Thinking About Taking Part In A Clinical Trial
Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they’re not right for everyone.
If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.
What Lies Ahead: Leading The Way With Alpha Therapies
The coming years will see even more powerful forms of radioactive therapy. The MSK laboratory of radiochemist Jason Lewis and other researchers are investigating the use of alpha particles, which have a much higher energy hundreds of times more potent than the photons used in conventional radiation or beta particles. Not only do alpha particles cause more damage when they slam into cancer cells but their path of destruction is more tightly focused, sparing normal cells.
MSK is building one of the nations first dedicated alpha particle GMP labs at a U.S. academic institution.
These radiopharmaceuticals that we are creating translate very well from bench to bedside, says Dr. Lewis, Chief of the Radiochemistry and Imaging Sciences Service and Director of the Radiochemistry and Molecular Imaging Probe Core Facility. When you see these striking responses to treatment, it brings real hope for the future and our patients.
Advances in radiotheranostics are supported by The Tow Foundation, long-time contributors to MSKs mission.
- A new FDA-approved drug could be an effective treatment against prostate cancer that has spread.
- The treatment uses a molecule that seeks out and attaches to a specific protein on the cancer cell surface called PSMA
- The technology delivers radiation that damages DNA and destroys the cancer cell..
Radiation Vs Chemotherapy For Prostate Cancer
There are some options of treatment for prostate cancer, a common cancerous tumor that affects men especially elderly men. The stage, PSA level, and Gleason score are some major variables that determine the way of how the treatment plan should go. Both radiation and chemotherapy can help treat this cancer, and each treatment has drawbacks and potential benefits.
Radiation therapy
It is a kind of treatment that uses the energy of radiation to kill and destroy cells of cancer. There are two major ways to deliver the radiation, internal and external.
Internal radiation therapy
In this procedure, the radiation is radiated from inside the body . In other words, there is special device inserted into the specific area of the body to release radiation and hit the target locally!
When do you need to take it?
Since it works locally, it is commonly not used when the cancer has spread. It is more likely to be used for low and intermediate risk of localized prostate cancer.
The word localized means that the cancerous cells have not spread yet and they are only found within the prostate gland.
The low risk of localized prostate cancer means the cancer tends to grow very slowly, even it is very unlikely to develop or progress after many years. Many men with this type are often recommended to only have an active monitoring, a procedure of when you are only recommended to regularly check the progression of your cancer.
Side effects
Other drawbacks may include:
Benefits
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Can Chemotherapy Cure Metastatic Prostate Cancer
Metastatic prostate cancer takes place when cancer cells have reached other organs, distant from the prostate gland. It takes its name from the verb metastasize which means to spread to other parts of the body through means of blood, lymphatic vessels, or membranous surfaces.
At this stage, there is currently no cure to reverse a metastatic phase. That being said, doctors are focusing on various strategies in order to prolong life expectancy.
For cases of metastatic prostate cancer, medical specialists are steering away from surgical procedures. Instead, they are likely to pursue other care plans that involve less invasive treatments, such as hormone therapy, immunotherapy, chemotherapy or even clinical trials. Therefore, patients who suffer from metastatic prostate cancer are usually undergoing sessions of chemotherapy in view of diminishing the symptoms rather than curing cancer.
Treatment Options For Prostate Cancer To Consider
Almost 90% of prostate cancer diagnoses are delivered at early stages. In these cases, there is plenty of room for doctors and their patients to discuss and address the situation at a steady pace.
Depending on the circumstances, doctors can call for monitoring the development of the tumor without taking any actionable steps. In the absence of harmful symptoms or a swift change in the progression of the disease, doctors usually incline towards prudent measures.
Given the slow progression of prostate tumors, it can take even years before medical specialists decide on a pragmatic approach. The moment the symptoms of prostate cancer start superseding the possible treatment side effects and affect the quality of life, a care plan is set into motion.
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First Evidence That Chemotherapy Extends Life In Advanced Prostate Cancer
Last Editorial Review: 11/12/2004
Key wordsProstate cancer, docetaxel , chemotherapy .
SummaryChemotherapy regimens that include the drug docetaxel extend median survival by two to three months in patients with advanced prostate cancer that is no longer responsive to hormone therapy, two large phase III studies have shown. These are the first clinical trials to show that chemotherapy can improve survival in advanced prostate cancer.
American Society of Clinical Oncology annual meeting, New Orleans, June 7, 2004. Final results subsequently published in the October 7, 2004, issue of the New England Journal of Medicine .
BackgroundTherapies that lower the body’s level of the male sex hormone testosterone, which encourages prostate cancer growth, are the mainstay of treatment for prostate cancer that has spread to other organs. However, many patients stop responding to hormonal therapies after two to three years of treatment. No effective therapy currently exists for advanced prostate cancer that stops responding to hormonal therapy.
Chemotherapy with the drugsprednisone and mitoxantrone has been shown to reduce pain in men with advanced prostate cancer that has spread to the bones, but this regimen does not help patients to live any longer. Several previous studies of different chemotherapy regimens had failed to identify a drug or combination of drugs that extended patients’ survival.
