r. Neil Fleshner hates cancer. “It’s the most diabolical entity on the planet,” says the physician, who is the Chair of Urology at the University of Toronto, holder of the Love Chair in Prostate Cancer Prevention, and a surgeon at the University Health Network.

When it comes to prostate cancer — the most commonly diagnosed cancer amongst Canadian men, according to Prostate Cancer Canada — Dr. Fleshner has seen what the disease can do to patients, particularly when it recurs. Last year, an estimated 24,000 Canadian men were diagnosed with prostate cancer, and approximately 4,100 lost their lives to the disease.

Metastatic castration-resistant prostate cancer, also known as mCRPC, is typically the last stage of the disease — when cancer has spread to other areas of the body and is no longer responsive to the hormone therapies traditionally used to treat it.

A little over a decade ago, Dr. Fleshner says that men diagnosed with mCRPC were given approximately a year to live. However, recent advances in the treatment of prostate cancer are giving mCRPC patients a new lease on life.

Revolution in treatment

Though the statistics can seem scary, Prostate Cancer Canada says the rate of death due to this disease has steadily been declining since 2001 due to better detection practices and new, targeted therapies. Dr. Fleshner, who has been practising for 19 years, has witnessed the recent and rapid advancement in the treatment of mCRPC and says it’s “nothing short of miraculous.” 

Physicians used to remark that they were fighting this battle with bows and arrows, says Dr. Fleshner, but now they finally have the tools to really understand it.

"There are a lot of interesting compounds and strategies that are going to continue to make these survival statistics better and better."

For instance, physicians and researchers made the connection between testosterone and prostate cancer, and now understand the male sex hormone as the fuel for the disease. However, new targeted oral therapies for mCRPC go beyond simply blocking testosterone, and target the body’s hormone receptors as well, slowing the growth of cancer significantly. Dr. Fleshner calls these oral treatments “super hormones,” and says that though they are not curative, they can make a huge difference for patients.

“What it means is that we now have well-tolerated pills — these have nowhere near the amount of side effects as, say, chemotherapy — that extend survival,” he says.

Living life to the fullest  

In his practice, Dr. Fleshner recalls an mCRPC patient who was essentially bedridden. While in the past that diagnosis would have meant a slow and painful decline, with the new therapies, Dr. Fleshner was able to help get this patient out of bed and back to his life. The patient spent his summer on the golf course, playing nearly twice a week. According to Dr. Fleshner, this patient’s story is no longer atypical.

The doctor encourages all men to get their prostates checked on a regular basis, in order to catch any abnormalities early — and if mCRPC is detected, there is now hope. 

While a cure for prostate cancer may take a while, Dr. Fleshner says that in the near future, new treatments will allow patients to control mCRPC and to live longer with the disease. “There are a lot of interesting compounds and strategies around the corner that are going to continue to make these survival statistics better and better,” he says.