While patients with Advanced Prostate Cancer [AIPC] have limited treatment options, two landmark clinical studies presented at the American Society for Clinical Oncology (ASCO) scientific conference in 2004 and published in the New England Journal of Medicine later that year. demonstrated for the first time that chemotherapy treatment could extend the survival of patients with this advanced disease.
Taxotere (docetaxel) was approved in 2004 by the U.S. Food and Drug Administration (FDA) for the treatment of Advanced Prostate Cancer [AIPC] based upon data from these studies. Currently, extensive scientific and clinical research is underway at several biopharmaceutical companies and academic research institutions to further improve the survival benefit for patients with advanced disease and to enhance the quality of life, efficacy and safety of these treatment regimens.
In the sections that follow, this informational package will provide additional background information and an overview of the:
Taxotere (docetaxel) was approved in 2004 by the U.S. Food and Drug Administration (FDA) for the treatment of Advanced Prostate Cancer [AIPC] based upon data from these studies. Currently, extensive scientific and clinical research is underway at several biopharmaceutical companies and academic research institutions to further improve the survival benefit for patients with advanced disease and to enhance the quality of life, efficacy and safety of these treatment regimens.
In the sections that follow, this informational package will provide additional background information and an overview of the:
(1) Four classifications (categories) of Advanced Prostate Cancer
(2) Currently approved treatment options for advanced patients
(3) Experimental treatments in clinical testing
(4) Information on accessing investigational products through clinical trials
Four Categories of Advanced Prostate Cancer [AIPC]
The four most commonly encountered disease categories of prostate cancer are summarized below. They range from prostate cancer confined to the prostate glad to prostate cancer that has spread to lymph node and bone.
Locally Advanced Prostate Cancer
Cancer that has grown to fill the prostate or has grown through the prostate and may extend into the glands that help produce semen (seminal vesicles), or the lymph nodes.
Occurs in men who have been treated for early prostate cancer, but the prostate specific antigen is rising. A bone scan and cat scan in these patients is usually shows no evidence of cancer
Biochemically Recurrent Prostate Cancer (Rising PSA)
Patients who have a rising PSA after treatment, but do not have any evidence of disease spread to bone or other organs. This can occur after local treatment, or after hormone therapy. The management of such patients is controversial, and may include investigational treatments, radiation therapy, or chemotherapy.
Metastatic Prostate Cancer (Hormone Sensitive)
Cancer that has spread (metastasized) to the bone , lymph nodes or other parts of the body.. Depletion of the male sex hormone, testosterone, results in improvement of tumor related symptoms such as bone pain or inability to urinate. This can be achieved by either surgical removal of the testosterone, as well as with medications such as lupron and zoladex.
Hormone Refractory Prostate Cancer
Prostate cancer that continues to grow despite the suppression of male hormones that fuel the growth of prostate cancer cells.
A Team Approach to prostate cancer is very important. Your Prostate Cancer Treatment Team may include a urologist, a radiation oncologist, a medical oncologist, your family and nurses, patient navigators and others.
Before a diagnosis of advanced androgen- independent prostate cancer:
Your doctor will ensure your testosterone level is zero.
Ensure that there’s a consistent rise in PSA, tested several times over several months.
Perhaps offer a secondary hormonal therapy in addition to the hormone suppression therapy you may already be taking to possibly control you PSA for an additional amount of time
Secondary hormonal therapies could include:
(1) Antiandrogen withdrawal (AAW)
(2) Antiandrogen addition (Low vs. High)
(3) Estrogens (I.V., oral, transdermal…)
(4) Ketoconazole (Nizoral)
(5) Aminoglutethimide (Cytadren)
(6) Corticosteroids
Currently Approved Treatment Options for Advanced Patients
There is no single treatment for advanced prostate cancer. Yet, there are ways to slow the course of the disease.
In addition to these new therapies, you are usually advised to stay on hormone-lowering therapy, even though it no longer stops your PSA from rising. The reason for this is that some of your prostate cancer cells remain sensitive to testosterone, and stopping hormone therapy may make them grow again.
Hormonal therapy
Treatments for cancer that has spread to the bones
(1) Salvage radiation therapy
(2) Chemotherapy
(3) Adjuvant Therapy
The correct treatment choices are different for each man and are based upon many factors which should be discussed in detail with medical experts.
Treating Metastases
Doctors today have many tools to treat metastases. The broad categories include:
(1) Chemotherapy. Anti-cancer chemicals that kill tumors
(2) Secondary Hormonal Treatment – compounds that change hormone levels, but are not the first testosterone-suppression treatment to be used.
(3) Radiopharmaceuticals. Drugs linked to radioactive compounds which can target cancer spreac to the bone as well as other specific targets. These radioactive elements are delivered to or near tumor cells. This approach is effective in controlling bone pain. Bone seeking radioisotopes such as strontium and samarium are effective in treating patients who have multiple sites of bone pain.
(4) External Beam Radiation. Targeted beams of radiation. Most useful when a man has just one or two specific sites painful sites.
(5) Surgery. Cutting the tumor out.
(6) Bisphosphonates. Drugs that help bones from breaking down. These drugs can prevent the thinning of bone, otherwise know as osteoporosis, which can increase the risk of bone fractures.
Within each of these treatment areas, there are several options. Your doctors will help choose the right treatments for you.
Side effects. You are probably aware that cancer treatments may have unpleasant side effects, such as nausea, weakness, and hair loss. While that’s true, it’s less true than it used to be. Today, side effects of treatment are usually short term, and most can be managed. In many cases, you can take a medication before your radiation or chemotherapy treatment, to keep the side effect from affecting your daily routine.
Alternative and Complementary Therapies
In addition to the medical options your doctors prescribe, other therapies can help you fight prostate cancer. Sometimes these are called “alternative” or “complementary” treatments. The National Institutes of Health (NIH) has an entire division devoted to research in these areas, called the National Center for Complementary and Alternative Medicine (NCCAM).
The nation's leaders in treating advanced disease recommend patients keep a diary of their medications and supplements.
Pain Management
Men with advanced prostate cancer may experience pain. The pain can have a lot of different sources, doctors have may different effective ways to releive pain, so that you can enjoy your life and fight the disease with energy.
Treat the underlying cause
When pain is caused by a tumor, treatment to reduce the tumor can also reduce the pain. Radiation, chemotherapy and bone-building drugs that shrink tumors can all be effective in controlling pain. Sometimes they are even more effective than heavy pain drugs. (abstract J. Clin Oncology 2004: 22: 3587-3592).
Narcotics
These powerful drugs mimic the body’s own pain-killing chemicals. Narcotics may be given as a pill, a patch, or as an intravenous (IV) drip by health-care professionals, for severe pain.
Pain pills and patches
Doctors have a wide range of drugs to choose from in treating pain. Different drugs work in different ways. If one does not work for you, tell your doctor, and ask about others.
Alternative therapies
Acupuncture has been proven in clinical studies to help relieve pain. Meditation, prayer, and hypnosis also help some people.
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