This study was supported by Aventis Pharmaceuticals, Inc., which manufactures docetaxel.
Questions To Ask Your Doctor Or Nurse
- How can chemotherapy help?
- How long will the treatment last, and how many sessions will I need?
- What are the possible side effects of chemotherapy, and how long will they last?
- Can I stop the treatment if I find the side effects difficult to deal with?
- Are there any other treatments available to me?
- Who should I contact if I have any questions during my treatment and how do I contact them?
- What happens if chemotherapy doesnt work? Are there other treatments I can have later on?
- Are there any clinical trials I can take part in?
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What Chemotherapy Drugs Are Used To Treat Prostate Cancer
The chemotherapy drugs used for prostate cancer are typically used one at a time. These drugs include:
In most cases, the first chemotherapy drug given to patients with metastatic prostate cancer is Taxotere.
If Taxotere doesnt work or stops working, the next chemotherapy drug doctors typically try is Jevtana, although doctors may try other drugs or treatment options.
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Benefits And Risks Of Prostate Cancer Chemotherapy
Despite the fact that chemotherapy is not usually the first option, it has been proven effective in helping patients with prostate cancer. Chemotherapy drugs attack the cancerous cells that are dividing fast, resulting in improvements in the patients condition. Over the last 10 years, chemotherapy drugs have helped patients who have prostate cancer that has spread. Overall survival rate increased with new drugs. Chemotherapy boosts the immune systems ability to fight cancer. Because chemotherapy improves survival and relieves symptoms of advanced prostate cancer, if your cancer has spread you may be a good candidate for this treatment, adds the Urology Care Foundation.
However, chemotherapy is also an aggressive approach, and it has several risks and side effects that need to be taken into consideration. Chemotherapy attacks not only cancerous cells, but also other cells, including the ones in the bone marrow, the lining of the mouth and intestines, and the hair follicles. Therefore, patients may experience hair loss, mouth sores, loss of appetite, nausea and vomiting, diarrhea, increased chance of infections related to low levels of white blood cells, easy bruising or bleeding related to low levels of blood platelets, and fatigue due to low levels of red blood cells. In the majority of the cases, the side effects stop as soon as the treatment is finished.
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Cancer That Clearly Has Spread
If the cancer has spread outside the prostate, it will most likely go to nearby lymph nodes first, and then to bones. Much less often the cancer will spread to the liver or other organs.
When prostate cancer has spread to other parts of the body , hormone therapy is probably the most effective treatment. But it isnt likely to cure the cancer, and at some point it might stop working. Usually the first treatment is a luteinizing hormone-releasing hormone agonist, LHRH antagonist, or orchiectomy, sometimes along with an anti-androgen drug or abiraterone. Another option might be to get chemotherapy along with the hormone therapy. Other treatments aimed at bone metastases might be used as well.
How Psma Lights Up Cancer Cells
In 2021, the U.S. Food and Drug Administration issued national approval to two new prostate cancer imaging tests based on similar technology. On a PET scan, the test lights up the cancerous cells that would otherwise be hidden, enabling doctors to precisely target treatment.
Both advances in imaging and therapy rely on targeting PSMA, which is not found on most normal cells but is overexpressed in cancer cells, especially those that have spread. The PSMA molecule was cloned at MSK in the early 1990s.
The Molecular Imaging and Therapy Service, led by Heiko Schöder, played a key role in the development and testing of a slightly different PSMA-directed imaging technology at MSK.
This advance is the result of years of work by the community of physicians promoting the use of PSMA agents, Dr. Schöder says. Its gratifying to see a collaborative effort result in a breakthrough that has the potential to make a difference for so many patients with advanced prostate cancer.
Before receiving the therapy, patients in the VISION trial were scanned with PSMA-directed PET imaging to make sure enough PSMA was present in the cells to make them likely to respond to the treatment. If so, they received the radioactive drug by injection over four to six sessions, spaced six weeks apart.
As a next step, Dr. Morris and colleagues are looking into using the PSMA-directed therapy earlier rather than only after the prostate cancer has spread.
Michael Morris
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Docetaxel Role In Early Hormone
For metastatic hormone-sensitive PCa, the cornerstone of treatment has been aimed toward addressing the androgen pathway, but most of these patients will progress to castration resistant PCa in 12 years. The mechanism of action of docetaxel raised the question of its possible benefit in hormone-sensitive PCa, which led to further investigations.58
A randomized study from the Genito-Urinary Group and the French Association of Urology 15 was a Phase III trial that evaluated the role of docetaxel in 385 men with metastatic hormone-sensitive PCa. Patients were randomized to receive either androgen deprivation therapy alone or with docetaxel and were followed up for 50 months. Results for the primary endpoint, OS, were not statistically significant , but the ADT plus docetaxel reported more adverse events . The authors concluded that the results of the trial did not support the use of docetaxel as part of first-line treatment for patients with noncastrate metastatic PCa.59 In 2015, long-term follow-up results were published that also showed no statistically significant benefit but did show an absolute difference in median OS of 14 months.60
Emerging Therapies For Prostate Cancer
Researchers are pursuing several new ways to treat advanced prostate cancer. Vaccines that alter the body’s immune system and use genetically modified viruses show the most promise. One vaccine technique works by manipulating blood cells from the patient’s immune system and causing them to attack the prostate cancer.
