Washington DC VA Medical Center Provides Cutting Edge Prostate Cancer Care
Prostate cancer is the most diagnosed solid tumor in Veterans enrolled in VA health care. In 2016, VA and the Prostate Cancer Foundation established a partnership to promote prevention, screening, and research to find new treatments for prostate cancer in Veterans.
Washington DC VA Medical Center was one of the first nine Precision Oncology Prostate Cancer Centers of Excellence (CoE) in VA’s network to help develop best practices for the treatment of Veterans with advanced prostate cancer.
Washington DC Precision Oncology CoE is led by oncologist Maneesh Jain, MD and supported by the Oncology Program Coordinator, Ramesh Subrahmanyam, PhD. Their team works closely with researchers at George Washington University to identify specific tumor mutations in Veterans with metastatic prostate cancer using next-generation DNA sequencing.
“We used to treat cancer like it was one disease with one treatment option but now, with the advancement of genetic sequencing, we know that every cancer diagnosis can be caused by different changes in the body, and each may respond to one treatment option better than another,” said Dr. Subrahmanyam. “We can then use the information we find through DNA sequencing to customize drug treatments for Veterans.”
Prostate cancer progresses through different stages, initially starting in the prostate, where it is easiest to treat with radiation or surgery. VA provides a lot of early screening to catch prostate cancer at this stage. If prostate cancer progresses beyond the first stage, a hormonal therapy called androgen-deprivation therapy, becomes the standard of care. Dr. Subrahmanyam said that while most patients respond to hormonal therapy initially, the cancer often returns and can become metastatic, meaning it has spread to multiple organs.
“Each time cancer comes back, it tends to be more aggressive,” said Dr. Subrahmanyam. “Patients begin more rounds of treatment but eventually, the cancer can become resistant to hormonal therapy all together. When this happens, the cancer enters the most advanced stage, castrate resistant prostate cancer.”
In addition to frequent screening and next-generation DNA sequencing to identify cancer traits in Veterans, the Precision Oncology Prostate Cancer Center offers access to cutting edge treatment trials designed to prevent prostate cancer from returning in an aggressive stage. One of their current clinical trials, called PSMAddition, pairs standard treatments with an approved drug, Lutetium PSMA (177Lu-PSMA-617), which can target abnormalities expressed in cancer cells and kill them, once and for all.
“In the PSMAddition trial, we are looking to identify if, by adding this extra treatment to the standard hormonal therapy, can we help the Veteran remain cancer free for longer,” said Dr. Subrahmanyam.
The PSMAddition trial is led by Frank Liu, MD from the Washington DC VA Medical Center Nuclear Medicine Section. After Dr. Jain and his team identify Veterans who are newly diagnosed with metastatic prostate cancer, Dr. Liu’s team performs imaging to see if their cancer cells express a protein called PSMA. PSMA is a protein that is often present on cancer cells but not on native, healthy cells. The PSMAddition trial uses a drug that pairs Lutetium-177, a radioisotope that can target cells and kill them, with an antibody to PSMA, which directs the drug to kill cancer cells without affecting healthy cells.
“Our earlier trials proved that this drug is effective in treating castrate resistant prostate cancer in patients that are no longer responsive to hormonal therapy,” said Dr. Subrahmanyam. “Now we are looking to see if it is effective at an earlier stage when the cancer still responds to hormonal therapy. To do this, we screen every Veteran newly diagnosed with metastatic prostate cancer to see if they are in the earlier stage and if their cancer expresses PSMA.”
The Washington DC VA Medical center was one of three VA's that participated in the original trial which led to FDA approval of Lutetium PSMA to be used in patients with advanced castrate resistant cancer. Dr. Jain believes their continued participation in PSMAddition trials provides a huge advancement in Veterans care.
“As an oncologist, it makes me proud to offer cutting edge treatment that is typically found in a larger academic center, to Veterans at the VA,” said Dr. Jain. “I believe the work we’re doing here can really advance the field for prostate cancer and help underserved minority groups of patients.”
Prostate cancer diagnosis rates among minority groups are higher, especially among African American men, who tend to be diagnosed younger and develop more aggressive prostate cancer. Dr. Jain hopes the data they gather will answer questions as to why some ethnicities are more prone to develop prostate cancer.
Army Veteran Allen Covington also hopes to help advance cancer research. Originally diagnosed with prostate cancer in 2015, he chose to enroll in the trial when his cancer returned last year.
“I participate because I have a lot of friends going through cancer who don’t have this opportunity through the VA. And here, I can get the best possible treatment available from a dedicated team,” said Covington.
Covington has been in the program for seven months and Dr. Jain said he is responding well to the treatments so far.
“It’s too soon to announce clear results of this trial, but so far Mr. Covington shows improvement. His pain is down, his cancer levels are down, and he hasn’t had any side effects,” said Dr. Jain.
Veterans enrolled in the clinical trial undergo more frequent visits than those with the regular standard of care to see how their cancer is responding but also to catch any adverse side effects that could potentially happen. Covington said that while the visits are frequent, they help to remind him of the support he has behind him.
“This team is amazing. I feel like Muhammed Ali and they’re my trainers. We’re in a fight, but we’re all in this together,” said Covington.
Currently, more than 90 Veterans are enrolled in prostate cancer trials at the Washington DC VA Medical Center. Dr. Jain and Dr. Subrahmanyam hope that their willingness to participate and advance research will lead to more treatment options for Veterans with prostate cancer.
“I lost my father to cancer when I was 12 years old. And I knew then that I did not want anyone to ever feel the way I did. That’s the reason I do what I do. As a researcher, I have dedicated my life to finding the answer to why people get cancer. But it wasn’t until coming to the VA that I finally got to see the effects of what I was doing,” said Dr. Subrahmanyam. “We still have a long way to go to curing cancer, but if these trials and research can give cancer patients even just a few extra months, it’s going to make a difference in their families.”
Funding for the Washington DC VA Medical Center Precision Oncology Prostate Cancer Program is provided by the Prostate Cancer Foundation. This grant establishes a partnership between Washington DC VA Medical Center and George Washington University to sequence Veterans with metastatic prostate cancer and connect them with cutting edge care best suited to treat their disease. To learn more about this partnership, visit: VA Partnership | Prostate Cancer Foundation (pcf.org)
To learn more about VA’s Precision Oncology Program for Cancer of the Prostate, visit: VA Precision Oncology Program for Cancer of the Prostate (POPCaP)