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Treatment Of Advanced Prostate Cancer

Antiandrogens For Prostate Cancer

New treatment for advanced prostate cancer shows progress

These prostate cancer drugs work by blocking the effect of testosterone in the body. Antiandrogens are sometimes used in addition to orchiectomy or LHRH analogs.This is due to the fact that the other forms of hormone therapy remove about 90% of testosterone circulating in the body. Antiandrogens may help block the remaining 10% of circulating testosterone. Using antiandrogens with another form of hormone therapy is called combined androgen blockade , or total androgen ablation. Antiandrogens may also be used to combat the symptoms of flare . Some doctors prescribe antiandrogens alone rather than with orchiectomy or LHRH analogs.

Available antiandrogens include abiraterone acetate , apalutamide , biclutamide , darolutamide , enzalutamide , flutamide , and nilutamide . Patients take antiandrogens as pills. Diarrhea is the primary side effect when antiandrogens are used as part of combination therapy. Less likely side effects include nausea, liver problems, and fatigue. When antiandrogens are used alone they may cause a reduction in sex drive and impotence.

What Is My Outlook

If youre diagnosed with advanced prostate cancer, you may want to know how well your treatment is likely to control your cancer and for how long it will control it. This is sometimes called your outlook or prognosis. But not all men will want to know this.

While it isnt possible to cure advanced prostate cancer, treatments can help keep it under control, often for several years. Treatments will also help manage any symptoms, such as pain.

No one can tell you exactly what your outlook will be, as it will depend on many things such as where the cancer has spread to, how quickly it has spread, and how well you respond to treatment. Some men may not respond well to one treatment, but may respond better to another. And when your first treatment stops working, there are other treatments available to help keep the cancer under control for longer. Speak to your doctor about your own situation and any questions or concerns you have.

What Is The Outlook

No cure is available for stage 4 prostate cancer. Your healthcare team will work with you to help control the cancer for as long as possible while maintaining a good quality of life.

Your outlook will depend on how fast the cancer is spreading and how well you respond to therapies.

With treatment, you can live for many years with metastatic prostate cancer.

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Treatment By Stage Of Prostate Cancer

Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers 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.

Early-stage prostate cancer

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 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.

ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.

Locally advanced prostate cancer

Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.

Treating Advanced Prostate Cancer

Oral Relugolix for Androgen

Advanced prostate cancer has no cure, but there are many ways doctors can treat the disease to ease symptoms and help you feel better and live longer.

Hormone therapy. Hormone therapy is the most common treatment for men with this disease. Prostate cancer cells need male sex hormones to help them grow. This therapy blocks them from getting or using those hormones. This is called androgen deprivation therapy. Some treatments lower the bodyâs levels of testosterone and other male hormones. Other types of therapy block the way those hormones work.

Cancer vaccine. One of the newer ways to treat advanced prostate cancer is to get the body’s immune system to attack the cancer cells. Doctors do this with a vaccine called sipuleucel-T . Itâs an option for men when hormone therapy isn’t working anymore. The vaccine is custom-made for each man. Scientists donât know if it slows or stops the cancerâs growth, but it does seem to help you live longer.

Chemotherapy. Chemo is another option when hormone therapy no longer works. It can slow cancer cellsâ growth, and shrink tumors. You usually go to a clinic to get the drugs through an IV. You may need to get a few rounds of treatment, called cycles, with some time in between for your body to recover.

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Questions To Ask Your Doctor Or Nurse

  • What type of hormone therapy are you offering me and why?
  • Are there other treatments I can have?
  • What are the advantages and disadvantages of my treatment?
  • What treatments and support are available to help manage side effects?
  • Are there any lifestyle changes that might help me manage my cancer, symptoms, or side effects?
  • How often will I have check-ups and what will this involve?
  • How will we know if my cancer starts to grow again?
  • What other treatments are available if that happens?
  • Can I join any clinical trials?
  • If I have any questions or get any new symptoms, who should I contact?

When Is Hormone Therapy Used

Hormone therapy may be used:

  • If the cancer has spread too far to be cured by surgery or radiation, or if you cant have these treatments for some other reason
  • If the cancer remains or comes back after treatment with surgery or radiation therapy
  • Along with radiation therapy as the initial treatment, if you are at higher risk of the cancer coming back after treatment
  • Before radiation to try to shrink the cancer to make treatment more effective

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Endocrine Drugs For Prostate Cancer

Drugs work as well as prostate cancer surgery to reduce the level of hormones in the body. Most men opt for drug therapy rather than surgery. The three types of hormone-related drugs approved to treat advanced prostate cancer include luteinizing hormone-releasing hormone analogs, luteinizing hormone-releasing hormone antagonists, and antiandrogens.

