How Is It Treated
Your treatment choices depend on your overall health, how fast the cancer is growing, and how far it has spread.
Locally advanced prostate cancer may be treated with surgery, radiation therapy, hormone therapy, or a combination of these.
Treatment of metastatic cancer focuses on slowing the spread of the cancer and relieving symptoms, such as bone pain. It also can help you feel better and live longer. Treatment may include hormone therapy, radiation therapy, chemotherapy, or immunotherapy.
Men over age 80 or those with other serious health problems may decide not to have treatment except for what is needed to treat any symptoms .
What Else Do People Living With Metastatic Prostate Cancer Need To Know About Their Treatment Options
I cannot stress enough the importance of picking the righttreatment for each individual. Side effects and the expectations for diseaseresponse should be clearly discussed and understood.
Statistically, about one-third of people with metastatic prostate cancer will live more than 5 years. Understanding where your disease is on that continuum can be important for both treatment and lifestyle decisions.
That said, I am consistently amazed by what we as a medical and scientific community can do together. The huge efforts being applied to prostate cancer research hold significant promise for new and better treatment options in the near future.
Dr. Joseph Brito provides general urologic care with a special focus on minimally invasive surgical techniques and urologic oncology. Dr. Brito received his MD from George Washington University School of Medicine and Health Sciences. Dr. Brito completed a residency in urology at Rhode Island Hospital and Alpert Medical School of Brown University and trained at Yale School of Medicine in clinical oncology. Dr. Brito is a member of the American Urological Association.
In Five Years A Major Treatment Shift
In men diagnosed with metastatic hormone-sensitive prostate cancer, the cancer is typically driven to grow and spread by androgens that are produced largely in the testes. For many years, treatments that block androgen production have been a mainstay for men initially diagnosed with metastatic prostate cancer.
Starting in 2014, that began to change after a large clinical trial showed that adding the chemotherapy drug docetaxel to ADT improved how long men with hormone-responsive disease lived. Shortly after, another clinical trial showed that adding abiraterone to ADT also improved survival in these men, although primarily in men with many metastatic tumors, known as high-volume disease.
However, docetaxel, which works by directly killing cancer cells, can have substantial side effects, and some patients arent healthy enough to tolerate it. And abirateronewhich blocks androgen production throughout the bodycan also cause side effects, including those that affect the liver. It also has to be given in combination with the steroid prednisone, which carries its own toxicity.
Doing so, Dr. Chi said during a presentation of the TITAN data at the ASCO meeting, might help stave off the typically inevitable development of hormone-resistant cancer, which is more difficult to treat and a key driver of prostate cancer deaths.
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Phase I Study Of Niraparib In Combination With Radium
Clin Cancer Res 2022 XX:XXXX
Clin Cancer Res
Zachary Quinn, Benjamin Leiby, Guru Sonpavde, Atish D. Choudhury, Christopher Sweeney, David Einstein, Russell Szmulewitz, Oliver Sartor, Karen Knudsen, Eddy Shih-Hsin Yang, Wm. Kevin Kelly Phase I Study of Niraparib in Combination with Radium-223 for the Treatment of Metastatic Castrate-Resistant Prostate Cancer. Clin Cancer Res 2022
Choosing A Treatment Option
Treatment Options for Localized or Locally Advanced Prostate CancerA man diagnosed with localized or locally advanced prostate cancer has 3 major treatment options: Active Surveillance, surgery, and radiation therapy. For patients whose cancer appears more aggressive, combination treatment may be recommended. For
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Bayers Nubeqa Receives Mhra Approval To Treat Metastatic Prostate Cancer
The treatment will be made available immediately through an early access deal with NHS England
Bayers Nubeqa tablets plus androgen deprivation therapy , in combination with docetaxel, have been approved by the Medicines and Healthcare products Regulatory Agency for the treatment of metastatic hormone-sensitive prostate cancer .
Nubeqa, which is already available on the NHS for patients with localised prostate cancer, was reviewed and approved through Project Orbis, an international programme to speed up the approval process of promising cancer drugs.
The commercial agreement between NHS England and Bayer is the first for a prostate cancer therapy and enables early access for eligible NHS patients in England for this indication while the National Institute for Health and Care Excellence completes its ongoing appraisal.
We are delighted that men with prostate cancer in England will have early access to another innovative treatment option, said Antonio Payano, chief executive officer, Bayer UK and Ireland.
