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    Treating Advanced Prostate Cancer

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    Provenge for Advanced Prostate Cancer continued...

    Provenge bypasses these problems. The treatment first removes a quantity of dendritic cells from a patient's blood. Dendritic cells show pieces of tumor to immune cells, priming them to attack cells that carry those pieces.

    The patient's doctor ships the cells to Provenge's manufacturer, Dendreon, which then exposes them to Provenge. Provenge is a molecule made inside genetically engineered insect cells.

    Once these cells have been exposed to Provenge, they're shipped back to the doctor who infuses them back into the patient. This is done three times in one month. The first infusion primes the immune system. The second and third doses spur an anticancer immune response.

    The most common side effect is chills, which occurs in more than half of the men that receive Provenge. Other common side effects include fatigue, fever, back pain, and nausea. Provenge has been remarkably safe. However, clinical trials suggest that the treatment might be linked to a slightly increased risk of stroke.

    Endocrine Drugs for Prostate Cancer

    Drugs work as well as prostate cancer surgery (orchiectomy -- removal of the testicles) 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 (LHRH) analogs, luteinizing hormone-releasing hormone (LHRH) antagonists, and antiandrogens.

    Luteinizing hormone-releasing hormone (LHRH) analogs

    Most patients who receive hormonal therapy choose LHRH analogs. These drugs work by decreasing testosterone production to very low levels by depleting the pituitary gland of the hormone needed to produce testosterone. However, before this decrease in testosterone occurs, patients experience a brief and temporary increase in testosterone production and tumor growth. This is due to a transient increase in release of LHRH from the pituitary gland with a resulting stimulation of testosterone production. This phenomenon, called tumor flare, can cause increased symptoms from the prostate cancer that didn't exist before the patient received the therapy. Some doctors prescribe antiandrogens (described below) to combat the symptoms caused by tumor flare. LHRH analogs are administered via injection or small implants placed under the skin. The most commonly used LHRH analogs in the U.S. are leuprolide (Eligard, Lupron), histrelin (Vantas), triptorelin (Trelstar), and goserelin (Zoladex). They cause side effects similar to those from the surgical orchiectomy. These drugs carry a risk of triggering diabetes, heart disease, osteoporosis, and/or stroke. Before starting one of these drugs, patients should tell their doctor if they have a history of diabetes, heart disease, stroke, heart attack, high blood pressure, high cholesterol, or cigarette smoking.

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