What Treatments Are Available

Treatments for Advanced Prostate Cancer in 2022 | Evan Yu, MD | PCRI

If you have advanced prostate cancer, treatment wont cure your cancer. But it can help keep it under control and manage any symptoms.

If youve just been diagnosed with advanced prostate cancer, you may be offered the following treatments:

Research has found that having radiotherapy together with one of the main treatments listed above can help some men with advanced prostate cancer to live longer. But radiotherapy isnt suitable for all men with advanced prostate cancer.

If you live in Scotland, you may also be offered a type of hormone therapy called abiraterone acetate together with standard hormone therapy. In the rest of the UK, abiraterone is currently only given to men with advanced prostate cancer that has stopped responding to other types of hormone therapy. The National Institute for Health and Care Excellence is currently deciding whether to make it available for men who have just been diagnosed with advanced prostate cancer.

Before you start treatment

Before you start any treatment, make sure you have all the information you need. Its important to think about how you would cope with the possible side effects. Speak to your doctor or nurse about this.

It can help to write down any questions you want to ask at your next appointment. It may also help to take someone with you, such as your partner, a family member or friend.

If you have any questions, speak to our Specialist Nurses.

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Prostate Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Prostate

The prostate is agland in the malereproductive system. It lies just below the bladder and in front of the rectum . It is about the size of a walnut and surrounds part of the urethra . The prostate gland makes fluid that is part of the .

Prostate cancer is most common in older men. In the U.S., about 1 out of 8 men will be diagnosed with prostate cancer.

Certain Factors Affect Prognosis And Treatment Options

The prognosis and treatment options depend on the following:

  • The stage of the cancer .
  • The patients age.
  • Whether the cancer has just been diagnosed or has recurred .

Treatment options also may depend on the following:

  • Whether the patient has other health problems.
  • The expected side effects of treatment.
  • Past treatment for prostate cancer.
  • The wishes of the patient.

Most men diagnosed with prostate cancer do not die of it.

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Fast Facts On Prostate Cancer

  • Prostate cancer rarely reaches an advanced stage.
  • People with the condition normally have a very good outlook when they receive an early diagnosis and treatment.
  • Hormone therapy is a treatment option for advanced prostate cancer, as are chemotherapy and immunotherapy.
  • Prostate cancer can spread to the bones, brain, and lungs.

Prostate cancer occurs when cells in the prostate gland mutate and start to develop abnormally, multiplying at an uncontrolled rate. In some instances, the cancerous cells can spread to other body parts through tissue, the blood, or the lymphatic system.

After a doctor diagnoses prostate cancer, they will test to see if the cancer has spread to other areas of the body, or how much of the body is affected.

The doctor will assign a stage of prostate cancer from 1 to 4. Stage 4 is the most advanced form.

Stage 4 prostate cancer has spread to pelvic lymph nodes or is blocking the ureters. The ureters are the tubes that connect the kidneys to the bladder. Stage 4 prostate cancer may also have spread to the bladder, the rectum, the bones, or distant lymph nodes.

Doctors will test any cancerous cells in the body to determine if the additional cells came from the prostate. Even if they detect cancer in the bones, doctors still consider this prostate cancer if that is where the cancer originated.

There are two types of stage 4 prostate cancer:

A Biopsy Is Done To Diagnose Prostate Cancer And Find Out The Grade Of The Cancer

Relugolix Approval Expected to Alter Treatment for Advanced Prostate ...

A transrectal biopsy is used to diagnose prostate cancer. A transrectal biopsy is the removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate. This procedure may be done using transrectal ultrasound or transrectal MRI to help guide where samples of tissue are taken from. A pathologist views the tissue under a microscope to look for cancer cells.

Sometimes a biopsy is done using a sample of tissue that was removed during a transurethral resection of the prostate to treat benign prostatic hyperplasia.

If cancer is found, the pathologist will give the cancer a grade. The grade of the cancer describes how abnormal the cancer cells look under a microscope and how quickly the cancer is likely to grow and spread. The grade of the cancer is called the Gleason score.

To give the cancer a grade, the pathologist checks the prostate tissue samples to see how much the tumor tissue is like the normal prostate tissue and to find the two main cell patterns. The primary pattern describes the most common tissue pattern, and the secondary pattern describes the next most common pattern. Each pattern is given a grade from 3 to 5, with grade 3 looking the most like normal prostate tissue and grade 5 looking the most abnormal. The two grades are then added to get a Gleason score.