Its vital that NHS patients are able to benefit from the best standard of care and full range of emerging therapies today and in the future. It requires direct and sustained collaboration between government, the NHS and the life sciences sector to properly realise these shared ambitions.
The results, published in the New England Journal of Medicine in February, also showed a 32.5% reduction in the risk of death in the Nubeqa group compared to the placebo.
Are There Any Lifestyle Changes I Should Consider While In Treatment For Metastatic Prostate Cancer
The most important thing you can do is to stay physically active and strong. This includes following a heart-healthy diet and exercising.
Cardiovascular exercise is the most important. The degree, or intensity and duration, of cardio exercise depends on the individual person.
Several studies have pointed to a link between obesity and aggressive prostate cancer, although the mechanism is still being worked out.
Weight loss is generally encouraged if youre overweight, but excessive or unintentional weight loss can be a sign of disease progression and should be discussed with your doctor.
Finally, if youre a smoker, stop! If youre finding it hard to quit, ask your doctor about products and medications that might help you.
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How Will My Cancer Be Monitored
Your doctor will talk to you about how often you should have check-ups. At some hospitals, you may not have many appointments at the hospital itself. Instead, you may talk to your doctor or nurse over the telephone. You might hear this called self-management.
You will have regular PSA tests. This is often a useful way to check how well your treatment is working. Youll also have regular blood tests to see whether your cancer is affecting other parts of your body, such as your liver, kidneys or bones.
You might have more scans to see how your cancer is responding to treatment and whether your cancer is spreading.
Your doctor or nurse will also ask you how youre feeling and if you have any symptoms, such as pain or tiredness. This will help them understand how youre responding to treatment and how to manage any symptoms. Let them know if you have any side effects from your treatment. There are usually ways to manage these.
Stereotactic Body Radiation Therapy Or Stereotactic Ablative Radiation Therapy
Guided by advanced imaging techniques, SBRT delivers large doses of radiation over a short period of time to a precise area. SBRT is commonly referred to by the names of the machines used to deliver the radiation. SBRT can offer some patients with localized prostate cancer the convenience of fewer treatments while maintaining treatment effectiveness and safety. SBRT may also be used to treat metastases for some patients to reduce tumor mass and potentially enhance survival.
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Lutetium Lu 177 Vipivotide Tetraxetan
Lutetium Lu 177 vipivotide tetraxetan is indicated for the treatment of men with prostate-specific membrane antigen -positive, metastatic castration-resistant prostate cancer who have been treated with androgen receptor pathway inhibition and taxane-based chemotherapy. It is a radioligand therapeutic agent. The active moiety is the radionuclide lutetium-177, which is linked to a moiety that binds to PSMA, a transmembrane protein expressed in prostate cancer, including mCRPC. Upon binding to PSMA-expressing cells, the lutetium-177 delivers beta-minus radiation to the cells, as well as to surrounding cells, inducing DNA damage that can lead to cell death.
Approval was based on the phase 3 VISION trial. Compared with patients receiving standard care , patients who received lutetium Lu 177 vipivotide tetraxetan plus standard care had significantly prolonged imaging-based progression-free survival and overall survival .
Considering Complementary And Alternative Methods
You may hear about alternative or complementary methods that your doctor hasnt mentioned to treat your cancer or relieve symptoms. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.
Complementary methods refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctors medical treatment. Although some of these methods might be helpful in relieving symptoms or helping you feel better, many have not been proven to work. Some might even be harmful.
Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known about the method, which can help you make an informed decision.
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A Goal Of Sparing Healthy Tissue To Help Speed Recovery
Proton therapy is a powerful treatment for cancer and a highly effective alternative to standard X-ray radiation therapy. Due to improved dose distribution with proton therapy, doctors can better conform radiation to the tumor site, which means less healthy tissue is exposed to radiation, and which in turn is expected to result in fewer short- and long-term side effects.
Choosing To Stop Treatment Or Choosing No Treatment At All
For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. Whether or not you continue treatment, there are still things you can do to help maintain or improve your quality of life.
Some people, especially if the cancer is advanced, might not want to be treated at all. There are many reasons you might decide not to get cancer treatment, but its important to talk to your doctors and you make that decision. Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms.
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Provenge For Advanced Prostate Cancer
Provenge isnt your everyday vaccine. Its 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.
Its 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 patients blood. Dendritic cells show pieces of tumor to immune cells, priming them to attack cells that carry those pieces.
