August - December 2007 Issue
Treatment Options for Advanced Prostate Cancer
Nancy B. Davis, MDMedical College of Wisconsin Medical Oncologist
When prostate cancer has spread beyond the prostate, it is called advanced prostate cancer. At this stage, while there is no cure there are treatments available to minimize symptoms and prolong life — without diminishing a man’s quality of life. Dr. Nancy Davis discusses treatment options for men with advanced prostate cancer.
Q. What is advanced prostate cancer?Advanced prostate cancer is cancer that has spread outside the prostate gland. When the cancer has grown outside the outer rim of the prostate and into nearby tissue, it is called locally advanced prostate cancer. When it has spread further, into the lymph nodes or other areas of the body, it’s called metastatic prostate cancer.
Up to 20 percent of newly diagnosed cases of prostate cancer are advanced by the time they are detected. Advanced prostate cancer can also occur in men who were initially treated for localized disease (cancer contained within the prostate) and whose prostate cancer then recurs.
Q. What are the signs and symptoms of prostate cancer? Are there more symptoms with advanced cancer?As with localized prostate cancer, sometimes there are no symptoms of advanced prostate cancer. When there are symptoms, they may include unexplained bone pain, weight loss and energy loss. About 85 percent of men with metastatic cancer have bone metastases that may cause pain that is usually localized in one area of bone.
A rise in a man’s protein specific antigen (PSA) level may also indicate the presence of cancer. PSA, a protein produced by the cells of the prostate gland, is found in an increased amount in the blood of men who have prostate cancer. In general, the higher the PSA level, the more likely that cancer is present. A biopsy, in which a sample of tissue is removed from the prostate gland or the area where the cancer may have spread, is the only way to know for sure if cancer is present.
Q. What treatment options are available for advanced prostate cancer?While there is no cure for advanced prostate cancer, men can benefit from treatment that slows the growth of the cancer, reduces symptoms and prolongs life.
Hormonal therapy is the first-line treatment to treat locally advanced and advanced metastatic prostate cancer. These drugs interfere with the production of testosterone, a hormone secreted by the testicles. Testosterone promotes or stimulates the growth of cancer cells. Hormonal treatment “tells” the brain to prevent the testicles from making testosterone.
The hormone therapy — called a gonadotropin agonist — is injected in the arm or implanted as tiny capsules.
New data show that the intermittent use of hormone therapy with metastatic cancer is not inferior to continuous use of hormone therapy. In intermittent therapy, if the PSA level responds to the hormones, the therapy can be stopped (a drug “holiday”) and resumed later when the PSA or symptoms warrant.
Surgical removal of the testicles is another option to eliminate the production of testosterone. Removing the testicles deprives the cancer cells of testosterone, causing the cancer to shrink and preventing further growth of the tumor.
Once hormonal therapy is no longer effective, chemotherapy has been shown to prolong survival. In most cases, chemotherapy is well-tolerated. Most men feel better because their symptoms are alleviated.
We’re also exploring using chemotherapy initially for advanced prostate cancer treatment. A clinical trial at Froedtert & the Medical College of Wisconsin is studying treatment with hormones alone, as well as treatment with hormones and a short course of chemotherapy to see if survival time can be prolonged.
Other treatments include bisphosphonate infusion and radiation therapy. Bisphosphonate infusion can help strengthen bones and prevent osteoporosis in men who are on long-term hormonal therapy. It can reduce pain and the risk of bone injury (e.g., fractures) associated with metastatic cancer in the bone. Radiation therapy may be used to treat painful localized cancer that has metastized in a bone.
Q. What are the side effects of these treatments?Side effects vary depending on treatment, and the severity of side effects varies from person to person.
Side effects of hormone treatment may include hot flashes, impotence, lack of libido, decreased muscle mass, breast tenderness, breast growth, osteoporosis and heart disease.
The side effects of chemotherapy include fatigue, temporary (predictable) decrease in blood counts leading to a risk of infection, anemia, or easy bruising/bleeding, fluid retention, hair loss and nausea
Men who have radiation treatment may experience fatigue, as well as skin and hair changes at the site of treatment. Other side effects depend on the body part being radiated.
Bisphosphonate treatment can lead to kidney damage; therefore, patients are closely monitored and the dose is adjusted or stopped based on blood tests. A rare, but serious, side effect of bisphosphonates is osteonecrosis of the jaw (bone death resulting from poor blood supply to an area of bone); otherwise, temporary bone aches and lower blood calcium may occur.
Q. What are the outcomes for a man with advanced prostate cancer?Treatment is allowing men with advanced prostate cancer to live longer — up to five years after diagnosis. Nearly all men respond to hormonal therapy for an average of two years. Then, first-line (the first course) chemotherapy may add another 20 to 24 months to a man’s life. Following that, second-line chemotherapy (a second course) may be used.
Q. What role do clinical trials play in treating advanced prostate cancer?Clinical trials are always available at Froedtert & the Medical College of Wisconsin for advanced prostate cancer. These trials seek to improve upon current treatments using hormonal therapy and chemotherapy.
Q. What are the benefits of receiving treatment at Froedtert & the Medical College of Wisconsin, an academic medical center?We have physicians who specialize not only in cancer but who also have a subspecialty focus in prostate cancer. We treat more men with advanced prostate cancer than the oncologist in the community. In addition, we take a multidisciplinary approach at every stage of patient care. Urologists, medical oncologists, radiation oncologists, palliative care specialists and other experts work together to optimize and individualize each man’s care.
Source: Every Day
Date: Aug - Dec 2007 Issue