Prostate cancer occurs when a tumor develops in the prostate gland, which makes the liquid portion of semen. Cancer that spreads outside the prostate gland to the lymph nodes, bones, or other areas is called metastatic prostate cancer. Currently, no treatments can cure advanced prostate cancer. However, there are ways to help control its spread and related symptoms.
Treatments that slow the spread of advanced prostate cancer and relieve symptoms often cause side effects. Some patients, often those who are older, decide that the risk of side effects outweighs the benefits of treatment. These patients may choose not to treat their advanced prostate cancer.
It's important to remember that researchers are always searching for new and better treatments that will cause fewer side effects, better disease control, and longer survival rates.
Male hormones, specifically testosterone, fuel the growth of prostate cancer. By reducing the amount and activity of testosterone, the growth of advanced prostate cancer is slowed. Endocrine therapy, known as androgen ablation, is the main treatment for advanced prostate cancer. It is the first line of treatment for metastatic prostate cancer.
In many patients, endocrine therapy provides temporary relief of symptoms of advanced prostate cancer. Endocrine therapy may reduce tumor size and levels of prostate specific antigen (PSA) in most men. PSA is a substance produced by the prostate gland that, when present in excess amounts, signals the presence of prostate cancer.
However, endocrine therapy is not without side effects. Some of the more serious side effects include loss of sex drive, impotence, weakened bones (osteoporosis), and heart problems.
Eventually, most patients with advanced prostate cancer stop responding to hormone therapy. Doctors call this castrate independent prostate cancer.
Chemotherapy for Prostate Cancer
Patients who no longer respond to hormone therapy have another option.
The chemotherapy drug docetaxel (Taxotere) taken with or without prednisone (a steroid) is the standard chemotherapy regimen for patients who no longer respond to endocrine therapy. Docetaxel works by preventing cancer cells from dividing and growing. Patients receive docetaxel, along with prednisone, through an injection. Side effects of docetaxel are similar to most chemotherapy drugs and include nausea, hair loss, and bone marrow suppression (the decline or halt of blood cell formation). Patients may also experience neuropathy (nerve damage causing tingling, numbness, or pain in the fingers or toes) and fluid retention.
Docetaxel, when used with or without prednisone, was the first chemotherapy drug proven to help patients live longer with advanced prostate cancer. The average survival was improved by about 2.5 months when compared to mitoxantrone with or without prednisone. Docetaxel has the best results when given every three weeks as compared to weekly dosing.
Cabazitaxel (Jevtana) is another chemotherapy drug, used in combination with the steroid prednisone, to treat men with prostate cancer. Cabazitaxel (Jevtana) is used in men with advanced prostate cancer that has progressed during, or after, treatment with docetaxel (Taxotere).