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Your Prostate Cancer Treatment Options

Combination Therapy for Advanced Prostate Cancer

To treat aggressive cancers that have spread beyond the prostate gland, doctors may recommend various types of therapies.

ADT and anti-androgens are often prescribed together, for example, to block the maximum amount of testosterone from reaching prostate cancer cells. Hormone therapies are also increasingly used in combination with radiation therapy or surgery. Doctors sometimes prescribe hormones to shrink the prostate cancer before delivering radiation.

There’s growing evidence that combination therapy improves survival time for men with aggressive cancers. In 2009, researchers at the Mount Sinai Medical Center in New York reported results from a study of combined radioactive seed implants, external beam radiation, and hormonal therapy. The 181 men in the study, with a median age of 69, all had Gleason scores of 8 or higher, indicating very aggressive tumors. Even in this high-risk group, prostate cancer survival rates after eight years were 87% with combined therapy.

Provenge (sipuleucel-T) is a "vaccine" for advanced prostate cancer. It doesn't cure prostate cancer but helps prolong survival. Provenge isn't your everyday vaccine. It's an immune therapy created by taking immune cells from a patient, genetically engineering them to fight prostate cancer, and then putting them back into the patient. It's approved only for treatment of patients with few or no prostate cancer symptoms whose cancer has spread outside the prostate gland and is no longer responding to hormone therapy. The most common side effect is chills, which occurs in more than half of the men that receive Provenge. Some other common side effects include fatigue, fever, back pain, and nausea. 

One drug, Xofigo, is approved for use in men who have advanced prostate cancer that has spread only to the bones. Candidates should have also received therapy designed to lower testosterone. Xofigo, given by injection once a month, works by binding to minerals within bones to deliver radiation directly to bone tumors. A study of 809 men showed that those taking Xofigo lived an average of 3 months longer than those taking a placebo.     

Another treatment for cancer that has spread and doesn't respond to hormone therapy is the medicine Zytiga. The drug is taken with the steroid prednisone and may help prolong survival. Common side effects include high blood pressure, fatigue, joint swelling or pain, diarrhea, and fluid retention.    

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Reviewed on August 31, 2012

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