Treatment Options  
 
Early Stage Prostate Cancer     Advanced Prostate Cancer    Hormone-Resistant Prostate Cancer

Emerging Treatments


There are many available treatment options for prostate cancer. The type of treatment that you or your loved one receives will be based on the stage of prostate cancer. You should work together with your doctor to weigh the risks, advantages, and disadvantages of each option and its side effects and determine what treatment is right for you or your loved one.

If you have been diagnosed with:
  • Early stage prostate cancer with a low risk of progression, or you are not expected to tolerate other therapies, your doctor may recommend watchful waiting, or short-term monitoring of the cancer with routine digital rectal exams (DREs) and prostate specific antigen (PSA) tests
  • Early stage prostate cancer, when cells have not spread outside of the prostate, your doctor may recommend surgery to remove the prostate and the seminal vesicles or radiation therapy to remove or destroy prostate gland and the cancer contained in it
  • Advanced prostate cancer, when cancer cells have spread to other parts of the body (called metastasis), your doctor may recommend hormone therapy to slow cancer cell growth and/or palliative radiation (to destroy as much of the prostate cancer as can be easily done)
  • Metastatic prostate cancer that is not responsive to hormone therapy (hormone resistant prostate cancer or androgen independent prostate cancer), your doctor may recommend radiation or chemotherapy that would be injected and treat the entire body.

Read the National Comprehensive Cancer Network Guidelines for Prostate Cancer Patients

The National Comprehensive Cancer Network (NCCN) is a not-for-profit alliance of 21 of the world’s leading cancer centers. The NCCN Guidelines are the most comprehensive and most frequently updated clinical practice guidelines availabe in any area of medicine. The guidelines, created by hundreds of medical experts, provide step-by-step strategies that many doctors follow to make sure their decisions for people with cancer are well informed.

Early Stage Prostate Cancer Top

There are 4 treatment options for patients who have early stage prostate cancer: active surveillance, plus 3 invasive options: prostatectomy (open, laproscopic, or nerve-sparing robotic), cryosurgery, and radiation therapy. The goal of all of the invasive options is to remove or destroy cancer cells before they can spread to other tissues in the body.

Active Surveillance

Active surveillance requires ongoing evaluation with DREs, PSA levels, and prostate biopsies. Active treatment, such as surgery or radiation therapy, does not occur until there is evidence that the cancer is growing. Active surveillance is considered appropriate for some men with very low- or low-risk prostate cancer. 

Watch video or read text interviews with Active Surveillance patients at www.active-surveillance.com 

Prostatectomy
 
  • Open

    • The surgical removal of the prostate and nearby tissues where cancer may have spread
    • Most often used during early stages (Stages Tl and T2), when cancer cells are located only within the prostate
    • Some surgeons are skilled in nerve-sparing techniques to maximize the preservation of nerves, muscles, organs, and other structures surrounding the prostate. If the nerves are not damaged during surgery, men have a better chance of having erections again between two and 18 months after the operation. Potency rates following nerve-sparing radical prostatectomy vary widely among surgeons and academic centers. In the hands of a highly skilled surgeon performing the technique in a center with extensive experience in the procedure, potency rates are much higher than the rates seen in community practice.
    • You can read or join discussions about prostatectomy at the RP bulletin board
       
  • Laproscopic

    • The surgeon uses a laproscope, a long instrument that provides 3D images of the interior of the body, together with other long instruments to assist with the removal of the prostate through 4-5 small slit (1 inch) incisions
    • This technique, as performed by a highly skilled and experienced surgeon, minimizes the risk of complications: minimal incisions, less pain, limited blood loss, and early recovery. Patients often go home the same day or the next morning
       
  • Nerve-Sparing Robotic (da Vinci)

