Today there are more and more effective treatment options available for advanced prostate cancer. The front-line treatment always includes medical treatments, most commonly hormone therapy and/or chemotherapy. Radiotherapy can be included in the treatment with special techniques, even if there are extensive metastases.
Full Answer
What are the treatment options for locally advanced prostate cancer?
Locally advanced prostate cancer may be treated with external-beam radiation therapy and concurrent hormonal therapy or with surgery alone. ASCO recommends that doctors consider hormonal therapy to stop testosterone production plus abiraterone and prednisolone when patients can receive this approach.
How has the therapeutic landscape of prostate cancer changed over time?
The therapeutic landscape of prostate cancer has been transformed over the last decade by new therapeutics, advanced functional imaging, next-generation sequencing, and better use of existing therapies in early-stage disease.
What are focal therapies for prostate cancer?
Focal therapies are less-invasive treatments that destroy small prostate tumors without treating the rest of the prostate gland. These treatments use heat, cold, and other methods to treat cancer, mostly for low-risk or intermediate-risk prostate cancer. Focal therapies are being studied in clinical trials.
What is included in active surveillance for prostate cancer?
Active surveillance requires regular prostate specific antigen (PSA) screenings and MRIs, with occasional biopsies. Men who are older and have a shorter life expectancy become candidates for active surveillance when they have a Gleason score of 7 (intermediate level).
What is the best treatment for advanced prostate cancer?
Hormone (endocrine) therapy, known as androgen ablation or androgen suppression therapy, is the main treatment for advanced prostate cancer.
What is the first-line of treatment for most patients with metastatic prostate cancer?
Since 1941, androgen deprivation therapy (ADT) has been considered the standard first-line treatment of patients with newly diagnosed metastatic prostate cancer. ADT is highly effective, convenient, durable, and associated with an acceptable quality of life.
What is the latest treatment for advanced prostate cancer?
The treatment, called 177Lu-PSMA-617, uses a molecule that selectively seeks out and attaches to a specific protein on the cancer cell surface called PSMA (prostate-specific membrane antigen). The technology delivers radiation that damages DNA and destroys the cancer cell.
What is front line cancer treatment?
First-line treatment or therapy simply refers to the initial, or first treatment recommended for a disease or illness. This may also be referred to as primary treatment, initial treatment, or induction therapy.
Which is better enzalutamide or abiraterone?
There was no difference in safety between abiraterone and enzalutamide. In addition, enzalutamide had better efficacy than abiraterone with regard to improving rPFS and TTPP but not OS, but the level of evidence was low. Therefore, a large direct comparison trial is needed to compare the efficacy of the two drugs.
What is the treatment for metastatic prostate cancer?
This is also called metastatic prostate cancer. Currently, no treatments can cure advanced/metastatic prostate cancer. However, there are effective ways to help slow its spread, prolong life, and control its symptoms, including immunotherapy, hormone therapy, chemotherapy, precision medicine and clinical trials.
What is advanced prostate cancer?
Advanced prostate cancer means the cancer has spread from the prostate to other parts of the body. It is sometimes called metastatic prostate cancer. It most commonly spreads to lymph nodes in other parts of the body or to the bones. It can also spread to other organs.
What is the gold standard for prostate cancer treatment?
Radical prostatectomy remains the gold-standard treatment for clinically localised prostate cancer. Cumulative data suggest that it has a survival advantage over radiotherapy, but it is troubled by surgical morbidity especially erectile dysfunction and incontinence.
Which is better eligard vs Lupron?
The bottom line. Both Eligard and Lupron Depot can be used for advanced prostate cancer. These two brand-name medications contain the same ingredient — leuprolide. They're similarly effective and carry the same side effects.
Is adjuvant therapy first line?
What is adjuvant chemotherapy? Adjuvant therapy is any type of therapy that follows the primary treatment. So, adjuvant chemotherapy takes place after you've had first-line treatment, such as surgery to remove a cancerous tumor.
What is first line and second line treatment?
Second-line treatment is treatment for a disease or condition after the initial treatment (first-line treatment) has failed, stopped working, or has side effects that aren't tolerated. It's important to understand "lines of treatment" and how they differ from first line treatment and can play a role in clinical trials.
What is a first line drug?
a drug that is the first choice for treating a particular condition because it is considered a very effective treatment for that condition with the least likelihood of causing side effects. A first-line medication may be a class of drugs (e.g., SSRIs for depression) as well as a single drug.
What is the best stage for prostate cancer?
Most cancers are graded from stage 1 to 4 in level of severity, ...
What is the Gleason score for prostate removal?
Surgical prostate removal, or prostatectomy, is an option for men with a Gleason Score of 7 or higher when the cancer has not spread beyond the prostate. Most surgeries are performed robotically using the Da Vinci surgical system.
What to do if you have a high Gleason score?
Other Treatment Options. If the cancer has a very high Gleason Score and has spread to other areas of the body, chemotherapy and immunotherapy may be suggested. Genetic testing of the cancer is also recommended, as it may be able to predict whether a Gleason Score 6 or 7 tumor will later become aggressive.
What does active surveillance mean?
Runz, DO, attending urologist at University of Maryland Shore Regional Health. “Active surveillance means we actively watch the cancer and make sure it stays low-grade, which means the cancer may potentially never spread.”.
How long does radiation therapy last?
Patients receive treatment five days a week for six weeks.
How to treat prostate cancer with radioactive substance?
