Surgery For Prostate Cancer
In some cases of advanced or recurrent prostate cancer, surgeons may remove the entire prostate gland in a surgery known as “salvage” prostatectomy. They usually do not perform the nerve-sparing form of prostatectomy. Often, surgeons will remove the pelvic lymph nodes at the same time.
Cyrosurgery may be used in cases of recurrent prostate cancer if the cancer has not spread beyond the prostate. Cryosurgery is the use of extreme cold to destroy cancer cells.
To reduce testosterone levels in the body, doctors may sometimes recommend removing the testicles, a surgery called orchiectomy. After this surgery, some men choose to get prosthetics that resemble the shape of testicles.
Doctors may also remove part of the prostate gland with one of two procedures, either a transurethral resection of the prostate or a transurethral incision of the prostate . This relieves blockage caused by the prostate tumor, so urine can flow normally. This is a palliative measure, which means it is done to increase the patient’s comfort level, not to treat the prostate cancer itself.
Dosage For Metastatic Castration
The usual recommended dose for metastatic castration-resistant prostate cancer is 1,000 mg of Zytiga taken once a day. The dosage may be taken as two 500-mg tablets or four 250-mg tablets.
With your Zytiga dose, you will also take 5 mg of prednisone by mouth twice a day. .
If you havent had your testicles surgically removed, youll take an additional medication to lower your hormone levels.
Combination Radiation And Endocrine Therapy
Sometimes, patients receive hormone therapy in combination with external beam radiation therapy for the treatment of prostate cancer. This treatment uses a high-energy X-ray machine to direct radiation to the prostate tumor. For patients with intermediate or high risk prostate cancer, studies show this combination is more effective at slowing the disease than endocrine therapy or radiation therapy alone.
Radiation can also come in the form of a monthly intravenous drug called Xofigo. Xofigo is approved for use in men who have advanced prostate cancer that has spread only to the bones. Candidates should have also received therapy designed to lower testosterone. The drug works by binding to minerals within bones to deliver radiation directly to bone tumors. A study of 809 men showed that those taking Xofigo lived an average of 3 months longer than those taking a placebo.
Two other similar drugs are strontium-89 and samarium-153 .
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What If I Miss A Dose
If you miss a dose of Zytiga or prednisone, take a dose the next day at the regular time. Dont take two doses at one time or in the same day. Taking more than one dose of Zytiga or prednisone can increase your risk for side effects.
If you miss more than one dose, call your doctor.
Using a reminder tool can help you remember to take Zytiga every day.
Edema Or Fluid Retention
Zytiga can cause edema .
Before starting Zytiga, tell your doctor about any swelling that you have. They will check to see if the swelling is caused by a disease that should be treated before you start taking Zytiga. If needed, theyll recommend treatment options to help prevent edema before or during your Zytiga treatment.
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Surprising Finding Upon Screening
“The main reason the prednisone is given is to help minimize the hypokaylemia that can be caused by the suppression of the steroid hormone pathway, and you end up with excess production of aldosterone,” Leonard G. Gomella, professor and chairman of the Department of Urology at the Sidney Kimmel Cancer Center, Thomas Jefferson University, said in an interview withTargeted Oncology. “By giving a very low dose of prednisone, what you really do is you keep the aldosterone level from rising and hopefully limit the side effect of hypokaylemia.”An award-winning poster also presented at the AUA Annual Meeting detailed a high rate of unsuspected asymptomatic metastatic disease, which was found during screening for the IMAAGEN trial.2During screening, patients who met entry criteria based on laboratory results underwent imaging to screen for local disease progression or metastatic disease. The study authors used this information to identify patients at high risk for progression from non-metastatic to metastatic disease.
Out of the 298 patients who were screened, 167 patients had screen failure, and 77 patients had metastatic disease. Of the men who were screened for this study, nearly 40% of them had metastatic disease. These were men who we thought were thought good candidates for this study and who we thought did not have metastatic disease, Crawford said.
Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will recommend a specific treatment plan for you based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.
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Antiandrogens For Prostate Cancer
These prostate cancer drugs work by blocking the effect of testosterone in the body. Antiandrogens are sometimes used in addition to orchiectomy or LHRH analogs.This is due to the fact that the other forms of hormone therapy remove about 90% of testosterone circulating in the body. Antiandrogens may help block the remaining 10% of circulating testosterone. Using antiandrogens with another form of hormone therapy is called combined androgen blockade , or total androgen ablation. Antiandrogens may also be used to combat the symptoms of flare . Some doctors prescribe antiandrogens alone rather than with orchiectomy or LHRH analogs.