Blood is drawn from the patient. From the blood sample, cells that are part of the immune system are exposed to cells that make up prostate cancer. Then the blood cells are placed back in the body, with the hope that they will cause other immune system cells to attack the prostate cancer. In a more traditional type of vaccine, the patient is injected with a virus that contains PSA. When the body is exposed to the virus, it becomes sensitized to cells in the body that contain PSA and their immune system attacks them.
Immune or genetic therapy have the potential to deliver more targeted, less invasive treatments for advanced prostate cancer. This would result in fewer side effects and better control of the prostate cancer.
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Antiandrogens For Prostate Cancer
These prostate cancer drugs work by blocking the effect of testosterone in the body. Antiandrogens are sometimes used in addition to orchiectomy or LHRH analogs.This is due to the fact that the other forms of hormone therapy remove about 90% of testosterone circulating in the body. Antiandrogens may help block the remaining 10% of circulating testosterone. Using antiandrogens with another form of hormone therapy is called combined androgen blockade , or total androgen ablation. Antiandrogens may also be used to combat the symptoms of flare . Some doctors prescribe antiandrogens alone rather than with orchiectomy or LHRH analogs.
Available antiandrogens include abiraterone acetate , apalutamide , biclutamide , darolutamide , enzalutamide , flutamide , and nilutamide . Patients take antiandrogens as pills. Diarrhea is the primary side effect when antiandrogens are used as part of combination therapy. Less likely side effects include nausea, liver problems, and fatigue. When antiandrogens are used alone they may cause a reduction in sex drive and impotence.
There Are Different Types Of Treatment For Patients With Prostate Cancer
Different types of treatment are available for patients withprostate cancer. Some treatments are standard , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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What Can Be Done To Treat Or Reduce Side Effects
Once chemotherapy treatment is complete, its side effects will typically cease. However, steps can be taken to combat any side effects as they occur. For instance, medications can help prevent nausea and vomiting, laxatives or stool-binding medications can manage constipation or diarrhea, respectively, and numbing gel can soothe mouth sores. Additionally, chemotherapy dosages can be changed or alternative chemo drugs can be considered, if appropriate.
What Are The Symptoms Of Lymph Node Metastasis
Lymph node metastasis symptoms can vary widely. Typically, one or more of your lymph nodes will become hard or swollen.
However, due to the variance of size and location of your lymph nodes, you might not even feel anything. This is especially true of lymph nodes located deep inside your stomach or internal organs. However, if your affected lymph node presses on organs or structures, you may have symptoms.
When the lymph nodes press on the blood vessels, it can interfere with how the blood moves and lead to blood clotting. You may have:
- Redness
- Trouble breathing
- Chest pain
Cancer cells can interfere with the passage of lymph fluid throughout your body. In the most severe cases, this happens in your arms or legs and is called lymphedema. As a result, you will notice swelling in those areas.
Otherwise, you might also have generalized cancer symptoms like:
- Loss of appetite
- Fatigue
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When Is Chemotherapy Given
Chemotherapy may be ordered for advanced prostate cancer that has not responded to hormone treatment. It is usually given for metastatic disease . Metastatic disease may be present at diagnosis or, in some cases, the cancer can return in a distant location months or years after initial treatment.
Chemotherapy is given to cause the cancer to shrink and, hopefully, to disappear. Even if the cancer does not disappear, symptoms may be relieved.
Should I Make Any Lifestyle Changes Including In My Diet Or Physical Activity
Achieving and maintaining a healthy weight by eating a balanced diet with plenty of fruits, vegetables, and whole grains, and staying physically active, can help your overall health. These lifestyle changes can also have a positive effect for men with bone metastases, Tagawa says. Both diet and exercise, he says, are things that are under a mans direct control.
A healthy lifestyle can help you better manage side effects from treatment as well. Try setting small but realistic goals for yourself when it comes to eating a healthy diet and getting plenty of exercise.
While no single food is likely to have a benefit for prostate cancer, smart food choices may help you feel better day to day. Start by cutting out foods high in sugar, saturated fat, and added flavorings and preservatives.
If youre not sure which healthy foods to choose, ask your doctor for a referral to a dietitian. This specialist can help you develop a meal plan that includes foods that offer the best chance of slowing the cancers growth and keeping you as healthy as possible.
As an oncologist, Tagawa says he concentrates on treating the cancer itself, but hes aware that many of the men he sees with advanced prostate cancer are older and more likely than younger men to have health problems that can benefit from diet and exercise.
And if youre on hormone therapy, talk to your doctor about investing in some weights or elastic resistance bands to support your bone strength too.
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