Radium-223 (Xofigo) is a radioactive substance used to treat castration-resistant prostate cancer that has spread to the bone. Radium-223 is an alpha-emitter radionucleotide that mimics calcium and targets areas in the bone where the cancer is causing changes. This treatment delivers radiation particles directly to tumors found in the bone, limiting damage to healthy tissue, including the bone marrow, where normal blood cells are made. Radium-223 is given by intravenous injection (IV) once a month for 6 months. This treatment is given by a radiation oncologist or a nuclear medicine doctor. Your medical oncologist should continue to follow your progress during this treatment to make sure the treatment is helping and that any potential side effects are managed. Treatment with radium-233 does not dependably lower PSA, so patients should not expect to see big decreases in PSA levels during treatment and, in fact, often PSA levels may rise.
What is standard of care for prostate cancer?
This section explains the types of treatments that are the standard of care for prostate cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option.
How does chemotherapy help prostate cancer?
Chemotherapy may help those with advanced or castration-resistant prostate cancer and those with newly diagnosed or castration-sensitive metastatic prostate cancer.
How long does it take for prostate cancer to grow?
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy (external-beam or brachytherapy) or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
What to do if prostate cancer gets worse?
If the cancer is found to be worsening, treatment will begin. Active surveillance is usually preferred for those with very-low-risk and low-risk prostate cancer that can be treated with surgery or radiation therapy if it shows signs of getting worse.
How long does it take for a person to get a definitive treatment for prostate cancer?
People with intermediate-risk prostate cancer should receive hormonal therapy for at least 4 to 6 months. Those with high-risk prostate cancer should receive it for 24 to 36 months.
What is it called when you talk to your doctor about prostate cancer?
In addition, it is important to discuss your doctor's experience with treating prostate cancer. These types of talks are called "shared decision making .". Shared decision making is when you and your doctors work together to choose treatments that fit the goals of your care.
Abstract
During the last decade, treatment strategies for patients with advanced prostate cancer (APC) involving stage IV (T4N0M0, N1M0, or M1) hormone-sensitive prostate cancer (HSPC) and recurrent prostate cancer (PC) after the treatment with curative intent as well as castration-resistant prostate cancer (CRPC) have extensively evolved with the introduction and approval of several new agents including sipuleucel-T, radium-223, abiraterone, enzalutamide, and cabazitaxel, all of which demonstrated significant improvement on overall survival (OS).
Introduction
Prostate cancer (PC) is the most common malignancy in men ( 1). Historically, since Charles Huggins first reported the effect of androgen deprivation therapy (ADT) for the patients with metastatic PC in 1941, suppression of androgen receptor (AR) signaling through ADT has remained the mainstay of treatment for metastatic PC for more than 70 years.
Five agents newly developed the FDA approved
Since docetaxel was approved for mCRPC patients after demonstrating a survival advantage over mitoxantrone in 2004 ( 2, 3), five newly developed drugs were additionally approved by 2014. Table 1 summarizes phase 3 trials of those drugs.
Treatment strategy and biomarkers for APC
As the five new drugs emerged and represented significant improvement in the treatment of mCRPC, it was natural that one of the next areas of research was determining whether combination use or sequential therapy was superior. Moreover, the focus is not only in mCRPC.
Footnotes
P.W.K.
What is the most common treatment for prostate cancer?
Prostatectomy (a surgery that removes the entire prostate) is one of the most common treatments for prostate cancer. If your doctor has recommended this surgery, you may have many questions, including:
What is robotic prostatectomy?
The Robotic approach (called robotic prostatectomy) uses robotic technology to mimic the surgeon’s movements. This surgery requires multiple tiny incisions. It also offers more precision, as it lets your doctor see the prostate in 3-D and magnifies everything 10 times.
When It's Used
Hormone therapy is a common treatment for all stages of prostate cancer. You might get it along with other treatments like radiation and chemotherapy.
How It Works
Hormone therapy stops your body from making androgens or keeps the prostate cancer cells from using these hormones to grow.
Types of Hormone Therapy for Prostate Cancer
There are many kinds of hormone therapy. Sometimes two or more types are used together. These are the most common ones:
Side Effects of Hormone Treatment
The loss of testosterone that hormone therapy causes leads to side effects in nearly all men. These can include:
What to Expect
You might get hormone therapy in your doctor’s office, in an outpatient treatment center, or as pills you take at home.
Treatment Overview
- In cancer care, different types of doctors—including medical oncologists, surgeons, and radiation oncologists—often work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician as…
Active Surveillance and Watchful Waiting
- If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting. Active surveillance. Prostate cancer treatments may seriously affect a person's quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when some…
Local Treatments
- Local treatments get rid of cancer from a specific, limited area of the body. Such treatments include surgery and radiation therapy. For early-stage prostate cancer, local treatments may get rid of the cancer completely. If the cancer has spread outside the prostate gland, other types of treatment called systemic treatments (see “Systemic treatment...
Systemic Treatments
- Systemic therapy is the use of medication to destroy cancer cells. Systemic therapies are generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). The types of systemic ther…
Physical, Emotional, and Social Effects of Cancer
- Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer. Palliative care focuses on improving how you feel during treatment by man…
Treatment by Stage of Prostate Cancer
- Different treatments may be recommended for each stage of prostate cancer. Your doctor will recommend a specific treatment plan for you based on the cancer’s stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Remission and The Chance of Recurrence
- A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED. A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiat…
If Treatment Does Not Work
- Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal. This diagnosis is stressful, and for many people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. T…