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A new clinical trial at MUSC Hollings Cancer Center will investigate whether a common statin – a drug used to lower cholesterol levels – affects an immune system pathway that could lead to a stronger anti-tumor response in patients with prostate cancer.

“There’s been a long-standing, consistent inverse association between statin use and a reduced risk of aggressive prostate cancer and, more recently, prostate cancer mortality,” explained Hollings researcher Michael Marrone, Ph.D. “It’s just been unclear in those observational epidemiological studies whether that inverse association is due to cholesterol reduction or some other non-cholesterol pathway. So, the focus of this trial is to investigate a specific non-cholesterol pathway through which statins might be contributing to reduced risk of aggressive prostate cancer.”

For this study, Marrone, a translational epidemiologist, is teaming up with Stephen Savage, M.D., vice chairman of the Department of Urology, who focuses on urologic cancers.

Savage has participated in many multidisciplinary trials, including a long-term trial looking at the role of vitamin D in prostate cancer. When Marrone, who joined MUSC last year, met Savage, he was excited about the potential for collaboration.

“I felt like that was a natural synergy there with that prior experience,” Marrone said.

Being able to work with people from different disciplines and to bring ideas from the lab into the clinic is one of the great opportunities of working in an academic medical center, Savage added.

“It keeps you excited and interested,” Savage said – especially when there’s a direct impact on patients.

And there will only be more of this type of collaboration, Marrone said.

“Having that kind of impact is what excites everyone at research institutions. And in order to have that kind of impact, you have to reach out and collaborate with people who have different expertise,” Marrone said. “Whereas if you’re segregated or siloed into your discipline, you can only do so much.”

In this trial, newly diagnosed prostate cancer patients will be signing up to potentially take the statin simvastatin for eight weeks before getting surgery. Because there are so many statins in use, with some 35 million Americans taking them, it was important for participants in the study to all take the same statin, Marrone said.

The participants will be randomized so that half get the statin and half do not. After surgery, their tumors will be examined and compared between both groups. Because of the relatively short time frame that the participants will be taking the medication, Marrone doesn’t expect to see differences noticeable to the naked eye, like a difference in tumor size. Instead, they’ll be looking to see if the statin has influenced an anti-tumor immune response.

Regulatory T lymphocytes, or Tregs, prevent the body’s immune system from attacking its own organs and tissues. Normally a good thing, this system backfires when Tregs proliferate in the tumor microenvironment and suppress an immune response against the cancer.

The Tregs need a transcriptional regulator called yes-associated protein, or YAP, to do their jobs. Without YAP, they don’t do as good of a job at keeping the immune system at bay. At the same time, statin drugs have been shown to inhibit YAP. So upon examining the tumors, Marrone hopes to see that the patients who took statins have a more robust anti-tumor immune response because the Tregs were forced to stand down.

Eventually, he’d like to see if statins can overcome the “cold” prostate cancer tumor environment and enable immune therapy to work. Tumors are characterized as “hot” or “cold” depending on how much immune system activity there is around them. Cold tumors are surrounded by cells that suppress the immune response and, as a result, generally don’t respond to immunotherapy.

“We believe that statins might be used to overcome the immunologically cold tumor environment,” Marrone said. That could mean they could help immune checkpoint inhibitors to work in men with prostate cancer.

“We won’t be able to necessarily answer that question with this trial, but hopefully, we’ll be able to generate some of the preliminary findings to determine whether or not there is this potential role for statins,” he said.

Savage and Marrone said that working across disciplines is important, not just for teasing out the biology of a cancer but also the reasons for disparities in outcomes among different groups. With prostate cancer, for example, the rates of this cancer are twice as high for Black men in South Carolina as for White men, and deaths from prostate cancer are almost three times higher for Black men than White men.

However, because South Carolina has a larger percentage of Black residents than the national average, and because the MUSC Health network is expanding to regional hospitals throughout the state, allowing it to serve people in rural areas more effectively, Hollings is in a position to find answers to these questions about disparities.

“We have a much larger minority population, and so the ability for us to identify how this type of intervention may impact a variety of minority or underserved populations is interesting,” Savage said.

Further, he has found that his Black patients tend to be very willing to participate in clinical trials like this one, even though the benefit to an individual patient is likely to be small because the study is gathering preliminary data.

“I explain to them what the clinical trial means and what impact it has on them, which in many cases is very little, but there’s potential benefit to have a greater understanding for their population,” he said. “I tell them this is an opportunity to address diseases that are disproportionally affecting this population, which has been understudied. So, it’s been neglected. And so, when they see that as an opportunity rather than an imposition, or worse, an experimentation, they sign up.”

 will open shortly at Hollings, then will be expanded to the Ralph H. Johnson VA Medical Center, where Savage also sees patients.

