Advanced Prostate Cancer
The Latest Treatments
Murthy Andavolu, MD
When prostate cancer is in its early stages, immediate treatment may not be necessary. Depending on a patient’s age and other determining factors, watchful waiting is an option — followed by radiation and surgery as the next line of defense. However, if the cancer has metastasized, spreading to other parts of the body, physicians have access to an array of systemic treatments.
According to Eisenhower Medical Center physician Murthy Andavolu, MD, MBA, Board Certified in Internal Medicine, Medical Oncology and Hematology, prostate cancer is the medical parallel to breast cancer in women. “Pathologically and physiologically, prostate cancer is the equivalent of female breast cancer — a hormonally dependent, hormonally driven cancer,” says Dr. Andavolu. “And, advanced prostate cancer is responsive to hormone treatments. As a result, hormone treatments are becoming more and more center stage in the treatment of prostate cancer as opposed to chemotherapy, although it is not the only mode of treatment.”
Two of the most recent hormone therapies garnering good results are Zytiga® and Xtandi®. Zytiga, a prescription medicine used in combination with prednisone (a synthetic corticosteroid drug), works by interrupting the androgen-making process (androgen is a male hormone such as testosterone). Xtandi is a oncea- day prescription medicine that lessens the ability of androgens to attach to and activate the androgen receptor which may decrease prostate cancer cell growth. “A trial with Xtandi in patients who have not yet received chemotherapy has shown a significant prolongation in survival for patients who are receiving the hormone therapy even before chemotherapy,” notes Dr. Andavolu.
If hormonal treatments do not prove effective in a patient, physicians look to immunotherapy.
“There are currently two different immunotherapies available, one of which is approved and one which is undergoing clinical trails and could be approved,” explains Dr. Andavolu.
Provenge® is an approved immunotherapy for advanced prostate cancer patients. “This is a very personalized treatment where we take the patient’s blood cells and deliver an antibody against an antigen [any substance that causes the immune system to produce antibodies against it] that is expressed by the prostate cancer cells. The antibody goes to the prostate cancer and the antigen on the prostate cancer cells. This is a targeted, individualized therapy for a patient’s prostate cancer antigen,” says Dr. Andavolu.
If patients fail to respond to hormone therapies and immunotherapy, physicians turn to chemotherapy to treat advanced prostate cancer patients. The chemotherapy drug Taxotere® works by preventing cancer cells from dividing and growing. A newer chemotherapy, Jevtana®, may fight tumors that have become resistant to Taxotere. In patients suffering from bone pain due to advanced cancer metastases, radiation treatment can help to ease pain. A radiopharmaceutical bone-seeking isotope delivered intravenously can also help with painful bone metastasis.
On the Horizon
Although the treatment of advanced prostate cancer from a surgical standpoint has remained relatively static, the availability of hormone therapy treatment during the past two years has significantly prolonged the survival of patients. “Hormone therapies should be used first, followed by immunotherapy, and then chemotherapy,” says Dr. Andavolu. “It’s the best approach for the management of advanced prostate cancer.”