    • This new technique is similar to laproscopic prostatectomy, but is robot-assisted using the da Vinci system. This robotic technique allows complex surgical tasks to be performed with dexterity and minimal fatigue due to their ergonomic design, expanded degree of movements, tremor filtering, and 3-D stereoscopic visualization
    • Two highly trained and skilled surgeons perform this surgery, one is beside the patient and the other controls the robotic system consisting of a laproscope and two multi-jointed arms
    • In addition to the advantages of laproscopic prostatectomy, benefits of robotic technology include the use of even more delicate instruments for more precise movement and maximum preservation of nerves, muscles, organs, and other structures surrounding the prostate. Outcomes may vary depending on the skill level and experience of the surgeon. Surgery time is about the same or slightly longer than open or laproscopic surgery (often being performed in one and a half to two hours)

Advantages of Prostatectomy

  • One-time procedure
  • May prevent spread of cancer to other tissues
  • May cure early-stage prostate cancer (if cancer cells are only located in the prostate)
  • Removes the prostate gland and the problem of future overgrowth of the prostate (called BPH—benign prostate hyperplasia—the non-malignant enlargement of the prostate)
  • May help extend life
  • When this operation is performed by an expert, the advantages are much more likely to occur, and the disadvantages are less likely to occur

Disadvantages of Prostatectomy

  • Requires hospitalization
  • May cause impotence (also known as erectile dysfunction, ED, the inability to get an erection of sufficient quality to penetrate or to fulfill the sexual act)
  • May cause incontinence (loss of urinary control)
  • May cause narrowing of the urethra, making urination difficult
  • When this operation is performed by a non-expert/caregiver, the disadvantages are more likely to occur

Radiation Therapy

  • Uses high-energy rays (eg, x-rays) or particles (eg, electrons or protons) to kill prostate cancer cells or prevent cancer cells from growing and spreading
  • Used to treat prostate cancer that has not spread beyond the prostate (Stages T1 and T2)
  • Often used in combination with hormone therapy if cancer cells have spread beyond the prostate to nearby tissues (Stage T3)
  • May be used for pain relief in prostate cancer that is no longer responding to hormone therapy and has spread to other tissues in the body, primarily bones (Stage M+)
  • Radiation therapy techniques
  • External Beam Radiation Therapy (EBRT): radiation is generated and administered by a machine outside the body, usually in brief daily sessions for several weeks. You can read or join discussions about EBRT at the EBRT bulletin board
  • The newest advance in radiation therapy is IMRT, intensity modulated radiation therapy, which minimizes radiation damage to normal tissues.
  • Proton Beam Therapy (PBT): this radiation therapy uses proton beams instead of x-rays to kill cancer. It is the most precise form of radiation, traveling through noncancerous areas to rest directly on the targeted area. The precision of this method allows for stronger doses of beam radiation with minimal damage to surrounding tissue. You can learn more about PBT by visiting The National Association of Proton Therapy Web site.
  • 3-D Conformal Radiation Therapy (3DCRT): this improvement in radiation treatment allows closer targeting of the prostate gland. The most cutting edge technique combines 3DCRT and IMRT, which more selectively focuses the dose of radiation on prostate cancer cells. 
  • Brachytherapy (“seeds”): radiation comes from small radioactive seeds (about the size of a grain of rice) inserted directly into the prostate that administer a constant dose of radiation for a few weeks to a year. Seeds are inserted while under anesthesia, and are too small to cause discomfort. 
  • High-Dose Rate (HDR) Brachytherapy: short-term internal beam therapy that uses higher dosage, non-permanent seeds. Because the seeds are implanted for a much shorter amount of time (approximately 1 hour), there is less likelihood of them migrating in the body. You can learn more about brachytherapy by visiting the Seed Pods Web site.
  • Systemic Radiation Therapy: radiation is delivered by injection of a radioactive compound to control pain caused by metastasized (Stage M+) prostate cancer that no longer responds to hormone therapy
  • CyberKnife Robotic Radiosurgery (Cyberknife): a non-invasive treatment option for prostate cancer that has the ability to deliver targeted and destructive doses of radiation, and tracks tumor motion and automatically corrects the aim of the treatment beam when movement is detected. Read additional information here: http://www.cyberknife.com/ 
  • New advance in radiation therapy technology - GPS for the body:

    Approved by the FDA, newly developed technology and equipment using radiofrequency waves allows for the very accurate alignment of a man’s prostate before each treatment session. It can also be used to monitor the position of the prostate at all times during radiation treatment delivery, objectively pinpointing the location of tumors and helping to minimize the amount of healthy tissue surrounding the prostate or prostate tumor that might be radiated due to organ movement. 