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“We have a much larger minority population, and so the ability for us to identify how this type of intervention may impact a variety of minority or underserved populations is interesting,” said Stephen Savage, MD, vice chairman of the Department of Urology.

Cholesterol-lowering drug tested for effect on prostate cancer tumors

Piece by piece, 76-year-old Friedrich Andreas is methodically building an outdoor kitchen for his son in Charleston. Andreas said the project reminds him of a recent bout with prostate cancer – you have to take both one step at a time.

Andreas, a native-born German, moved to Charleston in 2015 to enjoy mild weather during retirement. When he’s not working on a construction project, Andreas advocates for other men to pay attention to their health and get routine prostate-specific antigen (PSA) screenings.

“The only reason I even knew I had prostate cancer at first was because of a routine PSA test with my primary care physician,” Andreas said. “It really can be the difference between life and death. I think that really speaks to the importance of maintaining routine visits with your doctor.”

Andreas has battled prostate cancer twice – first in 2018, when he had his prostate removed at another medical facility in Charleston, and then again in June of 2021, when the cancer returned. Andreas decided to switch his care to MUSC Hollings Cancer Center after learning that the cancer had returned.

“At the other facility in Charleston, I felt more like a number. While at Hollings, I felt like my team of doctors really cared about my treatment and outcome,” he said. “They told me about the tumor board, comprised of prostate cancer specialists, who would meet to review my case and design a program specifically tailored for me.”

Andreas first was seen by Thomas Keane, MD, a Hollings urologist specializing in prostate and genitourinary cancers. Upon results of a PSA test showing elevated levels, Keane referred Andreas to David Marshall, MD, a Hollings radiation oncologist who specializes in prostate cancer.

“My approach with any patient is that when that person walks out of the exam room, they should feel better than when they walked in,” Marshall said. “You do that through education and talking with them about their options and what to expect.”

Marshall said Andreas is among the Hollings prostate cancer patients who have benefited from improved imaging. In Andreas’ case, a device called an Axumin, or fluciclovine F18 PET scan, was used, as its improved-imaging capabilities can pick up on and locate prostate cancer recurrences better than older types of scans. Improved imaging enables doctors to provide effective therapy to the affected areas.

“That really helps us to refine our treatment approach by giving us a better understanding of where the cancer cells making the PSA are located,” Marshall said. “That lets us target our radiation therapy to limit exposure to otherwise healthy cells.”

In the fall of 2021, Hollings also began offering prostate-specific membrane antigen (PSMA) tracers during PET scans to patients whose prostate cancer has returned in an effort to understand more fully where cancer cells are located in the body. PSMA is a type of protein found on the surface of prostate cancer cells.

“This improved imaging helps us to locate the cancer if it has already spread beyond the pelvis to determine if a radiation regimen is needed. It also lets us know if we should focus in on one area and provide a higher dose of radiation in that specific location,” he said.

Marshall said Andreas’ treatment for his prostate cancer recurrence consisted of 37 rounds of radiation over two months that ended at the beginning of September. Andreas said he is thankful for Marshall and his team of doctors who not only treated his cancer but also put his fears to rest.

Andreas said he fared well during radiation and didn’t experience any side effects besides being a little more tired. He continues to come back for checkups every six months to ensure there isn’t another recurrence. “There was no reason for me to be nervous or concerned. From the moment I walked into Hollings, I was at ease. Everyone was friendly and professional, and I just felt like I was in good hands. I still am in good hands.”

Andreas now shares his story with other men to raise awareness about prostate cancer. He said he’s looking forward to spending more time with his wife of 43 years, children and four grandchildren. It’s also a good bet you’ll find him with tools in his hand tackling yet another project.

“It keeps me busy and gives me something to look forward to. I also enjoy being creative, so these projects are fun for me. I’m able to complete them now, thanks to the care I received at Hollings.”

The patient's treatment included prostate-specific membrane antigen (PSMA)–PET imaging.

Hollings patient advocates for screenings after two battles with prostate cancer

Ending health disparities isn’t just something Nicholas Shungu, MD, preaches – it’s something he practices every day as an MUSC Health family medicine physician. It’s one reason he led a new study revealing barriers, and presenting solutions, to improving prostate cancer screening decision-making among Black men.

“Historically, Black men haven’t been included in studies that guide screening recommendations,” Shungu said. “I’ve always had a desire to change that.”

That desire became even stronger during medical school when Shungu’s father was diagnosed with and treated for prostate cancer near their New Jersey home. That experience was a driving factor in a study led by Shungu that was published in the Journal of the American Board of Family Medicine.

