age, life expectancy, and patient choice[14][15][20]

Surgery

For localised prostate cancer, surgery is a common treatment choice.[21]

The main type of surgery for prostate cancer is a radical prostatectomy, where the entire prostate gland, plus some of the surrounding tissue such as the seminal vesicles, are removed.[21]

Radiotherapy

Radiotherapy is also used to treat localised disease, as well as for more progressive cancers alongside other treatments.[21]

This uses high-energy rays or particles to kill cancer cells.[21]

Chemotherapy

Chemotherapy agents like docetaxel and cabazitaxel, plus hormonal therapies such as abiraterone and enzalutamide are used for the treatment of metastatic CRPC (mCRPC).[22]

These agents can disrupt the androgen receptor pathway and block androgen biosynthesis to lower androgen levels in the tumour.[23]

Unmet needs remain in the treatment of advanced prostate cancer.[3][20] Patients, their families, as well as the entire oncology community deserve meaningful change

radical proctectomy

20–40% of patients undergoing radical proctectomy and 30–50% of patients undergoing radiation therapy will experience biochemical recurrence within 10 years[20]

prostate cancer in Europe

nmCRPC has been estimated to account for 7% of prostate cancer cases in Europe and within 2 years of nmCRPC diagnosis, 33% of these patients develop mCRPC[20]

the median overall survival

The median overall survival from diagnosis of mCRPC is ~21 months[3]

ADT, androgen deprivation therapy. CRPC, castrate-resistant prostate cancer. DRE, digital rectum examination. HSPC, hormone-sensitive prostate cancer. mCRPC, metastatic castrate-resistant prostate cancer. mHSPC, metastatic hormone-sensitive prostate cancer. nmCRPC, non-metastatic castrate-resistant prostate cancer. PSA, prostate-specific antigen. TRUS, transrectal ultrasound-guided.

Date of preparation: June 2021 | CP-230390

References

International Agency for Research on Cancer/World Health Organization. Estimated number of new cases in 2020, Europe, males, all ages. Available at: https://bit.ly/3sqs3db. Accessed May 2021.
Higano CS et al. J Clin Oncol 2019. Published online. DOI: 10.1200/JCO.2019.37.7_suppl.256.
Leslie SW et al. Prostate Cancer. StatPearls Publishing LLC. 2020.
American Cancer Society. Prostate Cancer Early Detection, Diagnosis, and Staging. Available at: https://www.cancer.org/content/dam/CRC/PDF/Public/8795.00.pdf. Accessed May 2021.
Kirby M et al. Int J Clin Pract 2011; 65(11): 1180–1192.
UroToday. Treatment of in Metastatic Hormone-Sensitive Prostate Cancer. Available at: https://www.urotoday.com/library-resources/mhspc/111513-treatment-advances-in-metastatic-hormone-sensitive-prostate-cancer-mhspc.html#:~:tenxt=Metastatic%20hormone%2Dsensitive%20prostate%20cancer%20(mHSPC)%20is%20the%20disease,androgen%20deprivation%20therapy%20(ADT). Accessed May 2021.
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European Alliance for Personalised Medicine. The fight against prostate cancer in Europe – White Paper. Available at: https://www.euapm.eu/pdf/EAPM_Policy_Paper_The_fight_against_prostate_cancer_in_Europe.pdf. Accessed May 2021.
International Agency for Research on Cancer/World Health Organization. Estimated age-standardized mortality rates (World) in 2020, prostate, males, all ages. Available at: https://bit.ly/2PZSrO5. Accessed May 2021.
European Commission. Epidemiology of prostate cancer in Europe. Available at: https://ec.europa.eu/jrc/en/publication/epidemiology-prostate-cancer-europe#:~:text=In%20the%20European%20Union%2C%20prostate. Accessed May 2021.
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Patrikidou A et al. Prostate Cancer Prostatic Dis 2014; 17(4): 348–352.
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Sternberg CN et al. BMC Urol 2013; 13: 58. Published online. DOI: 10.1186/1471-2490-13-58.
Pharma Times. A new endpoint for patients. Available at: http://www.pharmatimes.com/magazine/2020/september_2020/a_new_endpoint_for_patients. Accessed May 2021.
Loriot Y et al. Cancer Treat Rev. 2018; 70: 223–231.
American Cancer Society. Treating Prostate Cancer. Available at: https://www.cancer.org/content/dam/CRC/PDF/Public/8796.00.pdf. Accessed May 2021.
Gravis G et al. Asian J Urol 2019; 6(2):162–168.
Damodaran S et al. Urol Clin North Am 2017; 44(4): 611–621.