    Image provided by Calypso Medical Technologies, Inc.

    (Left) Radiation, depicted by the arrows, is directed at cancer in the prostate gland. (Right) If the prostate moves due to gas in the rectum or natural breathing, the tumor may not get the right amount of radiation or other nearby organs may receive radiation they shouldn’t get.


    For further information about how this technology works with external beam therapy treatments, and to locate leading cancer centers offering it, please visit: www.calypsomedical.com

    Read article in the May 2008 HotSheet: Doctors Use “GPS for the Body” To Target Cancer Cells

Advantages of Radiation Therapy

  • Avoids major surgery
  • May cure prostate cancer in its early stages and may help extend life or eliminate symptoms in later stages
  • Most side effects are minor and disappear after therapy stops, especially when the latest IMRT and seeds techniques and equipment are used
  • This treatment can be very effective when performed by a radiation expert

Disadvantages of Radiation Therapy

  • Organs naturally move during treatment and your doctor can’t predict which way or how much your organs will move. Organ movement can be caused by breathing, gas in the intestines or rectum, blood flow through the circulatory system and other natural bodily functions. When your organs move, the tumor may not get the right amount of radiation or other nearby organs may receive radiation they shouldn’t get.
  • May cause damage to healthy cells, leading to side effects
    • Tiredness
    • Skin reactions
    • Frequent and painful urination
    • Upset stomach
    • Diarrhea
    • Rectal irritation or bleeding
  • Cancer of other tissues near the prostate could occur later due to the radiation.
  • The vascular tissues surrounding the prostate are damaged by the radiation. This damage will progress and continue for many years, possibly causing impotence
  • All radiation therapy is associated with decreased red blood cells, white blood cell, and platelet counts
  • The amount of radiation a human body can accept is limited, making future use of radiation therapy in most situations dangerous

Cryosurgery

  • Relatively new technique that is still emerging
  • Used to treat localized prostate cancer (Stages T1 and T2)
  • Freezes and immediately kills prostate cancer cells
  • Performed under anesthesia, uses ultrasound-guided placement of cooling probes into the prostate
  • Can be combined with hormone therapy to reduce the size of the tumor prior to freezing
  • Long-term effectiveness is not well known
  • You can read or join discussions about cryosurgery at the IceBalls bulletin board

Advantages of Cryosurgery

  • Avoids major surgery
  • Less likely to cause urinary tract damage, obstructions, or bowel difficulties than radiation
  • Procedure takes an hour and a half or less and patients often fully recover within days
  • Protects healthy tissue from damage
  • This procedure is becoming more reliable and with less complication in the hands of an expert

Disadvantages of Cryosurgery

  • Impotence due to nerve damage is a common occurrence
  • Urinary incontinence can occur but is rare
  • Approximately 2% of men develop an abnormal tissue mass (fistula) that connects the rectum and the bladder that may require surgery to repair
  • When this procedure is not performed by an expert, or without the most current equipment or techniques, the disadvantages are more likely to occur

Side Effects of Treatment

For many men, the most worrisome side effects of surgery and radiation therapy are incontinence and erectile dysfunction. These effects arise because of nerve damage that may occur during the surgery, but are reported less often in cancer centers where surgeons have performed many of these procedures. Be sure to ask the doctor about his experience performing prostate surgeries and whether he uses “nerve-sparing” techniques.

Incontinence is the inability to control urination. Normal bladder control usually returns a few weeks or months after prostatectomy; it is rare that surgery would lead to permanent incontinence when the surgery is performed by an expert. Surgery, certain medicines, and exercises that strengthen muscles of pelvis can improve this condition if it occurs.