In the study, titled Barriers and Facilitators to Informed Decision-Making About Prostate Cancer Screening Among Black Men, researchers found that the majority of the 21 Black men who participated didn’t feel as though they had adequate information to make an informed decision about prostate cancer screenings.

“We know that Black men have a higher incidence rate and mortality rate of prostate cancer than white men,” Shungu said. “Despite that, we are still falling short in providing adequate education about screenings and reaching the populations that are at a higher risk.”

Participants in the study took part in a focus group to discuss their experiences as patients, their knowledge of prostate cancer screening and their attitudes toward screening recommendations. A majority of the men, 61.9%, had a friend or family member diagnosed with prostate cancer and had also talked with a doctor about prostate cancer screening before. However, only 47.6% of participants had been screened for prostate cancer using a PSA blood test.

“I think there are two big takeaways. One, we as clinicians must do a better job about educating and talking with patients, especially Black men, about prostate cancer and screening options available to them,” Shungu said. “Second, we really need to help patients feel more comfortable making a decision about prostate cancer screening.”

Researchers identified several barriers in the study that affected the likelihood of making an informed decision about prostate cancer screening. In addition to not feeling educated enough to make an informed decision about screening, participants also told researchers that they hadn’t had proper discussions with their doctors about the perceived benefits and risks of getting tested. There also was concern about pride and the fear that being screened could impact a man’s sexual function.

“Screening doesn’t affect sexual function,” Shungu said. “If diagnosed with prostate cancer, there is the possibility of erectile dysfunction and urinary incontinence stemming from treatment, but that is down the road and not something caused by screening itself.”

Katherine Sterba, PhD, an MUSC Hollings Cancer Center researcher and co-author of the study, said she was also surprised about the confusion and misconceptions participants had about the types of screening tests available and the difference between prostate cancer screening and a colonoscopy. Sterba said many of the men thought that the only way to screen for prostate cancer was through a digital rectal exam and were unfamiliar with the PSA blood test option.

“This study is a great example of research questions coming directly out of clinical practice,” Sterba said. “It’s so important to listen to patients, understand their experiences and use research findings to guide clinical practice about how best to talk with and advise patients.”

By providing better resources and education about prostate cancer screening and encouraging dialogue about it in the community, researchers believe more Black men would make informed decisions about screenings.

Shungu said efforts already underway at Hollings, such as the 

, will play an important role in education and awareness within the Black community. Shungu believes that those efforts, along with candid discussions with their doctors about prostate cancer screening, could save lives moving forward.

“These are difficult conversations to have. We as doctors have to do better. We need to be more comfortable having real conversations with these men,” he said. “I hope that this study and my work in medicine can help to reduce health disparities and save lives. That’s my ultimate goal.”

“This study is a great example of research questions coming directly out of clinical practice. It’s so important to listen to patients, understand their experiences and use research findings to guide clinical practice about how best to talk with and advise patients," says Katherine Sterba, PhD.

New Hollings study reveals barriers, presents solutions to improve prostate cancer screening among Black men

Like a cheerleader at a pep rally before the big game, Marvella Ford, PhD, leads participants of the SC AMEN Program in a cheer.

“Early detection,” she chants, pausing for the response.

“Saves lives!” respond the participants.

It’s a call and response that’s not standard fare for the more than 25 members of Mt. Moriah Missionary Baptist Church, who have gathered virtually on Sept. 11 for this inaugural session of a prostate cancer prevention, awareness and navigation to screening program. That’s the point, though. Ford, associate director of Population Science and Cancer Disparities at MUSC Hollings Cancer Center, wants to get out into the community to drill home the message.

“One of the most positive aspects of the SC AMEN Program is that it focuses on Black men, who have sometimes been overlooked by the medical community,” Ford said. “This program creates a safe space for participants to share their comments, concerns and stories to help improve prostate cancer screening rates.”

The SC AMEN Program aims to reduce prostate cancer mortality rates in South Carolina Black men age 40 to 65 by increasing their prostate cancer knowledge and improving their prostate cancer screening rates. The program, supported by the TD Bank Foundation, hopes to raise awareness about prostate cancer, which disproportionally affects Black men who oftentimes present with later-stage disease and have worse overall outcomes. In fact, the prostate cancer death rate in South Carolina is 2.5 times higher for Black men than for white men with this disease.

Participants of the SC AMEN Program begin by attending a training session, led by Ford and program manager Melanie Slan, which covers topics including the importance of exercise and listening to your body, tips on a healthy diet and prostate cancer screening and early detection. They are then evaluated using a pre-test, post-test and three-month follow-up survey to gather information about whether they received prostate cancer screenings and increased their knowledge of prostate cancer. Those who complete the program receive monetary compensation.

