Jim Kiefert of Olympia, Wash., has been battling prostate cancer for 23 years. The retired school administrator, 74, has never been more optimistic about his prospects.
For the first time, thanks to a handful of drug approvals over the past 2 years, there are now multiple options for treating advanced prostate cancer. The newest drug, enzalutamide (brand name Xtandi), came on the market in September with the best survival data ever for prostate cancer.
None of the new drugs is a cure. Research shows enzalutamide extends life by just five months. But they help some patients and have fewer side effects, says the Prostate Cancer Foundation's Stuart Holden.
Prostate cancer is the most common non-skin cancer in the USA; 242,000 cases are expected this year . There is no way yet to distinguish between the benign ones that will stay in the prostate and the dangerous ones that will start creeping into the bones, the mostly likely place of spread.
Kiefert's cancer already had spread by the time it was discovered, before his 51st birthday. After surgery and 35 rounds of radiation, he was told he had one to three years to live.
He gave up red meat and began an exercise routine three days a week. He also started taking Lupron, which deprives the body of most testosterone.
It's standard for advanced cancers ; most feed on testosterone. But side effects include erectile dysfunction, loss of energy and more.
For decades, men who relapsed while on Lupron or similar drugs were usually given chemotherapy and, if that failed, told to wait for death.
When Kiefert got sick, there was little money for research and no new drugs reaching the market. That began to change in the early '90s, when troubled financier Michael Milken publicized his prostate cancer battle and the lack of funding. In 2005, the Department of Defense began to invest heavily, and drug companies got interested, says Howard Scher of New York's Memorial Sloan-Kettering Cancer Center. Collaboration of activists, academics, government and drugmakers led to more than 100 clinical trials.
Kiefert is the beneficiary of two. By the time Lupron stopped working for him six years ago, he joined a trial for Provenge, which ramps up the immune system and aims it at the cancer.
Provenge bought him another 2 years with no cancer growth, long enough to qualify for a trial of enzalutamide last year. His prostate- specific antigen number, a measure of the disease's progression , is down from 30 to 4.5, as good as it has been in decades.
Most trials are conducted on patients who have advanced disease. The drugs might be more effective if started earlier, but that's yet to be proven, says Scher, principal investigator on enzalutamide trials.
Now, figuring out which patients will do well on which drugs is mostly a game of chance. "In the future, the hope is we'll be smarter and be able to pick out the right therapies at the right time," says Philip Kantoff of the Dana-Farber Cancer Institute and Harvard Medical School.
For his part, Kiefert had his knees replaced last year. The doctor told him they came with a 30-year guarantee, "and I plan on wearing them out."
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