The VA’s Role in Progressing Prostate Cancer Research

Prostate cancer is a disease that affects the prostate gland, which is part of the male reproductive system. Doctors in London first described it in the 1850s, but they thought it was very rare.

In the 1900s, more men started to get prostate cancer. This happened because men lived longer and older men are more likely to get prostate cancer. Also, eating a Western diet filled with more animal fats, exercising less, and drinking more alcohol increased the number of men diagnosed with the disease.

At the time, many men had prostate cancer that spread to other parts of the body, like the bones. This is called metastatic disease. It was hard to treat and many men died from it.

In the 1940s, Dr. Charles Huggins found a new way to treat metastatic prostate cancer. He used hormone therapy, or androgen ablation therapy (ADT), to stop the growth of cancer cells. He won a Nobel prize for his discovery. Hormone therapy is still used today.

The VA has played a key role in improving prostate cancer treatment. In the 1960s, the VA Cooperative Urologic Research Group (VACURG) showed that a drug could work as hormone therapy for metastatic prostate cancer. The VA also created the Precision Oncology Program for Cancer of the Prostate (POPCaP) in 2016. This program uses genetic information to find the best treatment for each Veteran with advanced prostate cancer. The VA is still working on new and better ways to treat prostate cancer.

Research & clinical trials at the VA

Beyond its extensive commitment to research, the VA has treated countless veterans with prostate cancer.

“One of the major goals of our clinical research is not only to extend life expectancy, but to improve quality of life,” Dr. Matthew Rettig, the chief of hematology-oncology at the VA Medical Center in Greater Los Angeles told SurvivorNet. “And those are both the key features in the clinical trials programs that we have in the VA healthcare system.”

Here are just a few of the VA’s accomplishments that have helped veterans with prostate cancer:

1. The Prostate Cancer Intervention Versus Observation Trial ( PIVOT) was a VA-led study published in 2012. Results suggest that for men with early stage or low risk prostate cancer, surgery, radiation, and observation all lead to similar overall survival. This important finding allows doctors to personalize treatment for low risk prostate cancer. Based on the results, many men now delay or entirely omit treatment that could potentially have long-standing side effects.
2. In 2013 the VA identified exposure to agent orange as a significant risk factor for development of a prostate cancer, The study found that anyone exposed to agent orange were more likely to have aggressive disease. This information has helped guide screening for those at risk.
3. In 2016 the VA created the Precision Oncology Program for Cancer of the Prostate (POPCaP) , an initiative that uses precision medicine to individualize treatment based on the specific genetics and the unique characteristics of each prostate cancer case. As of 2022, POPCaP has initiated 2 new clinical trials.
4. A 2020 VA study suggests that African-American men did not have more advanced disease at time of prostate cancer diagnosis or die earlier compared to white men. This surprising finding was contrary to trends seen in the general US population and was attributed to the VA being an equal access health resource.
5. The 2021 VA STARPORT trial is still ongoing. Its goal is to  find out if adding targeted surgery or radiation to standard medication therapy can improve cancer control for Veterans with metastatic prostate cancer that has spread to other parts of the body.

“A lot of the effort now is on deescalating, reducing the intensity of treatment for the purpose of improving quality of life without compromising the quality of the care and the outcome,” Dr. Rettig says.

What the VA is doing now for treatment

The VA has been involved over the past several decades in numerous research projects and clinical trials that have helped shape the field of prostate cancer. Clinical trials and research are invaluable in the fight against cancer — and the VA is still hard at work.

Here are some highlights from ongoing VA projects and research:

• The VA uses cutting-edge PSMA PET-CT imaging for prostate cancer detection. This technology uses a molecule called Prostate-Specific Membrane Antigen (PSMA), which specifically targets a protein found on prostate cancer cells. By honing in on these proteins, doctors can detect even low levels of prostate cancer throughout the body, allowing for earlier and potentially more effective treatment.
• The Precision Oncology Program for Cancer of the Prostate (POPCaP) opened in 2016 at the VA with a goal of personalizing care for every veteran with prostate cancer. Its use of genetic testing and clinical trials is considered groundbreaking in advancing personalized cancer treatment.
• When you or a loved one is diagnosed with prostate cancer, doctors perform a variety of tests to assign your cancer a risk group. This risk group normally helps your care team decide what treatment they will recommend, with higher risk men receiving more intensive therapy. The process is not perfect. There is still quite a bit of difference for how men in the same risk group respond to treatment. The is working to incorporate artificial intelligence (AI) into treatment decisions to fine tune the care each veteran gets. Using a sophisticated AI algorithm helps identify differences in each case of prostate cancer allowing more precise personalization of care.

Learn more about SurvivorNet's rigorous medical review process.

---