Available antiandrogens include abiraterone acetate , apalutamide ,Ã biclutamide , darolutamide ,Ã enzalutamide , flutamide , and nilutamide . Patients take antiandrogens as pills. Diarrhea is the primary side effect when antiandrogens are used as part of combination therapy. Less likely side effects include nausea, liver problems, and fatigue. When antiandrogens are used alone they may cause a reduction in sex drive and impotence.
Provenge For Advanced Prostate Cancer
Sipuleucel-T is a “vaccine” for advanced prostate cancer that helps prolong survival.
Provenge isn’t your everyday vaccine. It’s an immune therapy created by harvesting immune cells from a patient, genetically engineering them to fight prostate cancer, and then infusing them back into the patient.
It’s approved only for treatment of patients with few or no prostate cancer symptoms whose cancer has spread outside the prostate gland and is no longer responding to hormone therapy.
Once a cancer grows beyond a certain point, the immune system has a hard time fighting it. One reason is that cancer cells look a lot to the immune system like normal cells. Another reason is that tumors may give off signals that manipulate the immune system into leaving them alone.
Provenge bypasses these problems. The treatment first removes a quantity of dendritic cells from a patient’s blood. Dendritic cells show pieces of tumor to immune cells, priming them to attack cells that carry those pieces.
The patient’s doctor ships the cells to Provenge’s manufacturer, Dendreon, which then exposes them to Provenge. Provenge is a molecule made inside genetically engineered insect cells.
Once these cells have been exposed to Provenge, they’re shipped back to the doctor who infuses them back into the patient. This is done three times in one month. The first infusion primes the immune system. The second and third doses spur an anticancer immune response.
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Endocrine Drugs For Prostate Cancer
Drugs work as well as prostate cancer surgery to reduce the level of hormones in the body. Most men opt for drug therapy rather than surgery. The three types of hormone-related drugs approved to treat advanced prostate cancer include luteinizing hormone-releasing hormone analogs, luteinizing hormone-releasing hormone antagonists, and antiandrogens.
Can People With Advanced Prostate Cancer Enroll In Clinical Trials
Major organizations such as the National Comprehensive Cancer Network recommend this course of action for all cancer patients. Researchers are exploring several new ways of diagnosing, monitoring, and treating prostate cancer. Clinical trials test the safety and effectiveness of these new methods and treatments. There are risks and limitations in every clinical trial. For example, you may be assigned to the “control” group, and not get the new medicine. In that case, the control medicine is the best therapy already available. Placebo — or ineffective treatment — is rarely if ever used anymore, and if it will be used in the trial, you would be informed. Keep in mind that the new medicine under investigation in the clinical trial may not work. But clinical trials also offer early access to new treatments.
You can find out more about clinical trials by asking a medical oncologist, inquiring at an academic medical center, or browsing a clinical trials listing service. The National Institutes of Health lists clinical trials at www.clinicaltrials.gov.
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Taking Zytiga With Food
Take Zytiga on an empty stomach, either one hour before a meal or two hours after a meal. Taking Zytiga on an empty stomach helps decrease your risk for side effects.
Take your dose of Zytiga with a glass of water.
However, according to current treatment guidelines, taking Zytiga with food may be an option. Talk with your doctor if you have questions.
How To Take Abiraterone
- Before you start the treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about abiraterone and will provide you with a full list of the side-effects which you may experience from taking it.
- Take abiraterone exactly as your doctor tells you to. The usual dose is two 500 mg tablets taken together, once a day. Your dose will be printed on the label of the pack to remind you about what the doctor said to you.
- You must take the tablets when your stomach is empty. This means that you should take abiraterone at least an hour before a mealtime, or wait until at least two hours after you have eaten. This is because taking abiraterone with food will increase the amount of the medicine in your blood in a way that isn’t predictable, and this is likely to cause side-effects.
- Take the tablets with a drink of water. Swallow the tablets whole – do not crush or break the tablets in order to swallow them.
- Try to take abiraterone at the same time of day each day as this will help you to remember to take your doses regularly.
- If you do forget to take a dose, take it as soon as you remember. If you do not remember until the following day, skip the forgotten dose. Do not take two doses together to make up for a missed dose.
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Prostate Cancer Drug Zytiga May Extend Life
Study Shows Zytiga Adds 4 Months of Life to Patients With Advanced Prostate Cancer
May 25, 2011 — The newly approved prostate cancer pill Zytiga may extend life by up to four months in men with spreading cancer who have already been treated with chemotherapy, a study shows.
This survival gain “means quite a bit,” says study researcher Howard I. Scher, MD, chief of the genitourinary oncology service at Memorial Sloan-Kettering Cancer Center in New York City. “These are a group of patients for whom there is no standard of care and it is particularly gratifying to see these results, to say the least.”
The new study is published in the New England Journal of Medicine.