Irradiation rarely causes urinary incontinence immediately, but the likelihood of incontinence will increase over time. Immediate incontinence is more frequent if the patient has an enlarged prostate and/or symptoms of lower urinary tract problems prior to treatment.

Erectile dysfunction can be present from 2 weeks to 1 year or longer following prostatectomy, and largely depends on the patient’s age at the time of treatment, the size of the prostate gland, and the surgical method used. The larger the prostate gland, the more likely the patient will be impotent. It may also develop over a period of several years following radiation therapy. Prostheses, prostaglandin injections, vacuum devices, and medications (Viagra®, Levitra®, Cialis®) are available treatment options for erectile dysfunction.

High Intensity Focused Ultrasound (HIFU)

HIFU: is a medical device piloted by a computer designed to treat localized prostate cancer using high intensity focused ultrasound (HIFU). 

What is HIFU?

  • HIFU is a procedure where the temperature inside the prostate is raised to 85° Celsius using a focused ultrasound beam
  • A probe is placed into the rectum after spinal or epidural anesthesia has been administered
  • This probe emits a beam of high intensity focused ultrasound
  • At the point where the ultrasound is focused (focal point) the sudden and intense absorption of the ultrasound beam quickly raises the temperature which destroys targeted cells
  • The area destroyed by each beam is very small and precise
  • By repeating the process and moving the focal point it is possible to destroy the prostate tissue
  • The treatment takes from 1 to 3 hours depending upon the size of the prostate and is usually performed on an outpatient basis

What Do the Clinical Studies Show?

  • HIFU has been extensively used in Europe
  • One report of 137 patients showed that 93% of the patients had negative prostate biopsies and 87% had PSA levels of less than 1.0 five years after the treatment
  • Over 90% of patients undergoing HIFU therapy will not require further treatment for their prostate cancer
  • HIFU treatment does not preclude other treatments. In those developing a recurrence, they remain candidates for surgery, radiation or hormone therapy
  • HIFU treatment has a similar success rate to radical prostatectomy but has the major advantage of using non-invasive technology with many fewer side effects
  • HIFU has proven to be an effective treatment for localized recurrent prostate cancer
  • Published results indicate that 100 consecutive unsuccessful external beam radiation patients shows 62% of patients had negative biopsies, stable psa results and zero rectal fistulae

Is HIFU a Proven Therapy?

  • In 1989, three European research groups united in their efforts and initiated a project to develop an efficient and non-surgical treatment for localized prostate cancer
  • After ten years of development, HIFU was approved for treatment in Europe. At present, HIFU is being used throughout Europe, Russia, Japan and other Asian countries. In 2003, it received Canadian government approval and patients are being treated in Toronto, Canada
  • To date, thousands of patients have been treated successfully in many European centers and throughout the world

Advantages of HIFU

  • Destruction of the cancerous tissue with no risk of injury to the surrounding organs
  • No chance of rectal injury
  • Patient does not undergo any radiation exposure
  • Usually no hospital stay is required
  • Treatment is performed under spinal or epidural anesthesia
  • Treatment can be repeated if necessary
  • Other therapeutic alternatives can be considered in case of incomplete results
  • Nerve sparing procedure can be performed
  • HIFU can be used for the treatment of local recurrences (i.e. after external beam radiotherapy)

Disadvantages of HIFU

  • No pathology (no tissue) to be examined following the procedure
  • A TUR-P may be required prior to treatment
  • Not yet available in the United States
  • Patients must travel to Canada for treatment
  • Not covered by many insurance plans, as treatment not available in the U.S.

Further information about HIFU can be found at www.hifu.ca, www.ushifu.com and www.internationalhifu.com.

Advanced Prostate Cancer Top

When cancer has spread beyond the prostate, complete removal of the prostate or destruction of cancer tissue by radiation or cryosurgery is uncommon. For stage T3 and T4 prostate cancer, hormone therapy is used to slow the rate of cancer cell growth and spreading to other areas of the body.

Hormone Therapy

Prostate cancer cells require male hormones (such as testosterone) to grow. Hormone therapy decreases production of testosterone by the testicles so that cancer cell growth slows down.

