Recent Breakthroughs Offer Hope for Men with Advanced Prostate Cancer

Recent Breakthroughs Offer Hope for Men with Advanced Prostate Cancer

In February 2008, Pete’s prostate-specific antigen (PSA) blood test came back high – 18.2.

It turned out that Pete had cancer. “When I was first told I had prostate cancer, I didn’t hear much else. Just the word ‘cancer’ was a great shock,” Pete said. “Some men may find it hard to think of anything else for a while.” The news that your cancer has returned after treatment can hit even harder and revive long-buried fears. “When I learned nearly five years later my cancer had returned and was now in my bones, I didn’t know what to think.”

Prostate cancer is the second most common cancer found in men. (Skin cancer is the most common cancer.) More than 230,000 new cases will be diagnosed this year. Chances are you know someone who has prostate cancer or has been treated for it. More than 2.5 million men in the United States are survivors of prostate cancer. The survival rate is rising. Awareness, screening and better treatments are some of the reasons. If found at an early stage, prostate cancer has a very high chance of cure. Also, many prostate cancers that are found early may not be fast-growing or life threatening.

However, when prostate cancer spreads outside the prostate or reappears after initial treatment, it is known as advanced prostate cancer. Some men are told they have advanced prostate cancer when they are first diagnosed. Other men are diagnosed with advanced prostate cancer when their PSA levels rise months or years after surgery or radiation. At first, your doctor may suggest hormone therapy if you have advanced prostate cancer.

Hormone Therapy. Male hormones can act as fuel to help prostate cancer grow. This is why one of the first treatments for advanced prostate cancer is hormone therapy. The goal is to lower or block male hormones, such as testosterone. This can cause prostate cancer to shrink or grow more slowly. Hormone therapy choices may include shots or oral pills to help control hormones. Another option is surgery to remove the testicles, where the male hormones are made.

Most often, prostate cancer responds to this treatment, and patients see their PSA levels drop. Still, hormone therapy does not cure the cancer. It often returns after a few years, even though hormonal therapy has lowered testosterone levels.

When prostate cancer shows signs of growing despite hormone therapy, it is known as castrate-resistant prostate cancer (CRPC). If your only sign of CRPC is rising PSA levels while on hormone therapy, your CRPC is non-metastatic. The American Urological Association (AUA) recommends that men continue with hormonal therapy when diagnosed with non-metastatic CRPC.

Metastatic CRPC (mCRPC) is when cancer has spread to bones or other areas far from the prostate, despite hormone therapy. There is no cure for mCRPC. Still, there is a lot of hope that symptoms can be managed, and life can be extended. Quite a few new treatments have been approved for mCRPC in the past few years. Yet there is no good scientific proof that these new treatments benefit men with non-metastatic CRPC. And all treatments have possible side effects. So the AUA recommends men with non-metastatic CRPC not use these treatments unless as part of a clinical trial.

New Breakthroughs and Treatment Options for Metastatic Castrate-Resistant Prostate Cancer (mCRPC)

In recent years, scientists have made some landmark discoveries in how to treat mCRPC. New treatments for this form of cancer are being found. Also, changes are being made to existing treatments so they work better. If you are diagnosed with mCRPC, your doctor may prescribe one of these treatments:

Vaccines or Immunotherapy. Usually, vaccines (shots) prevent infections. Lately, researchers have been looking into using vaccines to treat mCPRC. If your prostate cancer returns despite hormone therapy and is metastatic, your doctor may offer the cancer vaccine sipuleucel-T (Provenge®). Sipuleucel-T works by boosting the body’s immune system so it attacks cancer cells. This is the first vaccine that has been shown to help men with prostate cancer live longer. Other prostate cancer vaccines are also being studied.

New Hormone Therapies. Two new kinds of hormone therapies have helped men with mCRPC delay symptoms and live longer.

Androgen synthesis inhibitors. The oral drug abiraterone acetate (Zytiga®) stops your body and the cancer from making steroids (including testosterone). Because of the way it works, this drug must be taken with an oral steroid known as prednisone. Abiraterone is approved by the FDA for use before or after chemotherapy in men with mCRPC

Androgen receptor binding inhibitors. Enzalutamide (Xtandi®) is an oral drug that blocks testosterone from binding to the prostate cancer cells. Because it works differently than abiraterone, men do not need to take a steroid with this drug. Enzalutamide was approved in August 2012 by the FDA for use in men with mCRPC after chemotherapy.

Bone Targeted Therapy. If you have advanced prostate cancer or are taking hormonal therapy for your cancer, your doctor may offer calcium or Vitamin D supplements. Some newer drugs can also help strengthen and protect your bones such as denosumab (Xgeva®, approved in 2010) or zoledronic acid (Zometa®). Both drugs help prevent bad side effects from the cancer growing in your bones.

Another new treatment approved for men whose mCPRC has spread to their bones is radium-223 (Xofigo®, approved in 2013). This treatment is injected into your veins using an intravenous (IV) drip. It collects in the bones, mostly in areas with fast growth – like where cancer has spread. There, it gives off small amounts of radiation that can only travel short distances. This can target radiation to the exact areas of the bone where cancer cells are growing. Radium-223 has been shown to help men live longer.

Chemotherapy. Another treatment choice for men with mCRPC is chemotherapy. Chemotherapy drugs slow the growth of cancer and lessen symptoms. Most of the drugs are given into the vein (IV). Chemotherapy does not cure CRPC. Still, it can lessen pain linked to prostate cancer, shrink tumors and lower levels of PSA. Studies in recent years have shown that many chemotherapy drugs can affect prostate cancer. Some, such as docetaxel (Taxotere®, Docefrez™) and cabazitaxel (Jevtana®, approved in 2010), have been shown to help men live longer. Other new chemotherapy drugs and mixtures of drugs are now being studied.

Radiation. If your cancer has spread far from your prostate, your doctor may also suggest radiation. In mCPRC, radiation therapy can help ease pain or other symptoms. The bones are a common place for prostate cancer to spread. Radiation can help ease pain caused by cancer spreading to the bone. The radiation is most often given in one or a few visits. The treatment is like having an X-ray, and uses high-energy beams to kill tumors. New radiation techniques focus on cancer cells while saving healthy tissue nearby. Many radiation therapies use computers to map the prostate and target radiation just where it is needed. New software allows doctors to better plan and target radiation doses. These methods are expected to increase the success of radiation therapy while reducing the side effects. Studies are being done to find out which radiation methods are best suited for which men with prostate cancer.

“After the initial shock wore off, I realized I needed time to take in the information. I spent the next few days talking about my options with family and friends,” Pete said. “I was encouraged to learn all I could about my disease and treatment choices so I could help make decisions about my care. One of the best ways to get information is to ask your doctor and other health care professionals. And when talking to your doctor, don’t forget to ask how the treatment will change your daily life, how your diet might have to change and how you will look and feel,” he continued. Ask how successful the treatment usually is and find out about the risks and possible side effects. Even if you have advanced cancer, there are many treatments ready to help make your daily life better. There is also a lot of hope. Many new treatments are being explored every day.