When Giulio Picolli met David R. Wise, MD, PhD, in October 2020, he was nearly out of options.
The athletic 80-year-old from Paramus, New Jersey, had been treated for advanced prostate cancer for 11 years, receiving lymph node removal and radiation treatments and dealing with the long-term side effects of hormone therapy. But with the disease having spread to Picolli’s ribs and lower spine, making it painful for him to lift his right leg, his urologist in New Jersey suggested chemotherapy, a long shot with significant side effects.
Instead, Picolli’s wife, Galina, on the referral of a friend who had raved about the care of Dr. Wise, nudged him to make an appointment. The decision to seek care at Perlmutter Cancer Center with Dr. Wise, an oncologist who specializes in prostate cancer, was a game changer and, quite possibly, lifesaving. “He gave us a good feeling from the first day, that he had a plan, and there was a team behind me,” says Picolli, a retired office equipment technician.
Some 80 percent of prostate cancers are slow growing and present a variety of treatment possibilities, including 3 pioneered at NYU Langone: focal ablation, in which cold or high-intensity sound waves target tumors while preserving healthy tissue; stereotactic body radiation therapy, precise, high-dose X-rays delivered in only 5 treatments, as compared with 45 for standard radiation therapy; and nerve-sparing radical prostatectomy, which greatly improves sexual function post-surgery.
“Metastatic prostate cancer is difficult to treat, because it tends to stop responding to traditional treatments. For these patients, our goal is to offer therapies based on the genetic factors driving the cancer, if possible.”
—David R. Wise, MD, PhD, oncologist with Perlmutter Cancer Center
However, a solid 20 percent of cases defy standard treatment options. That’s where Dr. Wise shines. Determined to understand cancer from all angles, he holds a doctorate degree in cancer biology and has dedicated his oncology practice to treating the deadliest forms of prostate cancers. As director of NYU Langone’s prostate cancer clinical trials program, his goal is to pioneer new treatment options that could help patients like Picolli beat steep odds. Advanced prostate cancer has a 5-year survival rate of just 30 percent and accounts for most of the 34,000 annual deaths from the disease.
“Metastatic prostate cancer is difficult to treat because it tends to stop responding to traditional treatments,” says Dr. Wise, assistant professor in the Departments of Medicine and Urology at NYU Grossman School of Medicine. Dr. Wise immediately had Picolli get bloodwork and a biopsy to determine whether the cancer might be treated with one of two approved immunotherapies designed to boost the body’s own defense system. “For these patients, our goal is to offer therapies based on the genetic factors driving the cancer, if possible,” he says.
While these treatments are effective on only a small minority of patients with metastatic disease, Dr. Wise notes that “about 5 percent of men possess a genetic profile that confers a very good chance of dramatic improvement with immunotherapy, and they can be spared a lot of unnecessary, unpleasant treatments.” Picolli, who had never received genetic testing before switching his care to Perlmutter Cancer Center, was found to be among them.
In fall, 2020, he received a short course of radiotherapy with Andrew J. Evans, MD, medical director in the Department of Radiation Oncology at NYU Grossman School of Medicine. In May 2021, he began infusions of the drug pembrolizumab and stopped taking a testosterone suppressor. Within three weeks, his prostate-specific antigen, or PSA, a blood test marker for prostate cancer, had dropped from a dangerous level to an undetectable one. By June, he and his wife were trekking in the Dolomite Mountains in his native Italy. “I feel great,” Picolli says. “After all I’ve been through, it’s a miracle what Dr. Wise did for me.”
Dr. Wise sees things differently. To him, Picolli’s story reflects a critical mission of Perlmutter Cancer Center: to analyze a cancer’s genetic code in order to provide eligible patients with access to the most promising prostate cancer treatment options, a paradigm known as precision oncology. “This is an important step that’s still being skipped all too often,” he says. “Because when immunotherapy works, it works very well.”