Prostate Cancer: Latest Treatments and Emerging Therapies
What are the options for locally advanced, recurrent, or metastatic prostate cancer? continued...
Neither locally advanced, recurrent, nor metastatic prostate cancer can generally be cured with current treatments. But there are several treatments that provide long-term control of the cancer. Many men live for years or even decades with a good quality of life on these therapies. In addition, there are several promising therapies for advanced-stage prostate cancer that are now being studied.
Men with more advanced cancers are often treated with a combination of therapies. This includes surgery, radiation, hormone therapy, and chemotherapy. For instance, some studies show that men with locally advanced prostate cancer have better overall survival with radiation therapy combined with hormone therapy. They also have longer survival free of disease progression when compared to men with radiation therapy alone.
The man's age and his general overall health will be taken into consideration when planning a treatment strategy. For instance, for older men and those with other illnesses, the risks of surgery for advanced prostate cancer may outweigh the benefits.
Can surgery help with advanced prostate cancer?
In general, surgery cannot completely remove cancerous tissue in men with stage III prostate cancer. Instead, the role of surgery is to remove as much tissue from the tumor as possible. Such treatment is considered if the tumor is not fixed to adjacent tissues. Surgery may also be used to remove cancerous lymph nodes or to relieve symptoms such as urine retention. Often, surgery is used in combination with radiation therapy and/or hormonal therapy. Men with urinary symptoms such as painful or difficult urination caused by an enlarged prostate or large tumor may benefit from surgery to open a constricted urethra.
What are the complications and side effects of surgery for advanced prostate cancer?
As with surgery for early-stage prostate cancer, surgery for more advanced cancers can have significant side effects. Those include erectile dysfunction, urinary incontinence, and fecal incontinence.
Can radiation therapy be used for advanced prostate cancer?
External-beam radiation therapy can help control the growth of localized tumors. It can also help men live longer without symptoms of disease. Brachytherapy (radiation seeding) is technically difficult to do in large prostate tumors. So it is less often used in men with advanced disease.
External beam radiation can also be an effective method for controlling disease that recurs after radical prostatectomy. The radiation is directed to the part of the body where the diseased prostate was removed. Brachytherapy cannot be used in this case because the gland has been taken out. That leaves no place to embed the seeds.
Some men's tumors are not diagnosed until they have reached stage III or higher. When that's the case, whether radiation therapy will be effective depends on the status of regional lymph nodes. If the nodes are removed and appear to be disease-free, the chance for long-term survival is much better than if they have cancerous cells.
Radiation can also be delivered through a monthly intravenous drug called Xofigo. 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. The drug 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.