Advanced Prostate Cancer

Treatment options

Together you and your doctor will develop the best possible plan to treat your cancer based on the specific features of your disease. More effective treatment options are available today than ever before, which means that advanced prostate cancer patients need to be diligent with their research and questions before deciding which treatment plan is the best fit for their disease and quality of life.

The members of your treatment team are important assets to your overall health management, so make sure you’re comfortable and confident with the doctors and specialists you choose. In addition, different hospitals and cancer centers often have different capabilities and don’t always provide the same type or quality of care, so ask questions and be sure that the treatment you want is available nearby. Other factors you should consider when making treatment decisions include:

  • Life expectancy
  • Biopsy results
  • Cancer stage
  • Gleason score
  • Symptoms
  • Overall health

Treatment goals

The goal of your treatment will depend on the characteristics of your disease. Some treatment options are intended to stop or slow down the progression of cancer cells. In cases where cancer can’t be cured, treatment will be focused on managing your symptoms and keeping the cancer contained.

Treatments that stop or slow the growth of advanced prostate cancer include hormone therapy, chemotherapy, immunotherapy and radiation therapy.

Some therapies, medications or surgical procedures can be used in combination with these treatments, depending on your particular symptoms and your response to the treatment.

Managing treatment

Finding a healthy balance between fighting cancer and feeling well enough to do so is extremely important, so ask about combinations of treatment options that might help alleviate symptoms or conditions that develop.

For example, radiation therapy or transurethral resection of the prostate (TURP) can be performed to relieve symptoms; bone-modifying drugs can be given to prevent bone complications or to treat metastases; and chemotherapy can be used to lower your pain levels.

Because every man and every disease is different, each patient is encouraged to talk to several different types of specialists (oncologist, urologist, radiation oncologist, etc.) while making treatment decisions.

To learn more about how to manage the symptoms and side effects that come with advanced prostate cancer, click here.

Table 1. Treatment options for castration-resistant advanced prostate cancer

Treatment Type of treatment Use Most common side effects
docetaxel (Taxotere) Chemotherapy Used in combination with prednisone Hair loss, fluid retention, mouth sores, weakness, neuropathy (pain or abnormal sensations in the feet and hands), nausea, vomiting
cabazitaxel (Jevtana) Chemotherapy Used in combination with prednisone for cancer previously treated with a docetaxel-containing treatment Diarrhea, fatigue, nausea, vomiting, anemia, neutropenia, shortness of breath
abiraterone (Zytiga) Hormone therapy Used in combination with prednisone Joint swelling, diarrhea, heartburn, hot flashes, fatigue, swelling
sipuleucel-T (PROVENGE) Immunotherapy To treat asymptomatic or minimally symptomatic disease* Chills, fatigue, fever, back pain, nausea, joint ache
enzalutamide (Xtandi) Hormone therapy Used to treat prostate cancer that no longer responds to a medical or surgical treatment that lowers testosterone Fatigue, back pain, decreased appetite, constipation, joint pain, diarrhea
radium-223 (Xofigo) Radiation therapy Used to treat men with bone metastases (who have symptoms) but no known metastatic disease in an organ Nausea, diarrhea, vomiting, swelling, low white blood cell and platelet counts (rare)
*Additional requirements include good performance status (ability to carry out daily activities and perform ordinary tasks) and a life expectancy of more than six months.

Drugs for bone metastases

Men with castration-resistant prostate cancer and bone metastases are treated with drugs to prevent or delay skeletal-related events (such as fractures). As noted earlier, the bone-modifying agents used to prevent or manage osteoporosis related to ADT are the same ones used to treat bone metastases.

Two bone-modifying drugs are approved for advanced prostate cancer:

  • denosumab (Prolia, Xgeva)
  • zoledronic acid (Reclast, Zometa)

Both drugs have similar effectiveness in reducing skeletal-related events, but denosumab has been shown to delay the first skeletal-related event by a few months compared with zoledronic acid. Talk to your doctor about which drug may be better for you.

 

Medication Adherence: Following Your Prescription

As more anti-cancer drugs become available, the importance of medication adherence becomes increasingly apparent. So what is medication adherence? In medical terms, the word “adherence” refers to the extent to which a person takes the medication as prescribed or recommended by his or her health care provider. Proper adherence to a medication involves several factors, including taking the right drug, at the right dose, at the right time, and following the schedule and regimen exactly as prescribed. When patients don’t take their medications as prescribed, it’s called non-adherence. This varies from simply forgetting to take a prescribed medication to stopping a medication regimen earlier than instructed.

Taking your medication exactly as prescribed by your doctor is important in the fight against your cancer and in determining the effectiveness of your medication throughout treatment. Most anti-cancer drug regimens are designed to maintain a specific level of drugs in your system for a specific duration of time, based on your cancer type, stage, previous treatments and several other factors. Non-adherence to your medications can lead to cancer progression, unnecessary side effects, physician visits and hospitalizations.

Learn more about medication adherence here.

 

Monitoring response

Your doctor will probably order a bone scan or another imaging study periodically to monitor bone metastases during treatment. The goal of therapy with direct anti-cancer treatment and bone targeting agents is to slow or stop the development of bone damage. New areas of cancer cells in the bones mean that a different treatment may be necessary.

Additional Sources of Information

 

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