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Advanced Prostate Cancer
Advanced prostate cancer is when the cancer has spread outside of the prostate (metastatic disease) or shows signs of spreading after using hormonal therapy (castrate resistant prostate cancer CRPC).
What Is Castrate-Resistant Prostrate Cancer (CRPC)?
Castrate-resistant prostate cancer (CRPC) is when your PSA has risen or your cancer has shown signs of growing after hormone therapy. Prostate cancer usually responds to hormone therapy, but eventually cancer cells will “outsmart” the treatment. They can learn to grow even without testosterone to fuel their growth.
What is Metastatic Castrate-Resistant Prostate Cancer (MCRPC)?
Metastatic castrate-resistant prostate cancer or mCRPC is when your PSA has risen while on hormone therapy and your cancer has spread far from the prostate. Many of the newest treatments available are for patients with mCRPC.
What is Biochemical Recurrence?
Biochemical recurrence is when your PSA has risen after initial treatment and you have no other sign of cancer. The hormone therapy section of this booklet will help you understand treatments available to you.
Learn More About Immunotherapy.
Innovative Medications for Castrate-Resistant Prostate Cancer
PROVENGE
Provenge Activates T Cells to Attack Cancer
Provenge is an immunotherapy drug that harnesses the power of a patient’s own immune system to identify and target prostate cancer cells. It also helps the immune system fight disease. Each dose is made specifically for each patient. The personalized dose of Provenge consists of the patient’s own immune cells that have been trained to seek and attack prostate cancer. The treatment typically takes six weeks to be administered, and is given by intravenous infusions every two weeks. Provenge has allowed men to live longer with minimum side effects.
XTANDI
Xtandi is a medication that is used to treat men with prostate cancer that no longer responds to a medical or surgical treatment that lowers testosterone and that has spread to other parts of the body. For the treatment of advanced prostate cancer.
ZYTIGA
This medication is a type of hormone therapy and works a bit differently than other hormone treatments for prostate cancer. This medication is known as an androgen biosynthesis inhibitor. The male hormone testosterone may stimulate the growth of prostate cancer. The majority of testosterone is made in the testes, but some is also produced in other tissues and in tumor cells. An enzyme called cytochrome is essential to the production of testosterone. Zytiga works by blocking this enzyme which in turn stops the testes and the other tissues in the body from making testosterone.
XOFIGO
Xofigo giving off Radiation to Kill Cancer
Xofigo is used to treat prostate cancer that is resistant to medical or surgical treatments. This drug also helps extend life by more than 30% (14.9 months in Xofigo–treated men vs 11.3 months in placebo-treated men). Xofigo goes to the bone and helps kill cancer cells, but limits damage to healthy cells. Xofigo can be absorbed by organs other than the bone primarily the bone marrow and digestive system, which can result in side effects in healthy tissue.
What is the Best Therapy for Me?
This is by far the single most frequently asked question from men who have been recently diagnosed with advanced prostate cancer or biochemical recurrence. The answers you seek are probably unclear. You more than likely have been given information regarding your prostate cancer (gleason score, PSA, staging, imaging results, etc.) which can be very confusing, and now you are also dealing with questions about the dangers of metastasis and side effects of some drugs. Today there are more effective ways to treat and manage advanced prostate cancer than ever before. To make the best decisions, you need information and guidance from medical experts with extensive knowledge and experience in treating the different stages of prostate cancer successfully.
The experts at the Genesis Comprehensive Prostate Cancer Center will assist you in carefully evaluating all options for treating your particular stage of prostate cancer. They’ll help you weigh the benefits of each treatment, probable outcomes (likely results of treatment), side effects, and risks. You will become aware of promising new treatments and be provided with the education and support you will need to ensure the best in quality for treatment. Our goal is to connect you with the resources you will need, and provide you with a consistent high level of care and individualized treatment plan. Additionally, our staff will be monitoring your progress throughout your treatment.
What is Hormonal Therapy?
Hormone therapy is also called androgen deprivation therapy (ADT) or androgen suppression therapy. The goal is to reduce levels of male hormones, called androgens, in the body, or to stop them from affecting prostate cancer cells.
