Advanced Prostate Cancer Treatment

Q1: What are the treatment options for advancedA study of more than 1,000 men with advanced
prostate cancer?hormone-refractory prostate cancer demonstrated
Advanced prostate cancer is cancer that has spreadthat giving an injection of Taxotere in combination
from the prostate to the pelvic lymph nodes or towith prednisone every three weeks demonstrated a
other parts of the body. Advanced prostate cancersurvival advantageof 2.5 months over prednisone and
cannot be cured but the progression of the diseasethe chemotherapy drug mitoxantrone, which are
can be slowed and men can be made moreFDA-approved to relieve pain in men with
comfortable with hormonal therapy and, occasionally,hormone-refractory prostate cancer.
chemotherapy.Side effects of chemotherapy include nausea and
Hormonal therapy is currently the first treatment thatvomiting, fatigue, infection risk, hair loss and tingling
is recommended to men with advanced prostateand numbness in the hands and feet. People who
cancer. The goal of hormonal therapy is to lowerexperience side effects from chemotherapy,
levels of male hormones, or androgens, such ashowever, can takemedications to combat nausea and
testosterone, which can fuel the growth of prostatevomiting and low blood counts that lead to fatigue
cancer. This can be achieved with eithersurgery orand infection.
medication.Q4: What therapies can I take to control prostate
Testosterone levels can be reduced surgically bycancer symptoms?
removing the testicles in an outpatient procedureMen with advanced prostate cancer may experience
known as an orchiectomy; prosthetic testicles maysymptoms of their disease, such as pain, that require
be used in the testicles' place.treatment to make them feel more comfortable.
If a patient prefers medication to surgery, drugs suchExternal radiation treatments might be delivered
as LHRH agonists may be given as shots every fewperiodically to shrink tumors and help to relieve pain.
months to lower testosterone levels. Other drugs,A group of drugs called bisphosphonates can also be
such as anti-androgens and estrogen therapy, canused to ease pain from cancer that has traveled to
help block the activity of male hormones. Sometimesthe bones; these drugs may also help prevent bone
surgery and medications are tried in combination.metastases.
Side effects of hormonal therapy include impotence,Pain can also be managed with painkillers and
low sex drive, tiredness, hot flashes and weight gain.non-drug methods. Some men might try
While hormonal therapy can lead to remissions up tocomplementary therapies, such as acupuncture, herbal
two or three years, it cannot stave off thetherapies or meditation; it's important to tell your
progression of advanced prostate cancer indefinitelydoctors about the complementary therapies you are
and the disease usually returns.considering since there are risks for drug interactions
Q2: How will I know if hormonal therapy is working?and side effects.
The main way to determine whether hormonalQ5: Should I consider a clinical trial?
therapy is working is by measuring prostate-specificClinical trials are studies conducted in people to
antigen (PSA) levels with a blood test. Blood levels ofevaluate new methods and medications for safety
this protein can measure the presence and activity ofand effectiveness.
prostate cancer.Many ongoing trials are investigating new approaches
So if PSA levels are going up, that's usually a signto treating advanced prostate cancer, including
that the treatment isn't working as well as it hascryosurgery, which uses liquid nitrogen to kill prostate
been.cancer cells, as well as new chemotherapy
There are rare instances when the PSA may not gocombinations and new approaches to radiation
up as the cancer is growing. In those cases, peopletherapy.
usually have symptoms, such as bone pain, whichYou should discuss the risks and benefits of
should be evaluated with X-rays. Some doctors mayparticipating in a clinical trial with your doctor.
monitor for metastases with CT scans, MRIs or boneTips on how you can prepare for this discussion:
scans.Get a three-ring binder for all of your medical
Q3: What can be done if the hormonal options don'tdocuments.
work?Get copies of all of your laboratory and pathology
When someone has advanced prostate cancer that isreports.
no longer responding to hormonal therapies-aBring a note pad, tape recorder or a friend as
condition known as hormone-refractory prostateanother set of ears to your doctor's appointments to
cancer-other forms of treatment may be required.be sure you do not miss any of the information.
Until recently, chemotherapy, which kills fast-growingMake a list of all medications and complementary
cells typical of most cancers, was not thought totherapies you are taking.
work against prostate cancer cells, which are usuallyConsider your goals for treatment.
slow growing. Even though chemotherapy wasIf considering hormonal therapy, consider whether
sometimes used to relieve pain in men withyou prefer surgery or medications that will suppress
hormone-refractory prostate cancer, it had neveryour hormones.
beenshown to improve survival.Make a list of all symptoms and medication side
But in May 2004, the U.S. Food and Drugeffects you are experiencing.
Administration (FDA) approved a chemotherapy drugPrepare a list of your questions and concerns.
called Taxotere (docetaxel) for use in combinationFind out what clinical trials might be available to you.
with the steroid prednisone, for the treatment ofConsider your expectations for participating in a
advanced prostate cancer that is not responding toclinical trial.
hormone therapy. This new combination can helpConsider the advantages and disadvantages of being
some patientslive longer with the disease.in a clinical trial.