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How Effective Is Radiation On Prostate Cancer

Radiation is an effective treatment option for prostate cancer. It has the same cure rate as surgery without the risks and side effects associated with surgical procedures.

Some doctors believe that hypofractionated and ultrahypofractionated radiation may be even more effective than conventional radiation. This is due, at least in part, to the use of advanced technology, which helps physicists calculate the right dose of radiation and precisely position it on the affected region of the body.

Although hypofractionated and ultrahypofractionated radiation treatments are usually safer than surgery, they can cause some side effects. These include:

  • increased frequency of urination or bowel movements

These side effects usually do not last longer than 1 or 2 weeks.

There are also some long-term risks associated with this treatment. They include:

Side Effects Of Chemotherapy

All chemotherapy drugs work in slightly different ways, making it challenging to predict side effects for individual patients. Dosages, drug combinations and drug responses will vary from patient to patient.

The American Cancer Society lists the following as the most common side effects of chemotherapy:

  • Increased risk of infections

  • Easy bruising or bleeding

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Multidisciplinary Nature Of Treatment In Todays Advanced Prostate Cancer Care Paradigm

As the therapeutic landscape evolves to include increasingly complex combinations of systemic therapies with or without local therapies, advances in imaging, and germline and somatic genetic testing, treating men with advanced prostate cancer is increasingly one that must embrace multidisciplinary management approaches. Team members should include urologists, medical oncologists, and radiation oncologists at a minimum when supporting treatment decisions for advanced disease. Additional specialists may also include genitourinary pathology, genetic counseling, palliative care, and holistic specialists, as appropriate, in addition to primary care. Best practices must also include clinicians comfortable describing the use of germline and somatic genetic testing, and when advanced imaging techniques could be optimally used or avoided. Radiologists and nuclear medicine specialists are valuable in helping to accurately interpret scans. Palliative care team members may also play a key role when treating men with symptomatic metastatic disease. Palliative care itself is an interdisciplinary, holistic approach to managing an advanced disease such as prostate cancer with a guarded prognosis. It can include controlling symptoms that are physical, psychological, spiritual, and social. The goal of palliation is to prevent and relieve suffering and to support the best possible QOL for the patient and family.

Types Of Chemotherapy Drugs

Treatment Options for Advancedâ Prostate Cancer (High Royal Stage) | Prostate Cancer Staging Guide

The most common chemotherapy drug for prostate cancer is docetaxel , which is usually given with prednisone, a steroid medicine. After starting docetaxel, many men experience the improvements in disease-related symptoms, including pain, fatigue and loss of energy.

If docetaxel does not work or stops working, cabazitaxel may be used.

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Eight Types Of Standard Treatment Are Used:

Watchful waiting or active surveillance

Watchful waiting and active surveillance are treatments used for older men who do not have signs or symptoms or have other medical conditions and for men whose prostate cancer is found during a screening test.

Watchful waiting is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change. Treatment is given to relieve symptoms and improve quality of life.

Active surveillance is closely following a patient’s condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests, including digital rectal exam, PSA test, transrectal ultrasound, and transrectal needle biopsy, to check if the cancer is growing. When the cancer begins to grow, treatment is given to cure the cancer.

Other terms that are used to describe not giving treatment to cure prostate cancer right after diagnosis are observation, watch and wait, and expectant management.

Surgery

Patients in good health whose tumor is in the prostategland only may be treated with surgery to remove the tumor. The following types of surgery are used:

Biochemical Recurrence Without Metastatic Disease After Exhaustion Of Local Treatment Options

Prognosis

4. Clinicians should inform patients with PSA recurrence after exhaustion of local therapy regarding the risk of developing metastatic disease and follow such patients with serial PSA measurements and clinical evaluation. Clinicians may consider radiographic assessments based on overall PSA and PSA kinetics.

5. In patients with PSA recurrence after exhaustion of local therapy who are at higher risk for the development of metastases , clinicians should perform periodic staging evaluations consisting of cross-sectional imaging and technetium bone scan.

6. Clinicians may utilize novel PET-CT scans in patients with PSA recurrence after failure of local therapy as an alternative to conventional imaging or in the setting of negative conventional imaging.

Treatment

7. For patients with a rising PSA after failure of local therapy and no demonstrated metastatic disease by conventional imaging, clinicians should offer observation or clinical trial enrollment.

8. ADT should not be routinely initiated in this population . However, if ADT is initiated in the absence of metastatic disease, intermittent ADT may be offered in lieu of continuous ADT.

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