Why is Bone Health Important While Taking Hormonal Therapy?
Bone health preservation is critical for improving quality and quantity of life. Bone is a frequent site of metastases in men with advanced prostate cancer. Without testosterone, bones can become weak and break more easily, a condition known as osteoporosis. Since both prostate cancer and osteoporosis are more likely to occur in older men, men undergoing prostate cancer treatment may already have weakened bones. Studies have shown that treatment may make them even weaker. When prostate cancer cells invade the bone, they disrupt the normal bone remodeling process and weaken the bone structure. Genesis Comprehensive Prostate Cancer Center helps patients maintain strong healthy bones through regular bone density testing and improve bone health through nutrition, exercise, healthy lifestyle choices, and when appropriate, medication.
What If My Hormone Therapy Is No Longer Working?
Usually, physicians will keep you on hormone therapy because it keeps the levels of testosterone in your body at a minimum. But, if the therapy isn’t working as well, you doctor may suggest a combination treatment. Anti-androgens are a type of hormone therapy that’s taken with your usual treatment to prevent the hormone from reaching the cancer cells.
Active Surveillance
Active surveillance is an approach to monitoring prostate cancer considered low risk for spread (clinically insignificant) and delaying treatment unless changes are noted that would indicate that the tumor is more aggressive requiring treatment. This approach attempts to avoid surgical or radiation treatment when considered unnecessary, however, identify those cancers which demonstrate characteristics that pose a risk to the patient, considered life threatening and curable because of early detection.
The goal is to provide patients with better quality of life (avoiding side effects of prostate cancer treatment) yet maintain the ability to cure the cancer if considered necessary. With our active surveillance program, we attempt to avoid overtreatment in many patients at low risk for spread. We attempt to cure those patients when treatment is considered necessary. Thirty five to forty percent of patients on an Active Surveillance program will eventually require treatment.
Active surveillance protocols remain experimental and have not been conclusively validated and patients enrolling in our active surveillance program need to comply with their urologists recommendation for close supervision and treatment when considered necessary. There is always the risk, even though small, that the prostate cancer may spread before curative treatment is administered.
Prostate Cancer Screening
Prostate cancer screening can help men at risk identify cancer early, when treatment is most effective. Men at an increased risk include:
- Men of African-American descent
- Men with a family history of prostate cancer
- Older men. The risk of getting prostate cancer increases rapidly after 50. Over half of new diagnoses of prostate cancer affect men over 70
Prostate cancer screening can also help reassure you that it’s unlikely you have prostate cancer. Prostate cancer is one of the most common cancers among men in the United States with 240,890 new cases of prostate cancer diagnosed in the United States in 2011.
Typical prostate cancer screening includes a PSA (prostate specific antigen) test and digital rectal examination. This has long been recommended starting at age 40-50 depending on risk factors and continuing annually in men with a 10 year life expectancy.
PSA is a protein that is specific to prostate and passively makes its away into the bloodstream and can be detected by a simple blood draw. It is an indicator of how the prostate is behaving. PSA level can be elevated for many reasons and therefore is not very specific. PSA levels can rise because of infection, inflammation, ejaculation, as we age or because of cancer. What the PSA level provides is an indicator that brings our attention to the prostate and may prompt further workup or treatment, including antibiotics and biopsy.
In 2011, the United States Preventative Services Task Force (USPSTF) issued a recommendation arguing against PSA screening in healthy men. The same task force made a controversial recommendation against screening mammogram in certain women back in 2009. The prostate cancer death rate has decreased by 33% in the last 15 years, according to the American Cancer Society (ACS). Remarkably, this reduced prostate cancer mortality rate during the “PSA era” is not even contemplated in the USPTS draft report, which instead, focused solely on the smaller comparative studies.
The American Cancer Society and the American Urologic Association (AUA) offer different conclusions and recommendations. AUA recommends screening to start at age 40, and the American Cancer Society recommends screening to be considered starting at age 40-50 depending on risk factors of men who have 10 years life expectancy.
To Get Or Not To Get A PSA Test?
Talk to your Genesis Healthcare physician about whether prostate screening is right for you.