  • May also be used in early stage prostate cancer (Stage T2) in combination with radiation therapy or prior to surgery to reduce the size of the prostate and make it easier to remove
  • Types of hormone therapy: 
    • Surgical removal of the testicles (orchiectomy)
    • Drug treatment that reduces testosterone levels, reduces the effect of testosterone or adrenal androgens from acting on the prostate, or reduces conversion of testosterone to dihydrotestosterone (DHT). Dihydrotestosterone is a powerful stimulus for prostate cell growth
  • Common side effects of reducing male hormone activity by hormone therapy (listed in order of most to least common):
    • Osteoporosis (bone weakening)– See more on bone health issues here
    • Loss of muscle mass and increase of body fat
    • Hot flashes
    • Anemia (decreased level of red blood cells)
    • Depression
    • Gynecomastia (breast enlargement)
    • Reduced libido
    • Impotence

Types of Hormone (Androgen Deprivation) Therapies

Orchiectomy

An operation that removes the testicles, which produce 95% of the body's testosterone.

Advantages of Orchiectomy

  • One-time procedure
  • Effective, permanent reduction in testosterone
  • Patients typically go home the same day as the surgery
  • Cost (relatively inexpensive) and convenience

Disadvantages of Orchiectomy

  • Side effects, such as reduced or absent sexual desire, impotence, and hot flashes and emotional impact make this procedure difficult for some patients to accept
  • Irreversible surgical procedure
  • In some cases, may require hospitalization
  • Will not allow for intermittent androgen deprivation (IAD) therapy

LHRH Therapy

The administration of an injectable luteinizing hormone-releasing hormone (LHRH) agonist or antagonist that causes a drop in testosterone levels in the body.

Currently available LHRH agonists:
  • Lupron® (leuprolide acetate)
  • Eligard® (leuprolide acetate)
  • Viadur® (leuprolide acetate implant)
  • Vantas® (histrelin implant)
  • Zoladex® (goserelin acetate)
  • Trelstar™ (triptorelin)
  • Plenaxis™ (abarelix)

Advantages of LHRH Agonists

  • Easy administration of injections monthly or every 1, 3, 4, or 12 months
  • Treatment with LHRH agonists is as effective as orchiectomy in reducing testosterone levels
  • Side effects can be reversible upon termination of the treatment so as to allow IAD therapy
  • Causes immediate suppression of testosterone levels without the initial “flare” except for tumors that are large and next to the spine
  • No need for antiandrogen therapy unless the tumor is large and next to spine

Disadvantages of LHRH Agonists

  • Side effects of hormone therapy may be difficult to treat and hard for some people to accept
  • In a few patients, LHRH agonist therapy may cause a brief initial rise in symptoms “testosterone flare” before the testosterone level begins to fall
  • Requires monthly injections or every 1, 3, 4, or 12 months
  • Less clinical data available for LHRH antagonists compared with LHRH agonists*

* LHRH antagonists work by directly inhibiting LHRH so that there is no more production of testosterone. In contrast, the LHRH analogs stimulate the LHRH receptor and cause initial production of testosterone for one to two weeks which is then exhausted.

GnRH Therapy

The administration of an injectable gonadotropin-releasing hormone (GnRH) receptor antagonist provides rapid, profound and sustained, suppression of testosterone.

Currently available GnRH receptor antagonists:
  • Firmagon® (degarelix for injection) – indicated for the treatment of advanced prostate cancer (similar indication as leuprolide)

Advantages of GnRH Receptor Antagonists

  • Reduces testosterone levels quickly without the initial “testosterone surge” seen with an LHRH agonist
  • Antiandrogen therapy is not needed to prevent possible flare symptoms.
  • Reversibly binds to the GnRH receptors in the pituitary gland, immediately suppressing the secretion of the luteinizing hormone (LH), follicle-stimulating hormone (FSH), and subsequently, testosterone and PSA levels.
  • GnRH receptor antagonists are at least as effective as leuprolide in sustaining castrate levels or lowering of testosterone.
  • Easy subcutaneous (just under the abdomen skin) injections monthly.