The patients doctor ships the cells to Provenges 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, theyre 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.
Chemotherapy For Metastatic Prostate Cancer
Chemotherapy may be used for patients with metastatic prostate cancer, with the aim of slowing any further spread of cancer and improving quality of life.
The most commonly used chemotherapy medications, typically given via an intravenous line, are docetaxel combined with prednisone. However, there are several chemotherapy drugs available, so ask your doctor which types may be most appropriate for your treatment.
In some cases, these treatments are considered palliative, intended to relieve difficult symptoms and improve quality of life.
Prostate cancer treatment: The care you need is one call away
Your multidisciplinary team will work with you to develop a personalized plan to treat your prostate cancer in a way that fits your individual needs and goals.
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Surgery In Metastatic Disease
Physicians have suggested that the benefits seen from radiation to the prostate point to the benefits of local therapy, raising the question of whether radical prostatectomy might have the same results. Trials are ongoing, and at present the use of surgery should be considered investigational and conducted only within the context of a trial. However, transurethral resection is sometimes needed in men who develop obstruction secondary to local tumor growth. Bilateral orchiectomy can be used to produce androgen deprivation in patients with widely advanced and metastatic prostate cancer.
Since the introduction of LHRH agonist and antagonist therapies, surgical intervention has been practiced less often. An indication for immediate bilateral orchiectomy is spinal cord compression, because it avoids the potential flare response that can occur during the first 3 weeks of treatment with an LHRH agonist.
What Is Advanced Prostate Cancer
When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.
Prostate cancer is often grouped into four stages, with stages III and IV being more advanced prostate cancer.
- Early Stage | Stages I & II: The tumor has not spread beyond the prostate.
- Locally Advanced | Stage III: Cancer has spread outside the prostate but only to nearby tissues.
- Advanced | Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs.
When an early stage prostate cancer is found, it may be treated or placed on surveillance . Advanced prostate cancer is not curable, but there are many ways to treat it. Treatment can help slow advanced prostate cancer progression.
There are several types of advanced prostate cancer, including:
With biochemical recurrence, the prostate-specific antigen level has risen after treatment using surgery or radiation, with no other sign of cancer.
Castration-Resistant Prostate Cancer
Non-Metastatic Castration-Resistant Prostate Cancer
Prostate cancer that no longer responds to hormone treatment and is only found in the prostate. This is found by a rise in the PSA level, while the testosterone level stays low. Imaging tests do not show signs the cancer has spread.
Metastatic Prostate Cancer
- Lymph nodes outside the pelvis
- Other organs, such as liver or lungs
Metastatic Hormone-Sensitive Prostate Cancer
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Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.
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What Should You Ask Your Doctor About Treatments
The American Cancer Society recommends that you ask questions like these:
- What treatment might be best for me?
- What are the possible benefits of getting it?
- How soon would I need to start treatment?
- Will I need to get surgery as part of my treatment? If so, what will it be like and who will do it?
- Will I need other treatments, too? If so, how might they benefit me?
- What side effects could my treatments cause? And what should I do if I get them?
- Is there a clinical trial that might be a good option for me?
- Can you review any vitamins or diet Iâm on to make sure it wonât interfere with my cancer treatment?
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Radiopharmaceuticals For Painful Bone Metastasis
When cancer spreads to bones, it can sometimes cause great discomfort and impact your quality of life. This therapy involves injecting a group of radioactive drugs such as radium into the body, to settle into bones with cancerous cells and kill them. It can often relieve pain for long periods of time.
Hormone Therapy Also Called Androgen Deprivation Therapy
Hormone therapy is used to control the production or block the impact of male hormones, called androgens, on theprostate cancer cells. However standard hormone therapy may lead to side effects such as hot flashes, weight-gain,dizziness, and osteoporosis, often diagnosed through a bone scan. To avoid these side effects, we always useappropriatelevels of immunotherapy as a follow-up to hormone therapy.
There are several types of hormone therapy to lower testosterone levels and other androgens, produced by thetesticles,adrenal glands, and even the prostate cancer cells. Some of the different types of hormone therapy include:
- Orchiectomy, which is the surgical removal of testicles
- Luteinizing hormone releasing hormone agonists and antagonists
- Anti-androgens or androgen receptor antagonists
We also use different proprietary procedures to heal your bones and relieve you from pain, in case your bone densityisaffected by hormone therapy prior to starting treatment at Envita.
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