Ron Scolamiero: Keeping Metastatic Prostate Cancer at Bay with Apalutamide
Since I was diagnosed with prostate cancer 18 years ago, I have had several treatments. For the past 6 1/2 years, I’ve been receiving apalutamide (Erleada) through a clinical trial. It has prevented the cancer from metastasizing and allowed me to continue living an active life. I love boating, offshore fishing, golf, and spending time with my family and friends. None of this would have been possible without the research that led to the apalutamide clinical trial.
I was diagnosed with prostate cancer 18 years ago, when I was 55. The diagnosis was a complete surprise. It came about because I needed to take out a life insurance policy to complete a business deal. I was denied coverage because the physical exam revealed that I had a very high level of PSA.
The life insurance agent told me to see a urologist as soon as possible. A local urologist did a biopsy, which showed that I had prostate cancer. In delivering the news, the urologist told me that I had a maximum of five years to live. I was so numbed by the blunt assessment of my prospects that I drove by my exit on the highway several times on the way home.
After sharing the news with my immediate family, I set out to educate myself about the disease. At the time, it was extremely difficult to get health information on the Internet, so I wrote to the National Institutes of Health and several cancer organizations asking them to send me information. Wanting to keep my diagnosis private, especially for business purposes, I had the information sent to a post office box in a different town, which I rented especially for this mail. I was worried that people would think that it was a death sentence.
The urologist recommended immediate surgery. However, after seeking opinions from many prostate cancer specialists in Boston, I eventually decided on a combination approach to treatment. I took Lupron, which is a therapy that suppresses the production of hormones, and had a course of external-beam radiotherapy.
For about five years, it worked. There was no sign of prostate cancer. Then, the routine blood tests that I was having to monitor for a recurrence showed that my PSA levels were rising. After a period of watching my PSA levels slowly rise, I elected to have a salvage radical prostatectomy.
I was told that the surgery was my only shot at a cure. For about 12 months it seemed to be working; then, my PSA levels started rising again.
My doctors told me that the only thing they could offer me was the same hormone therapy but that it would not be a cure. Sure enough, my PSA levels rose gradually over the next few years. This was a difficult time for me. I was constantly worried that the prostate cancer would metastasize.
Fortunately, in 2012, one of the doctors in my medical team at Massachusetts General Hospital in Boston began a phase II clinical trial testing apalutamide. It was a new therapy designed to more effectively suppress hormones than the treatment I was on. I jumped at the chance to participate in the trial.
The apalutamide has pretty much controlled my prostate cancer for the past 6 1/2 years. In that time, the cancer has recurred locally, at the site where my prostate use to be. But these tumors have been removed through surgery. For the past two years, there has been no sign of cancer at all. I have a PSA test every 28 days, and a bone scan and CT scan every three months.
I am so grateful that I have been able to overcome all the speed bumps that prostate cancer has put in my way. There was a point after the salvage radical prostatectomy that my lifestyle was severely affected. The surgery had left me incontinent and I was unable to do very much for almost two years. Thankfully, my surgeon placed an artificial sphincter valve at the neck of my bladder that has enabled me to be continent and get back to living my life.
I feel very lucky that my cancer has been controlled by apalutamide. I know that research was critical to the development of this treatment that is making it possible for me to enjoy life. We need to put as many of our resources as possible into cancer research. It is the only thing that will allow us to one day find a cure.