If you just learned that you or a loved one has advanced prostate cancer, you may have many questions and concerns. By taking the time to research your condition, you've taken a good first step. Here are answers to the most common questions. After looking over these answers, click on other articles in this guide to find in-depth information about treatments, side effects, and other issues that affect you and your family.
What is advanced prostate cancer?
Prostate cancer is defined as ''advanced'' when it spreads outside the prostate gland. It may spread to nearby tissues, lymph nodes, bones, or other parts of the body. When it is spread beyond the tissues directly adjacent to the prostate gland, it is called metastatic prostate cancer.
Can advanced prostate cancer be cured?
No cure exists for advanced, or metastatic, prostate cancer, but treatments may greatly extend life and reduce symptoms. A look at treatments:
- Most prostate cancer grows in response to male hormones (androgens) in the body, such as testosterone. That’s why one of the first treatments for advanced prostate cancer is to decrease these hormone levels (called androgen deprivation therapy). There are several medications that can do this, including degarelix (Firmagon), leuprolide (Lupron, Eligard), triptorelin (Trelstar), histrelin (Vantas) or goserelin (Zoladex). These drugs work to reduce testosterone levels to those seen in castrated patients.Other hormonal treatments include antiandrogens, estrogen- and progesterone-type drugs and cortisone derivatives.
If these stop working, the drugs abiraterone (Zytiga), (apaleutamide (Erleada), darolutamide (Nubeqa) or enzalutamide (Xtandi) may still be effective. The most frequent side effects from hormone therapy include reduced sex drive, impotence, erectile dysfunction, infertility, and bone loss. Your doctor may be able to help prevent some side effects, such as bone loss. In the past, it was common for doctors to recommend surgical removal of the testicles to decrease hormone levels. This is usually not necessary, because medications typically work, though such medications are more expensive than the surgical procedure to remove the testes (bilateral orchiectomy). The use of medical rather than surgical treatment offers the option of stopping -- sometimes temporarily, sometimes permanently -- the medicines if the side effects are intolerable, or if the patient or doctor prefers. The surgery is not reversible.
- If hormone therapy ultimately fails to slow the growth of the cancer, the next step may be a prostate cancer "vaccine" called Provenge (sipuleucel-T). Most men who take Provenge survive at least 2 years after starting the treatment. Provenge isn't your everyday vaccine. It's a 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 used for men with few or no symptoms and when advanced prostate cancer no longer responds to hormone therapy. The most common side effect is chills, which occurs in most men. Other common side effects include fatigue, fever, back pain, and nausea.
- Chemotherapy is another option when hormone therapy stops working. Only a few chemotherapy medications have been shown to work for advanced prostate cancer. The chemotherapy drug Taxotere, when taken with the steroid prednisone, can help extend survival in some men. When Taxotere stops working, other chemo drugs, such as Jevtana (cabazitaxel), can help extend survival in some men. Possible side effects of Taxotere include nausea, hair loss, and decreased production of blood cells. Men may also develop fluid retention and pain, tingling, or numbness in the fingers or toes. Jevtana has side effects similar to Taxotere.
- One drug, Xofigo (Radium -223), is approved for use in men who have advanced prostate cancer that has spread only to the bones. Candidates should have also received androgen deprivation therapy. 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.Metastron (strontium-89) and Quadramet (Samarium-153) can also be used to treat prostate cancer that has spread to bone.
What are the symptoms of advanced prostate cancer?
- Difficulty urinating if the cancer has enlarged the prostate; this can be a symptom of early or advanced disease and should prompt an evaluation by your doctor.
- Weakness from anemia if the prostate cancer is disrupting the production of red blood cells in bone marrow
- Pain, especially when the cancer has spread to the bones
- Fractures if bones are severely weakened
Men who notice early symptoms such as difficulty urinating may have more treatment options than those who notice symptoms only after cancer has spread to the bones.
What can be done to relieve the symptoms of bone metastases?
Drugs called biphosphonates (Actonel, Xgeva, Zometa, and others) can help make bones stronger and prevent fractures. Doctors sometimes perform surgery to support affected bones. Plus, radiation therapy directed at the bone can reduce pain caused by bone metastases.
A newer noninvasive procedure uses MRI scanning to focus the energy from ultrasound in order to destroy nerve endings in the bone around the tumor. This can provide relief from bone pain with a low risk of complications. Other treatments include the use of extreme cold or electrical currents to reduce or destroy the tumor.
Can patients with advanced prostate cancer enroll in clinical trials?
Major organizations such as the National Comprehensive Cancer Network recommend this course of action for all cancer patients. Researchers are exploring several new ways of diagnosing, monitoring, and treating prostate cancer. Clinical trials test the safety and effectiveness of these new methods and treatments. There are risks and limitations in every clinical trial. For example, you may be assigned to the "control" group, and not get the new medicine. In that case, the control medicine is the best therapy already available. Placebo -- or ineffective treatment -- is rarely if ever used anymore, and if it will be used in the trial, you would be informed. Keep in mind that the new medicine under investigation in the clinical trial may not work. But clinical trials also offer early access to new treatments.
You can find out more about clinical trials by asking a medical oncologist, inquiring at an academic medical center, or browsing a clinical trials listing service. The National Institutes of Health lists clinical trials at www.clinicaltrials.gov.