‘It gives us hope’: Quebec expands access to life-extending prostate cancer treatment

A life-altering treatment for prostate cancer with fewer side effects is now more accessible in Quebec.

A Quebec man who has spent years fighting for access to a promising prostate cancer treatment says he was overcome with emotion when the province finally approved it last week.

Jean Krashevski was first diagnosed with aggressive prostate cancer in 2015. After surgery and 33 rounds of radiation, he hoped the disease was behind him. But within a year and a half, it returned — this time spreading to other parts of his body, including his brain.

“I should be dead by now,” he said. “But we moved quickly, and we fought hard. This new treatment gives us something we haven’t had in a long time: hope.”

Pluvicto, the drug for this treatment, is a radiopharmaceutical therapy that delivers targeted radiation directly to prostate cancer cells. It’s designed for patients with metastatic castration-resistant prostate cancer who have already undergone hormone therapy and chemotherapy. On July 2, the Quebec government added it to the province’s list of publicly covered medications.

For Krashevski, who launched a petition a year ago demanding the province fund Pluvicto, it was a long-awaited breakthrough.

“I couldn’t believe it when we got the news,” he said. “I was with my family and we all cried because this treatment is a game-changer — not just for me, but for so many men waiting for this.”

Dr. Frédéric Arsenault, president of the Association of Nuclear Medicine Specialists of Quebec, calls the decision “a milestone.”

“There was a clear gap in treatment options for patients with advanced prostate cancer,” he said. “Pluvicto fills that gap — it not only prolongs life, but it does so with better quality and fewer to no side effects.”

The therapy works by binding to a protein found on the surface of prostate cancer cells called PSMA (prostate-specific membrane antigen). A radioactive atom then delivers targeted radiation directly to the tumour.

Because it attacks only the cancer cells and not healthy tissue, Dr. Arsenault explained that the treatment avoids some of the harsh side effects of traditional therapies, including erectile dysfunction, severe fatigue, and damage to surrounding organs.

In clinical trials, Pluvicto led to a 50 per cent drop in PSA levels, the key blood marker used to monitor prostate cancer, and significantly delayed disease progression.

Until now, patients in Quebec had to pay $27,000 per dose out of pocket, with a full course of six doses totalling over $160,000. Dr. Arsenault said some were able to access it under RAMQ’s “exceptional medications” program, but only on a case-by-case basis with added red tape.

Years of waiting and fighting

Like many medical experts and prostate cancer patients, Krashevski had been following Pluvicto’s development closely. His wife Céline, a biologist, has helped him navigate research, protocols, and treatment options since his diagnosis. Together, they advocated for the drug’s approval in Quebec, speaking to doctors, politicians, and the media.

“It was an uphill battle,” he said. “Some officials were sympathetic but told me their hands were tied, others were dismissive.”

Krashevski has undergone multiple rounds of hormone therapy and other treatments that have taken a toll on his body and mind. He continues to stay active — practicing martial arts in a more meditative way — but said the effects of cancer are far-reaching.

“Your sex life changes entirely — you also lose your strength and your muscle mass,” he said. “Psychologically, it’s tough too because you’re always just gaining time — one more day, one more treatment — waiting and hoping that something new will come.”

He has just undergone a new round of imaging tests and is waiting for the green light to begin Pluvicto. “I’d love to start tomorrow but there’s a protocol,” he said.

‘Raising awareness remains key’

Krashevski said he wants other men to speak up about prostate cancer — and get screened early, especially if there’s a family history.

“It’s a simple blood test, and, if you catch it early, the treatment is much easier,” he said. “Once it metastasizes, it’s a whole different ballgame.”

He also urged patients to be proactive in their own care — to ask questions, seek second opinions, and bring a trusted person to medical appointments to take notes and advocate.

“We have great doctors here in Quebec, but time is of the essence when you’re diagnosed,” he said. “Don’t wait.”

Another encouraging aspect of Pluvicto is its potential beyond treating prostate cancer.

Dr. Arsenault said the drug is being studied for a range of other cancers, including breast, gastric, liver, and pancreatic cancer. That research is already underway, including in Quebec at McGill’s Jewish General Hospital.

“We think that in the next 10 years, there could be 10 other types of cancer or other diseases that will benefit from this kind of treatment,” he said.

For now, Krashevski is focused on the next steps in his care. And for the first time in a long time, he says, he’s optimistic.

“For a while, I had lost hope, but this news gives me the chance to keep fighting,” he said. “And, after all these years, I’m still hoping for a chance at full remission.”