If you or a loved one has recently been diagnosed with prostate cancer, or if you are part of a high-risk group, you have probably heard about clinical trials.
A clinical trial is a research study that involves people. After showing promise in a lab, a clinical trial is the next step. Clinical trials look at the effect of a medical action on people’s health and often compare one treatment to another. The studies often look at how well new treatments work and how safe they are to administer.
When it comes to prostate cancer — the most commonly diagnosed cancer in men — there are tons of trials with a wide range of focuses.
“There’s a trial available for every point of the prostate cancer experience – from detection to diagnosis to treatment and beyond. There’s a whole team here dedicated to this,” said Dr. Stanley Liu, a radiation oncologist at Sunnybrook. “These trials are looking for better ways to find prostate cancer, better ways to figure out whose cancer will be aggressive, and better ways to treat it at any stage.”
How can we see the cancer?
Many researchers are looking at how prostate cancer is detected and diagnosed. This type of trial might look at the use of imaging and what type of imaging can best see the cancer. Participants could be randomized to get one type of image or another.
Whose cancer will be aggressive?
Some men with low-grade prostate cancer may never go on to have an advanced form of the disease. But how can doctors determine who’s cancer will be aggressive?
“At Sunnybrook, we are involved in several trials that are looking at ways to determine who’s prostate cancer will be more aggressive – for example, looking at cells in urine to see if there’s signatures in there that indicate the cancer is more aggressive,” Dr. Liu said. This type of trial might involve blood tests, urine test or other samples being collected and examined.
How can we best treat prostate cancer?
How you are diagnosed with prostate cancer and treated is based on many years of research, evidence and trials. Researchers constantly revisit that evidence to come and with better, safer ways to find and treat the disease.
A Sunnybrook-trial led to the widespread use of “active surveillance” for prostate cancer, where men with early stage disease are closely monitored rather than treated aggressively. The 15-year results were recently published by Drs. Andrew Loblaw and Laurence Klotz from Sunnybrook, and they demonstrated that this is a safe and effective approach to manage early stage prostate cancer. This key trial helped make active surveillance a standard-of-care in North America.
At Sunnybrook and around the world, researchers such as Dr. Loblaw have been looking at newer forms of radiation that target the tumours more precisely. One example of this is stereotactic body radiation therapy (SBRT), where high levels of targeted radiation are given over a short period of time. This type of treatment is already used for other cancers. At Sunnybrook, we are involved in several SBRT trials, looking at if a shorter course of higher dose radiation (e.g., 5 days versus 20 days) can improve prostate cancer cure while minimizing effects on a patient’s quality of life. This would involve radiation treatments as well as surveys or interviews to help determine how your quality of life is after treatments.
How can we treat prostate cancer that comes back or is advanced?
These types of trials might add an additional chemotherapy drug or a targeted agent to the current standard of care (radiation, surgery or chemotherapy) to see if there are better patient outcomes.
How do I know if a trial is right for me?
At an academic health sciences centre, there are many options for trials. There is infrastructure in place to allow involvement with lots of trials. Some of Sunnybrook’s doctors are the lead investigators or the site leads on an international trial. Talk to your doctor for more information about what trials you might be eligible for.
Do I have to join a trial?
Being a part of trial is a personal decision. It can be overwhelming to learn about them all, but ultimately it’s up to you as the patient.
“Your care team can offer you information about whether you are eligible for a trial so that you can make an informed decision on whether you want to join a trial,” Dr. Liu said.
If you are not in a trial, you will receive the standard treatment. By participating in a clinical trial, you may be among the first to receive a new treatment that is otherwise not available. But, the new treatment has not yet been proven to be better than the current standard. It’s important you discuss this with your care team.
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