September marks the 60th anniversary of President Kennedy’s Moonshot speech, where he pledged to put a man on the moon. Through a second iteration of the Cancer Moonshot Initiative, President Biden seeks to eclipse that feat. At the advent of the initiative in 2016, under President Obama, the Cancer Moonshot had three goals:
Earlier this year, President Biden announced plans to revamp the Cancer Moonshot, with a goal of reducing the cancer death rate by at least 50 percent over the next 25 years. This is an ambitious goal given that cancer is currently the second leading cause of death in the United States. However, like President Kennedy, President Biden keeps faith in the ability of American exceptionalism to excel in the face of daunting odds.
In a proclamation recognizing September as Prostate Cancer Awareness Month, President Biden highlighted the steps his administration has taken to end cancer, including creating a new Cancer Cabinet to optimize research conducted by federal agencies. With bipartisan support, the administration secured $1 billion in Congressional funding to launch the Advanced Research Projects Agency for Health, which will support the development of revolutionary anti-cancer therapies and early detection technologies. These technologies cannot be utilized if people are not aware of the importance of prostate cancer screening, further exemplifying the importance of raising awareness.
The Clinician Perspective
To learn more about the current landscape of prostate cancer care and what improvements lie ahead, ACCCBuzz spoke with David R. Wise, MD, PhD, a medical oncologist and director of genitourinary medical oncology at NYU (New York University) Langone’s Health Perlmutter Cancer Center.
Dr. Wise cares primarily for patients with prostate cancer and while he is proud of the progress that has been made in screening, diagnosing, and treating the disease, he believes there is room for improvement. “There are a lot of areas we are doing well on, and there are areas that we need to do better,” he said. According to Dr. Wise, the information gathered over the last 10 years has highlighted the need to intensify treatment for men who present with metastatic prostate cancer. “Our long-term outcomes are far better than they were 10 years ago now that we have incorporated newer androgen receptor-directed therapies and chemotherapy together with androgen suppression as first line therapy,” he said.
Dr. Wise describes cancer as a disease of the genes, and his understanding of one’s genetics informs his clinical approach to treatment. “It is really not one disease, even within prostate cancer. There are many different genetic subtypes,” he said. “It is very important to raise awareness about biomarker testing because it helps people get better information on their prognosis and may also change treatment options that can be far more effective.”
The development of effective anti-cancer treatment options is one area Dr. Wise believes the healthcare community can improve. According to Dr. Wise, patients with aggressive variants of prostate cancer respond very poorly to therapies that modulate antigen receptor activity. As such, the medical community must pool their resources together to develop better anti-cancer treatment for those with aggressive subtypes of the disease.
Costs of care is another area Dr. Wise identified as needing improved. “The oral medication we need for prostate cancer is very expensive,” he said. “We need to consider costs when we are thinking about new drugs, and we need to make sure that we don’t deliver the message that ‘newer and more expensive is better’ to our patients.”
While clinical trials give scientists and healthcare providers the chance to test new treatments and, patients access to innovative—and potentially lifesaving— therapies, Dr. Wise believes that adding more clinical trial opportunities in the community setting and establishing satellite sites to increase accessibility is important for improving prostate cancer care. “We need to build bridges,” he said, as he highlighted the work of his colleague Dr. Joseph Ravenell, who is building community partnerships with local barbershops to provide education about prostate cancer screening to men in the community.
Early Detection Is Key
“I still don’t think we have enough unambiguous support for prostate-specific antigen screening, particularly in the Black community,” Dr. Wise added.
Prostate cancer is the second most common cancer among men, with over 260,000 people estimated to be affected in the U.S. this year. Black men are disproportionately affected by the disease, as well as those older than 65 years and/or those with a family history of prostate cancer.
Shannon Sharpe—2011 inductee in the Pro Football Hall of Fame and former tight end for the Denver Broncos and Baltimore Ravens—falls into two of these categories. As part of the Talk That Talk™ campaign (a program designed by Janssen to spark a conversation among Black men about prostate cancer and screening), Sharpe recently revealed that he was diagnosed with prostate cancer in 2016. “At the time they [Janssen] asked me to do it [share my story], they had no idea I had been diagnosed and treated for prostate cancer,” Sharpe shared on FOX NFL Sunday.
Sharpe has been getting screened for prostate cancer since he was 35, primarily due to his family’s medical history. “My dad died at 39 from cancer. He had a brother die in his 40s, and another brother that barely made it to 50. So I felt I needed to get screened early,” Sharpe said. He is currently cancer free, attributing his wellness to his proactive approach toward cancer screening. “There is a 96 percent survival rate if screened and detected early,” Sharpe said. “I am a part of that 96 percent.”
Prostate cancer treatment has come a long way since Dr. J Adams, a surgeon at The London Hospital, described the first case of the disease in 1853. Looking to the future, Dr. Wise asserts that ambition and boldness should characterize objectives for improving prostate cancer care. “The priority should be placed on investment in research,” Dr. Wise said. “Without more research into the mechanisms of cancer, we are not going to find the game changing treatments we need. Research is hard and most of it fails, so we need to cast a wide net.”
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