why do treatments/trials focus on crpc?

It seems so many (all?) new treatments (at least the trials) focus on CRPC. Why isn't there a focus on treatments intended to work without the need for chemical or physical castration? Or do the trials just pick difficult cases in the hope that the new therapy will work better prior to HT? Is HT just the cheapest way for insurance companies to deal with this? I agree that sexual function is third on the list of treatment goals but it seems we're locked into sexual failure as the default state if the primary treatment fails.

The new treatments focus on CRPC because that is the lethal one. The local tumor can be treated locally (surgery, radiation). Hormonally-dependent tumor will be treated with HT first, because it is efficient (survival advantage proven in randomized controlled trial) and with less side effects than standard cancer treatment such as chemotherapy. Prostate cancer is hormonally-dependent disease, and this is something that researchers have explored and exploited: PC cell needs testosterone to grow, well, let us take testosteron away! Even after HT fails, we have now second generation of hormone drugs like Zytiga and Xtandi because researchers have recognized that fueling of tumor by testosterone even in CRPC still remains a player to be targeted.

There are other therapies being developed that are neither HT nor chemotherapy and they are mostly designed to turn our own immune system against the cancer cells (Provenge, Prostavac, etc) or drugs that target different mechanisms of cancer like Cabozantinib.

But your comment is valid, and the patients should demand from the research community medicines and mechanisms for drug delivery that are safe, with tolerable side-effects. This is as important as prolonging the life.

So they "just" need to figure out how to make a poisoned testosterone that only cancer cells absorb.

I'd settle for a drug combo that mimics the effects of testosterone on our brains, muscles, and peckers but prostate cancer can't use it -- something like muscle-builder steroids plus Viagra plus, I dunno, something like bremelanotide to get our heads back in the game.

If you can't find a better treatment, treat the side effects, too.

clinicaltrials.gov/ct2/show/NCT01630590

Official Title: An Observational Study of XL-184 Cabozantinib and Androgen Ablation in Patients With Androgen-Dependent Metastatic Prostate Cancer

Jim,
A trial of cabozantinib for androgen dependent PC. A catch is that HT must be new?
Another search might have others, maybe,
clinicaltrials.gov/ct2/results?term=hormone+sensitive&recr=Recruiting&rslt=&type=&cond=prostate+cancer&intr=&titles=&outc=&spons=&lead=&id=&state1=&cntry1=&state2=&cntry2=&state3=&cntry3=&locn=&gndr=&rcv_s=&rcv_e=&lup_s=&lup_e=

Post Edited (robertC) : 2/26/2014 7:29:24 PM (GMT-7)

robertC said...
clinicaltrials.gov/ct2/show/NCT01630590

Official Title: An Observational Study of XL-184 Cabozantinib and Androgen Ablation in Patients With Androgen-Dependent Metastatic Prostate Cancer

Jim,
A trial of cabozantinib for androgen dependent PC. A catch is that HT must be new?
Another search might have others, maybe,
clinicaltrials.gov/ct2/results?term=hormone+sensitive&recr=Recruiting&rslt=&type=&cond=prostate+cancer&intr=&titles=&outc=&spons=&
lead=&id=&state1=&cntry1=&state2=&cntry2=&state3=&cntry3=&locn=&gndr=&rcv_s=&rcv_e=&lup_s=&lup_e=

Thanks Robert.

Yes that't the other critera that eliminates me usually since I have been on Lupron for almost a year now.

LupronJim