LOUISVILLE, Ky. (WHAS11) – Dr. Greg Steinbock is a urologist with over 30 years of experience treating prostate cancer. He is currently the co-director of research at First Urology, specializing in urologic and prostate cancer research.
I sat down with Dr. Steinbock to learn about the current state of prostate cancer research, how it has evolved in recent years and how advancements in the field are changing the ways patients are treated today.
The following has been edited for clarity.
Will Weible: How does the current state of prostate cancer research compare to other cancer research efforts, such as breast cancer?
Dr. Greg Steinbock: Unfortunately, prostate cancer doesn’t have the funding that some of the other cancers have, and we’re sort of riding the coat tails of the revolution in breast cancer, both in terms of the knowledge of the hormone receptors and in terms of that funding. So, there’s a little bit of cross-pollination, if you will, and benefits to our field because of the advances in breast cancer.
WW: Is your current research focused in on a specific thing – a “silver bullet” – or is the focus broader at this point?
GS: Well, in essence we are trying to get to that, but it’s very elusive, so as a result we have really a more broad-based approach where we are trying to influence, at every stage of disease, basically defense mechanisms that help curtail growth and spread of the cancer. Much of what we do centers around new molecules that will inhibit certain hormone receptors in a different way than just reducing testosterone overall does, and the other thing that we do utilize as well, as part of our therapy for different patients, is we have the help of an oncologist, Dr. Rezazadeh, who administers chemotherapy in patients that require that.
Our team consists of the medical oncologist, two radiation therapy doctors, two pathologists, about eight radiologists and 25 urologists. That’s our team that we bring to bear for each patient, and we have a tumor board that [discusses] important concepts and difficult patients on a monthly basis.
WW: So that is the local team a patient could be working with?
GS: That’s right, that’s the First Urology prostate cancer team. And we try to really figure out not only what is the best possible therapy for an individual patient at a given time, but we have to educate them as to what potential therapies are in their future. We utilize different therapies in a sequence and we understand that many patients will require a multitude of therapies over the course of years in their cancer.
WW: So, the field is advancing in such a way that one patient’s treatment options could evolve throughout the course of their treatment?
GS: That’s right, they are, they’re continually evolving, both with the options that we have now that are already FDA approved and the options that we have available for them in the clinical trials, and then the options that will come to bear in the near future.
It’s constantly changing, and actually the number of changes is accelerating, even more recently, because there are new molecules, new medications and drugs that need to be tested. There’s new modalities of therapy for prostate cancer, which can include not just surgery and radiation, but High-Intensity Focused Ultrasound, freezing therapy called cryotherapy—those are used usually earlier on in the disease—and then now we have a host of forms of hormone therapies that we utilize for the prostate cancer when it’s spread.
WW: Is there a treatment or therapy that has evolved in recent years that excites you as a researcher?
GS: There are several that we utilize now that were available on a research basis three or four years ago, and one of those is the prostate cancer vaccine called Provenge. Provenge is a procedure whereby we’re able to stimulate a patient’s white blood cells to fight their cancer and we do that by a transfusion process where we remove the blood and the white blood cells, stimulate the white blood cells, and put them back into the patient. And that form of immune therapy is very unique, and that’s a great method of defense for us for patients with metastatic, or prostate cancer that’s spread. So that’s one.
Another form of therapy we didn’t have before is called Xofigo, and that is made up of a radioactive element called radium-223 that we can inject into a patient who has painful bone spread of prostate cancer. It’s a series of six injections once a month for six months, and that medication goes to the areas of boney involvement and treats that cancer in that area and is proven to prolong survival.
WW: What do you see as the biggest threats to men when it comes to this disease—is it a lack of information, lack of communication, or is it something in our lack of an ability to treat it?
GS: There still is an element, in spite of all of the education that’s gone on about prostate cancer, there’s still an element of certain men are unwilling to be evaluated, to be diagnosed with the possibility of prostate cancer. So, we still have that hurdle, though it’s less than before. The other problem that we have is that some of these cancers are very aggressive, and I will see the patients from 23 of my partners, who all deal with prostate cancer, but I’ll end up seeing patients who have more advanced disease, or more aggressive disease, and we have to treat them aggressively or they will prove to be fatal.
WW: If you could tell men who do not have this disease anything about prostate cancer you think they should know, what would it be?
GS: Well I think it’s reasonable to ask people to be aware of symptoms and if something’s troubling them they need to have it evaluated, number one. And number two, they need to understand that we’ve never cured a case of prostate cancer that we didn’t detect, so it is reasonable to seek out early detection and not shy away from that. And then finally, that we view the prognosis in a much more favorable light today than we did ten, twenty years ago in terms of being able to add to an individual’s survival.
WW: And if you could tell a new patient who has been diagnosed with prostate cancer anything, what would it be?
GS: Well, as patients present, early on, we like to emphasize to them that early prostate cancer is a curable disease. Not everyone is cured, and for those patients that are not cured there are a host of therapies. Really, I would just encourage them to be focused on their education and to continually quiz their physicians about what their particular situation is in terms of the course of their disease and how aggressive their cancer appears to be and what options may they consider in the future.
I would just have people be open-minded and not get too, sort of fatalistic about their disease and to understand that there are very many resources to bring to bear, both here locally and, if need be, in other centers around the country.
For more information on Dr. Greg Steinbock and the First Urology team, click here.
Next week, I sit down with Dr. John Eifler, a urologic oncologist who specializes in surgical treatments for prostate and testicular cancers, to discuss what surgery options patients of these cancers have and what kind of treatments are on the horizon.
If you would like to donate to WHAS11’s Movember fundraising effort to fight prostate and testicular cancers, or join our fundraising team, you can do so at moteam.co/whas11.
For more information on these cancers and the Movember initiative, click here.