The following are treatment options for castrate-resistant prostate cancer (also called hormone-refractory prostate cancer). The types of treatments given are based on the unique needs of the person with cancer.
Hormonal therapy
If a man is only taking an LHRH agonist, an anti-androgen (usually bicalutamide) will be added when there are signs of hormone-refractory growth (usually a rising PSA). The LHRH is not stopped. The PSA will often come down for a period of weeks or months before rising again. When it rises, the anti-androgen is stopped but the LHRH is continued.
Chemotherapy
The most common chemotherapy drugs used to treat prostate cancer are:
- docetaxel (Taxotere)
- mitoxantrone (Novantrone)
- cabazitaxel (Jevtana)
The most common chemotherapy combinations used are:
- docetaxel and prednisone – This combination reduces pain, improves quality of life and increases survival.
- mitoxantrone (Novantrone) and prednisone (Deltasone) – This combination reduces pain and improves quality of life.
- cabazitaxel (Jevtana) and prednisone – This combination prolongs survival in castrate-resistant prostate cancer.
Radiation therapy
- short course of treatment (1–10 treatments) to relieve bone pain
- not given for 4–6 weeks after a transurethral resection of the prostate (TURP), to reduce the risk of scarring in the urethra (urethral stricture)
Bisphosphonates
The type of bisphosphonate used with hormone-refractory prostate cancer is zoledronic acid (Zometa). It decreases bone-related complications in men with prostate cancer.
Biological therapy
Surgery
Transurethral resection of the prostate (TURP) may be offered for hormone-refractory prostate cancer. This type of surgery is used to relieve urinary symptoms caused by the prostate tumour (palliative surgery).
Clinical trials
References
Cancer information / Cancer type / Prostate / Treatment / Castrate-resistant prostate cancer
American Cancer Society. Prostate cancer overview. (2011, May 4). Detailed Guide: Prostate Cancer. Atlanta, GA: American Cancer Society. Retrieved from: http://www.cancer.org/.
de Bono,J.S., Oudard,S., Ozguroglu, M., et al. Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: a randomised open-label trial. (2010, October 2). Lancet. New York, NY: Elsevier, Inc. Retrieved from: http://www.thelancet.com/journals/lancet/issue/current.
Fizazi K, Carducci M, Smith M,et al. Denosumab versus zoledronic acid for treatment of bone metastases in men with castration-resistant prostate cancer: a randomised, double-blind study. (2011, March 5). Lancet. New York, NY: Elsevier, Inc. Retrieved from: http://www.thelancet.com/journals/lancet/issue/current.
Prostate Cancer Treatment (PDQ®). National Cancer Institute. (2010, August). National Cancer Institute (NCI). Bethesda, MD: National Cancer Institute. Retrieved from: http://www.cancer.gov.
Prostate cancer. National Comprehensive Cancer Network. (2010). NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network (NCCN).
Ross, P. L., Carroll, P. R., Small, E. J., et al. Prostate. Ko, A. H., Dollinger, M., & Rosenbaum, E. (2008). Everyone's Guide to Cancer Therapy: How Cancer is Diagnosed, Treated and Managed Day to Day. (5th Edition). Kansas City: Andrews McMeel Publishing. pp. 789-806.
Zelefsky MJ., Eastham JA, Sartor OA, et al. Cancers of the genitourinary system: cancer of the prostate. Devita, V. T., Jr., Lawrence, T. S., & Rosenberg, S. A. (2008). Cancer: Principles & Practice of Oncology. (8th Edition). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 40.6: 1392-1451.
Source - Canadian Cancer Society:
http://www.cancer.ca/en/cancer-information/cancer-type/prostate/treatment/castrate-resistant-prostate-cancer/?region=on