Disadvantages of GnRH Receptor Antagonists

  • Overall rate of adverse reactions is similar to leuprolide. Injection site reactions were mostly transient and of mild to moderate intensity.

Antiandrogen Therapy

The administration of a drug called an antiandrogen that blocks the action of male hormones, including testosterone and androgens released by the adrenal glands.

  • Used in combination with LHRH agonist therapy in a strategy called maximal androgen blockade (MAB) or combined androgen blockade (CAB). You can read or join discussions about CAB at the CHB bulletin board.
  • Currently available antiandrogens:
    • Casodex® (bicalutamide)
    • Eulexin® (flutamide)
    • Nilandron® (nilutamide)
    • Androcur® (cyproterone)

Advantages of Antiandrogen Therapy

  • May provide a small survival advantage over either orchiectomy or LHRH analog therapy alone

Disadvantages of Antiandrogen Therapy

  • In addition to common side effects of hormone therapy, you also may develop
    • Breast pain or enlargement
    • Diarrhea
    • Gastrointestinal pain
    • Anemia
    • Adverse effects on liver function (possible elevation of liver enzymes that must be monitored)

5-alpha Reductase (5-AR) Inhibitors

Block conversion of testosterone to DHT, a more potent stimulator of prostate cell growth than testosterone.

  • Currently available 5-AR inhibitors:
    • Proscar®, Propecia® (finasteride) – reduces DHT levels in the blood by 70% and 80%-90% on prostate
    • Avodart® (dutasteride) – reduces DHT levels in the blood by 98% and can slow prostate cell growth

 

Advantages of 5-AR Inhibitors

Disadvantages of 5-AR Inhibitors

Reduces the prostate cell growth and prostate size Causes only modest reductions in PSA levels (15-20%) when used alone
Highly effective in reducing PSA levels when used in combination with antiestrogens May not be effective in the treatment of advanced cancer
May reduce the risk of recurrence following surgery  

Estrogen Therapy

Administration of estrogen hormones lowers testosterone production and has some direct apoptotic effects on both androgen-dependent and androgen-independent prostate cancer cells.

  • Currently available estrogen therapies:
    • DES (diethylstilbestrol)
    • Stilphosterol® (stilbestrol diphosphate)
    • Honvan® (fosfestrol tetrasodium)
    • Estradurin® (polyestradiolphosphate)
    • Estraderm® patch (estradiol) – only one small-scale trial has investigated the benefits of delivering estrogen through the skin (transdermal) to block testosterone production in men with prostate cancer. In that study, the patch was successful in reducing testosterone levels, with fewer cardiovascular or other side effects (gynomastia). Phase III trials are currently comparing the effects of patch and injected forms of estrogen in men with prostate cancer.

Advantages of Estrogen Therapy

  • Does not cause bone loss
  • Dose not induce androgen-independent cancer growth
  • Can dramatically slow the growth of some prostate cancer cell types
  • Inexpensive

Disadvantages of Estrogen Therapy

  • Will cause gynecomastia, unless prevented by breast irradiation
  • Depending on the rate of administration, it may promote hypercoagulation of blood, causing blood clots in the legs, lungs, heart, and brain. Blood thinners may need to be taken to prevent these complications.
  • Causes decreased libido and impotence

P450 Enzyme Inhibitors

The P450 enzymes are involved in the synthesis of several hormones, including testosterone, that stimulate prostate cancer cell growth. Inhibitors of these enzymes can decrease the levels of testosterone and adrenal androgens, and have direct cytotoxic effects on prostate cancer cells.