“We fully expect that this inaugural session of the SC AMEN Program is just the beginning,” Ford said. “As more people learn about the prostate cancer education and screening navigation services that are offered through the program, they will choose to participate.”

Ending health disparities and saving lives in South Carolina is a personal mission for dentist Larry J. Ferguson, DMD, who served as the keynote speaker and primary organizer for this session. Ferguson knows just how important screenings, early intervention and education are. His own journey with prostate cancer began in 2012, when Ferguson and his primary care doctor noticed his prostate-specific antigen (PSA) levels were above normal.

“When I saw my PSA levels rising above the recommended levels, I went into denial,” he said. “I didn’t want to think about the possibility of having prostate cancer and going through treatment. Fear was setting into my heart, and I’m a doctor.”

Ferguson shared his story with the other men who took part in the SC AMEN Program session. In 2016, following his annual PSA blood test, Ferguson’s primary care physician referred him to Hollings researcher Thomas Keane, MD, who is also the chair of the MUSC Department of Urology.

“Having attended school at MUSC for dentistry, there wasn’t a question in my mind where I wanted to go for treatment,” Ferguson said.

For the next four years, Keane actively monitored Ferguson’s cancer through rounds of biopsies and MRIs. Active surveillance was chosen as the course of treatment due to the size and nonaggressive nature of Ferguson’s prostate cancer. In 2020, results of surveillance tests showed the tumor pattern was becoming more aggressive. In February 2021, Ferguson was put on hormone reduction medication to reduce testosterone levels to help to prevent the cancer from growing further.

In addition to that medication, Ferguson was referred to Hollings researcher David Marshall, MD, who is also the chair of the MUSC Health Department of Radiation Oncology, for radiation treatment. Due to his tumor responding well to the hormone reduction medication, Marshall told Ferguson he would only need 20 rounds of radiation, versus the 28 they had originally planned for. Radiation wrapped up in June, and Ferguson came off the hormone medication in August 2021.

“My journey with prostate cancer continues today. I am walking my journey as I speak with other men in the SC AMEN Program. That is important to me because I want to develop a prostate cancer ministry so that we can encourage one another — both current patients and prostate cancer survivors.”

By sharing his experiences, Ferguson hopes to affect other men and encourage them to get early, and routine, prostate cancer screenings. He’s excited about starting the conversation about a cancer that many men don’t feel comfortable talking about.

“I know of too many men who have suffered from this disease, and they suffered in silence. They didn’t feel like they could talk to anyone. I want to be as transparent as I can with other men about my story to encourage other men to talk about prostate cancer and get screened. That’s what the SC AMEN Program helps to do.”

Improving prostate cancer screening with the SC AMEN Program

Marshall said early detection of prostate cancer truly saves lives. It is a big reason why he is supportive of the SC AMEN Program’s efforts to educate medically underserved communities about lifesaving screenings.

“The more we can communicate the need for screenings and the availability of treatment options at Hollings that result in a high quality of life, the better,” Marshall said. “I applaud the efforts of Dr. Marvella Ford and her team to get this important message out and to navigate the participants to prostate cancer screening.”

Ford said the inaugural session was a huge success, and they’re already getting calls to book more sessions throughout the state. “This is the tip of the iceberg, and this is going to snowball. We’re so appreciative of the support of the TD Bank Foundation to launch this key initiative in our state.”

Ferguson also believes that this is just the beginning for the SC AMEN Program. He credits his doctors at Hollings for helping to make life after cancer possible so he can educate others. “My own cancer journey helped open my eyes to just how important Hollings is to Charleston and South Carolina as a whole.”

By educating and encouraging a space for dialogue among men, Ferguson believes more lives will be saved, thanks to early screening, prevention and treatment.

“I think this is a tremendous opportunity for the Black community and for Black men,” he said. “I hope my story can encourage other men to get prostate cancer screenings and possibly save a life. Every life is important. These men represent somebody’s father, husband, brother and an important community member. Those lives are needed. Those lives count.”

Black men age 40 to 65 who are interested in participating in the SC AMEN Program should contact program manager Melanie Slan at 843-876-2427 or slan@musc.edu.

“I think this is a tremendous opportunity for the Black community and for Black men. I hope my story can encourage other men to get prostate cancer screenings and possibly save a life. Every life is important," says Larry J. Ferguson, DMD.

MUSC Health

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Hollings patient advocates for screenings after two battles with prostate cancer

New Hollings study reveals barriers, presents solutions to improve prostate cancer screening among Black men

Hollings' SC AMEN Program for prostate cancer screening launches with enthusiastic support