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Advanced Prostate Cancer Treatment

Date Added: August 16, 2007 10:34:53 PM

Q1: What are the treatment options for advanced prostate cancer?
Advanced prostate cancer is cancer that has spread from the prostate to the pelvic lymph nodes or to other parts of the body. Advanced prostate cancer cannot be cured but the progression of the disease can be slowed and men can be made more comfortable with hormonal therapy and, occasionally, chemotherapy.

Hormonal therapy is currently the first treatment that is recommended to men with advanced prostate cancer. The goal of hormonal therapy is to lower levels of male hormones, or androgens, such as testosterone, which can fuel the growth of prostate cancer. This can be achieved with either surgery or medication.

Testosterone levels can be reduced surgically by removing the testicles in an outpatient procedure known as an orchiectomy; prosthetic testicles may be used in the testicles' place.

If a patient prefers medication to surgery, drugs such as LHRH agonists may be given as shots every few months to lower testosterone levels. Other drugs, such as anti-androgens and estrogen therapy, can help block the activity of male hormones. Sometimes surgery and medications are tried in combination.

Side effects of hormonal therapy include impotence, low sex drive, tiredness, hot flashes and weight gain. 
While hormonal therapy can lead to remissions up to two or three years, it cannot stave off the progression of advanced prostate cancer indefinitely and the disease usually returns.

Q2: How will I know if hormonal therapy is working?

The main way to determine whether hormonal therapy is working is by measuring prostate-specific antigen (PSA) levels with a blood test. Blood levels of this protein can measure the presence and activity of prostate cancer.

So if PSA levels are going up, that's usually a sign that the treatment isn't working as well as it has been. There are rare instances when the PSA may not go up as the cancer is growing. In those cases, people usually have symptoms, such as bone pain, which should be evaluated with X-rays. Some doctors may monitor for metastases with CT scans, MRIs or bone scans.

Q3: What can be done if the hormonal options don't work?

When someone has advanced prostate cancer that is no longer responding to hormonal therapies - a condition known as hormone-refractory prostate cancer-other forms of treatment may be required.

Until recently, chemotherapy, which kills fast-growing cells typical of most cancers, was not thought to work against prostate cancer cells, which are usually slow growing. Even though chemotherapy was sometimes used to relieve pain in men with hormone-refractory prostate cancer, it had never been shown to improve survival.

But in May 2004, the U.S. Food and Drug Administration (FDA) approved a chemotherapy drug called Taxotere (docetaxel) for use in combination with the steroid prednisone, for the treatment of advanced prostate cancer that is not responding to hormone therapy. This new combination can help some patients live longer with the disease.

A study of more than 1,000 men with advanced hormone-refractory prostate cancer demonstrated that giving an injection of Taxotere in combination with prednisone every three weeks demonstrated a survival advantage of 2.5 months over prednisone and the chemotherapy drug mitoxantrone, which are FDA-approved to relieve pain in men with hormone-refractory prostate cancer.

Side effects of chemotherapy include nausea and vomiting, fatigue, infection risk, hair loss and tingling and numbness in the hands and feet. People who experience side effects from chemotherapy, however, can take medications to combat nausea and vomiting and low blood counts that lead to fatigue and infection.

Q4: What therapies can I take to control prostate cancer symptoms?

Men with advanced prostate cancer may experience symptoms of their disease, such as pain, that require treatment to make them feel more comfortable.

External radiation treatments might be delivered periodically to shrink tumors and help to relieve pain. A group of drugs called bisphosphonates can also be used to ease pain from cancer that has traveled to the bones; these drugs may also help prevent bone metastases.

Pain can also be managed with painkillers and non-drug methods. Some men might try complementary therapies, such as acupuncture, herbal therapies or meditation; it's important to tell your doctors about the complementary therapies you are considering since there are risks for drug interactions and side effects.

Q5: Should I consider a clinical trial?

Clinical trials are studies conducted in people to evaluate new methods and medications for safety and effectiveness. Many ongoing trials are investigating new approaches to treating advanced prostate cancer, including cryosurgery, which uses liquid nitrogen to kill prostate cancer cells, as well as new chemotherapy combinations and new approaches to radiation therapy. You should discuss the risks and benefits of participating in a clinical trial with your doctor.

Tips on how you can prepare for this discussion:

  • Get a three-ring binder for all of your medical documents.
  • Get copies of all of your laboratory and pathology reports.
  • Bring a note pad, tape recorder or a friend as another set of ears to your doctor's appointments to be sure you do not miss any of the information.
  • Make a list of all medications and complementary therapies you are taking.
  • Consider your goals for treatment.
  • If considering hormonal therapy, consider whether you prefer surgery or medications that will suppress your hormones.
  • Make a list of all symptoms and medication side effects you are experiencing.
  • Prepare a list of your questions and concerns.
  • Find out what clinical trials might be available to you.
  • Consider your expectations for participating in a clinical trial.
  • Consider the advantages and disadvantages of being in a clinical trial.
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