  • Available P450 enzyme inhibitors:
    • Nizoral® (ketoconazole used in combination with hydrocortisone)

Advantages of P450 Enzyme Inhibitors

  • May still be useful in men for whom CAB has failed (who are androgen resistant)
  • Reduces both testicular testosterone and adrenal androgen production 
  • Additional cytotoxic effect on prostate cancer cells

Disadvantages of P450 Enzyme Inhibitors

  • Requires continued use of LHRH agonists or estrogen therapy to block pituitary stimulation of testicular hormone production (unless the patient had an orchiectomy)
  • Non-selective effects on other cells may cause discomfort (nausea, gastric irritation)
  • May have significant adverse effects on liver function (must measure liver enzymes)

Hormone-Resistant Prostate Cancer Top

Prostate cancer that is no longer responsive to hormone therapy is referred to as hormone-resistant prostate cancer, hormone refractory prostate cancer (HRPC), castrate resistant prostate cancer (CRPC) or androgen-independent prostate cancer. 

Autologous Cellular Immunotherapy 

Provenge® (sipuleucel-T) - indicated for the treatment of asymptomatic or minimally symptomatic metastatic castrate resistant (hormone refractory) prostate cancer, Provenge is the first in a new class of autologous cellular immunotherapies that use a patient’s own antigen-presenting cells (APCs) to stimulate the body’s immune system against prostate cancer.

Advantages

  • Provenge is given by intravenous (IV) infusion in 3 doses, given approximately 2 weeks apart over the span of a month. Blood is collected a few days prior to each infusion. Total course of therapy is generally completed in 4-6 weeks.
  • Minimal typical side effects compared to other treatment options.
  • Largest survival benefit of any CRPC approved treatment option.
  • In a clinical trial, Provenge reduced the risk of death from prostate cancer by 22.5% in men who received treatment.

Disadvantages

  • The most common side effects reported with Provenge treatment – usually occurring within the first few days of treatment – are: chills, fatigue, fever, back pain, nausea, joint ache and headache. Other side effects are also possible.
  • In a very small number of men, Provenge can cause severe acute reactions resulting from the infusion, which typically occur within 1 day of infusion.
  • As the treatment option is so recently new (with approval by FDA in 2010), access to the treatment has been somewhat limited until production capacity can be fully maximized.
  • Some private insurance payers may not yet cover the cost of treatment.

For more information on Provenge, visit Dendreon ON Call

Systemic Radiation Therapy

Estrogen Therapy

Administration of estrogen hormones lowers testosterone production and has some direct apoptotic effects on both androgen-dependent and androgen-independent prostate cancer cells.

P450 Enzyme Inhibitors

The P450 enzymes are involved in the synthesis of several hormones, including testosterone, that stimulate prostate cancer cell growth. Inhibitors of these enzymes can decrease the levels of testosterone and adrenal androgens, and have direct cytotoxic effects on prostate cancer cells.

Chemotherapy

The administration of powerful toxic drugs that circulate throughout the body and eliminate rapidly growing cancer cells

  • Also affect rapidly growing healthy cells, which can lead to side effects
  • Dose and frequency of chemotherapy treatments are carefully controlled to minimize harm to healthy cells
  • Reserved for patients with advanced stage cancer (Stage M+) that does not respond to hormone therapy
  • Currently available chemotherapy drugs:
    • Jevtana®(cabazitaxel) - indicated in combination with prednisone for the treatment of patients with metastatic hormone-refractory prostate cancer (mHRPC) previously treated with a docetaxel-based treatment regimen
    • Novantrone® (mitoxantrone; specifically approved for hormone resistant prostate cancer)
    • Taxotere® (docetaxel)
    • Taxol© (paclitaxel)
    • Emcyt® (estramustine)
    • Adriamycin® (doxorubicin)
    • Cytoxan® or Neosar® (cyclophosphamide)
    • Paraplatin® (carboplatin)
    • Thalomid® (thalidomide)
  • Recent Phase III randomized studies have shown that Taxotere in combination with either Prednisone or Estramustine can modestly increase survival in patients with hormone resistant prostate cancer

Advantages of Chemotherapy

  • May prolong survival
  • Provides cancer symptom improvement

Disadvantages of Chemotherapy

  • Side effects
    • Hair loss
    • Nausea
    • Vomiting
    • Diarrhea
    • Anemia
    • Reduced blood clotting
    • Increased risk of infection
    • Lowered white cell count (ie, leukine)
 
 

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