Prostate cancer is the most common cancer diagnosed in men besides skin cancer, according to the American Cancer Society. One out of every six men will be diagnosed with prostate cancer during his lifetime.
The new drug, which was approved by the FDA in April, inhibits a protein that helps form male hormones. The findings may help reshape the way doctors view and treat advanced prostate cancer.
The new study included 1,195 men with metastatic prostate cancer whose disease had progressed after chemotherapy. Those men who received steroid therapy along with the new pill survived for 14.8 months, on average, compared with 10.9 months seen among those who received a placebo along with steroids. This translated into a 34% reduction in risk of dying, the study shows.
Zytiga To Treat Prostate Cancer
According to a Phase 3 trial of Zytiga, overall survival was longer in the abiraterone acetate-prednisone group than in the placebo-prednisone group after a median follow-up of 12.8 months . The clinical trial included 1,195 patients from 13 countries whose metastatic prostate cancer had previously been treated with one of two chemotherapy regimens that included Taxotere. Treatment with Zytiga improved PSA progression, progression-free survival, and PSA response rate, according to the study.
Over time, most prostate cancers become resistant to treatment. Zytiga works by blocking the production of androgen in the testes, adrenal glands, and prostate cancer tumors themselves. The group of 797 patients randomly assigned to receive Zytiga plus prednisone reported a median overall survival of 14.8 months, four months longer than patients treated with prednisone plus a placebo.
According to the FDA, The recommended dose and schedule for abiraterone acetate is 1000 mg administered orally once daily in combination with prednisone 5 mg administered orally twice daily. Abiraterone acetate must be taken on an empty stomach.
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How You Have Abiraterone
Abiraterone is available as tablets that you take once a day. The usual dose is 2 tablets per day.
You should swallow your tablets whole with a glass of water on an empty stomach. Take them at least one hour before food, or at least 2 hours afterwards.
You take abiraterone with a steroid called prednisolone to help reduce some of the side effects.
Cancer That Clearly Has Spread
If the cancer has spread outside the prostate, it will most likely go to nearby lymph nodes first, and then to bones. Much less often the cancer will spread to the liver or other organs.
When prostate cancer has spread to other parts of the body , hormone therapy is probably the most effective treatment. But it isnt likely to cure the cancer, and at some point it might stop working. Usually the first treatment is a luteinizing hormone-releasing hormone agonist, LHRH antagonist, or orchiectomy, sometimes along with an anti-androgen drug or abiraterone. Another option might be to get chemotherapy along with the hormone therapy. Other treatments aimed at bone metastases might be used as well.
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Understanding Advanced Prostate Cancer
There are different forms of advanced prostate cancer. Two types are metastatic castration-resistant prostate cancer and metastatic castration-sensitive prostate cancer .
- Metastatic castration-resistant prostate cancer is a form of prostate cancer that is resistant to medical or surgical treatments that lower testosterone, and has spread to other parts of the body
- Metastatic castration-sensitive prostate cancer is a form of prostate cancer that still responds to medical or surgical treatments that lower testosterone, and has spread to other parts of the body. Certain men may be considered to have metastatic high-risk castration-sensitive prostate cancer. Talk to your doctor about what this may mean for you
Abiraterone Acetate Treatment For Prostate Cancer
It is a standard medicine for prostate cancer treatment. It is marketed by the name “Zytiga.” as an oral pill. The prostate is the gland around the urethra in the male reproductive system. Testosterone is the natural male hormone that propagates the growth of prostate cancer. Common symptoms of cancer include difficulty in urination, blood in the urine, pelvic pain, etc. Abiraterone inhibits the production of the hormone and slows the spread of prostate cancer. Ideally, you can pair the drug with a corticosteroid . It can treat metastatic castration-resistant prostate cancer and metastatic high-risk castration sensitive prostate cancer. The treatment is practically a form of hormone therapy. It goes for the class of anti-androgens.
Hormones are chemical substances that affect the tissues and are formed in glands. Our body hosts various hormones for different purposes. Hormone therapy works by altering or stopping the production of a specific hormone. It works well against cancer by observing how receptors for particular hormones can treat tumor cells by growing on the surface. Decreasing hormone production helps fight prostate cancer. Metastatic tumors can produce testosterone on their own. Androgen deprivation therapies focus on reducing the androgens levels produced by the testicles and not the adrenal glands. Abiraterone works slightly differently.
If the drugs seem useful in the treatment, physicians are known to expand its use for other cures.
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Infection Of The Water Works
You might have an infection of the water works called a urinary tract infections . This can make it difficult to pass urine, you might go with some urgency or more often. There may be pain or burning when you go. You may see blood in your urine, or your urine might smell bad or look cloudy.
Tell your doctor or nurse if you think you might have a urinary tract infection.