Exploring the Future of Prostate Cancer with City of Hope

Statistics show that one in nine men will receive a prostate cancer diagnosis during his lifetime, making it the most common cancer among men after skin cancer. But thanks to the work being done at institutions like City of Hope Comprehensive Cancer Center in California, more men are being cured each year, and those who aren’t cured are living longer.

One such program that sheds light on this cause is City of Hope’s NoShaver November. The month-long fundraising and awareness campaign urges participants to forego shaving to start a conversation, encourage testing and raise critical funds to continue leading-edge prostate cancer research and promising new therapies conducted at City of Hope.

CURE® recently spoke with Dr. Tanya Dorff, a medical oncologist at City of Hope who specializes in prostate cancer, about the campaign, her current work and where she sees the future of prostate cancer treatment shifting in the coming years.

CURE®: What led you to City of Hope? What do you do there?

Dorff: City of Hope was attractive to me because I am a clinical and translational researcher. The reason I came here was to work with scientists who share what we are seeing in the clinic and who incorporate the latest insights from the scientific discoveries in our laboratories into patient care. There is a real sense of mission and urgency that binds scientists to clinicians at City of Hope in a way that is unique and gratifyingly productive.

First and foremost, I take care of patients who remain my central inspiration and raison d’etre, but I spend part of my time writing and running clinical trials that have real potential to impact how we treat patients in the future — how we can do even better in the future than we do today. I lead the genitourinary cancer program, which includes fostering collaborations between the incredible physicians from urology, radiation oncology, radiology and pathology to work together both clinically and in research projects.

You are Grammy-winning songwriter and vocal producer Kuk Harrell’s physician. Can you tell me what it was like to treat him?

Kuk is such an incredible gentleman; it has been a pleasure to be part of his care team. His attitude toward treatment was one of diligence, and he has approached his illness as an opportunity for personal growth and for giving back by promoting prostate cancer awareness through his story. It has been inspiring to see him come through what was a lengthy and involved treatment with so much positive energy.

How has the field of prostate cancer treatment evolved in recent years?

More and more men with prostate cancer can be cured, and the men who cannot be cured with today’s treatments are clearly living longer and better. This is thanks to new drug approvals in advanced, resistant prostate cancer but even more so to the application of more intensive therapy earlier in the course of the disease. This has been the biggest paradigm shift in prostate cancer over the last five years: up-front intensification in metastatic hormone sensitive prostate cancer.

The next big shift in prostate cancer treatment is just now upon us — molecular selection of therapies to “individualize” prostate cancer treatment. The most imminent example is olaparib (Lynparza), a PARP inhibitor, which worked better than standard treatment in patients with castration-resistant prostate cancer whose tumors harbor mutations in DNA repair genes. But the ingenious “theranostic” approach will be close behind — where imaging (scans) show us whether a cancer is expressing a certain target (i.e. PSMA) and if so, a radioactive particle linked to that target is applied (i.e. Lu-177 PMSA).

What are you most hopeful for in cancer treatment in the future?

I believe immunotherapy will be the way to durable remission or a cure. Here at City of Hope, we are working hard to improve the effectiveness of immunotherapy for patients with metastatic prostate cancer, studying intensive treatments such as CAR-T and bispecific T-cell engaging antibodies, among other approaches. Our scientists are looking at our patients’ in real time to learn why treatments work or don’t work, and how to better engage the immune system. I am very hopeful that these biologic insights will eventually translate into therapeutic success such as we have seen in leukemia with CAR-T and melanoma with immune checkpoint inhibitors.

What advice would you offer someone who has just received a cancer diagnosis of their own?

One: Play an active role. Ask questions, and if something doesn’t sound right or make sense, ask again. It is so important that patients buy into their treatment, understand and feel confident about the treatment plan. No one is perfect, not even the best doctor, and working together as a team will lead to the best success.

Two: Be a squeaky wheel. Patients who communicate symptoms in real time fare better because problems are addressed before they become more serious.

Three: Stay active. Exercise is one of the things that has been shown over and over again to help cancer survivors and cancer patients in various stages. Obviously, a conversation should occur with the treatment physicians to ensure that there are no restrictions but patients who are more active will come through treatment in better shape.