What Is Intermittent Adt
Researchers have investigated whether a technique called intermittent androgen deprivation can delay the development of hormone resistance. With intermittent androgen deprivation, hormone therapy is given in cycles with breaks between drug administrations, rather than continuously. An additional potential benefit of this approach is that the temporary break from the side effects of hormone therapy may improve a mans quality of life.
Randomized clinical trials have shown similar overall survival with continuous ADT or intermittent ADT among men with metastatic or recurrent prostate cancer, with a reduction in some side effects for intermittent ADT .
Study Shows Which Patients With Advanced Prostate Cancer Will Benefit From Chemotherapy
24 June 2022
Researchers have recommended changes to how cancer patients are treated, after a new UCL-led study discovered that chemotherapy is significantly more effective for some men with advanced prostate cancer than others.
On average, docetaxel chemotherapy improved 5-year survival by 10% compared to standard hormone therapy, which works by reducing the levels of male hormones in the body to stop them from reaching the cancer cells.
And both treatments may be offered to all men diagnosed with advanced prostate cancer.
However, the research, which was presented at the American Society of Clinical Oncology and funded by Prostate Cancer UK, found that men who had many metastases when they were diagnosed benefitted most from docetaxel chemotherapy, with 39% surviving five years, compared to 26% who had hormone therapy alone.
Among those with many metastases who also had larger prostate tumours, 55% survived for five years after having the treatment, compared to just 20% of men who just had hormone therapy.
In this study, those with many metastases or high volume metastatic disease, had either four or more secondary tumours in the bones and/or any metastasis in an organ such as the liver or lungs.
Meanwhile, men with fewer than 4 bone metastases and who had been diagnosed with prostate cancer at an earlier stage, did not benefit from docetaxel chemotherapy at all.
Around 47,500 men are diagnosed with the cancer each year, with 6,000 cases classed as advanced.
What Are Male Sex Hormones
Hormones are substances that are made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs.
Androgens are a class of hormones that control the development and maintenance of male characteristics. The most abundant androgens in men are testosterone and dihydrotestosterone .
Androgens are required for normal growth and function of the prostate, a gland in the male reproductive system that helps make . Androgens are also necessary for prostate cancers to grow. Androgens promote the growth of both normal and cancerous prostate cells by binding to and activating the androgen receptor, a protein that is expressed in prostate cells . Once activated, the androgen receptor stimulates the expression of specific genes that cause prostate cells to grow .
Almost all testosterone is produced in the testicles a small amount is produced by the adrenal glands. Although prostate cells do not normally make testosterone, some prostate cancer cells acquire the ability to do so .
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Do Zoladexs Side Effects Vary Depending On The Condition Its Used To Treat
Yes, some of the common side effects of Zoladex vary, depending on the condition being treated.
For example, mood changes and depression are more common side effects in people having the treatment for endometriosis or breast cancer. Mood-related side effects werent commonly reported in studies of the drug for prostate cancer.
For more information, see More common side effects above. If you have questions about the side effects that Zoladex can cause for people with your condition, talk with your doctor.
Staging Of Prostate Cancer
Doctors will use the results of your prostate examination, biopsy and scans to identify the stage of your prostate cancer .
The stage of the cancer will determine which types of treatments will be necessary.
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.
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Guide To Managing Side Effects Of Chemotherapy
Follow these simple rules to manage your side effects:
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Pay attention. Be aware of all expected and unexpected reactions to the drugs.
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Be proactive. Make a list of your medications. Talk with your health care providers about what signs to look for and when to call them.
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Relax and get well. Chemotherapy drugs are powerful and can take a toll on the body. Focus on getting well by finding ways to alleviate stress. These may include listening to music, doing yoga or stretching exercises, taking walks or watching TV.
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Keep a journal. Write down any physical and emotional changes you experience while taking the medications. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your health care team to manage your side effects.
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Consult your doctor. Talk with your health care providers about any side effects you experience. There are several drugs designed to help ward off or treat different side effects.
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..
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Possible Side Effects Of Radiation Treatment For Prostate Cancer
The radiation used to destroy cancer cells can also hurt normal cells in the nearby area. Side effects from radiation treatment are related to the area of the body being treated. Patients start to have side effects a few weeks into their treatment. While side effects may be unpleasant, there are treatments to help deal with them. Most side effects are temporary and slowly start to go away once treatment is done.
You will be seen by your radiation oncology providers often during treatment. These visits are a chance to ask questions and to talk about any side effects and how to best manage them. You can also call your providers to speak about any side effects.
Before You Start Chemotherapy
You need to have blood tests to make sure its safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Your doctors and pharmacists work out your chemotherapy dose based on your blood cell levels, and your weight, height and general health.
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Standards Of Care In Hormone Therapy
Most doctors agree that hormone therapy is the most effective treatment available for patients with advanced prostate cancer. However, there is disagreement on exactly how and when hormone therapy should be used. Here are a few issues regarding standards of care:
Timing of Cancer Treatment
The disagreement is due to conflicting beliefs. One is that hormone therapy should begin only after symptoms from the metastases, like bone pain, occur. The counter belief is that hormone therapy should start before symptoms occur. Earlier treatment of prostate cancer is associated with a lower incidence of spinal cord compression, obstructive urinary problems, and skeletal fractures. However, survival is not different whether treatment is started early, or deferred.
The only exception to the above, is in lymph node-positive, post-prostatectomy patients, given androgen deprivation as an adjuvant immediately after surgery. In this situation, immediate therapy resulted in a significant improvement in progression free survival, prostate cancer specific survival, and overall survival.
Length of Cancer Treatment
The disagreement in this situation is between continuous androgen deprivation and intermittent androgen deprivation.
Combination vs. Single-Drug Therapy
Chemotherapy For Metastatic Prostate Cancer
Chemotherapy is a common treatment for metastatic or advanced prostate cancer. Chemotherapy uses anti cancer drugs to destroy prostate cancer cells. The drugs circulate throughout the body in the bloodstream. The most common type of chemotherapy used for prostate cancer is docetaxel.
Metastatic prostate cancer is a cancer that began in the prostate and has spread to other parts of the body such as the bones.
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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.
Medications For Prostate Cancer
Other names: Cancer, Prostate Carcinoma of Prostate
Prostate cancer is a cancer that occurs in the prostate, which is a small, walnut-sized gland that is located just below the bladder in men and which surrounds the urethra .
Prostate cancer is common, and many men have a slow-growing form of prostate cancer. Death, when it happens, is usually from other causes rather than the cancer itself. However, some prostate cancers are aggressive and can quickly spread outside the confines of the prostate. These are associated with a lower rate of survival.
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Endocrine Drugs For Prostate Cancer
Drugs work as well as prostate cancer surgery 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 analogs, luteinizing hormone-releasing hormone antagonists, and antiandrogens.
Active Surveillance And Watchful Waiting
If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.
Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.
ASCO encourages the following testing schedule for active surveillance:
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A PSA test every 3 to 6 months
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A DRE at least once every year
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Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years
Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.
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Just One Weapon Against Cancer
Before treatment with PLUVICTOTM is recommended, patients undergo a PSMA-PET/CT scan to determine if their tumor contains the PSMA target. If it does not, PLUVICTOTM would not be appropriate, explained Dr. Wong. At Duke we treat you as an individual. Each case is discussed among a multidisciplinary team of surgeons, radiation oncologists, medical oncologists, radiologists, and nuclear medicine specialists. He emphasized that PLUVICTOTM is not for everyone and is just one weapon in the arsenal for fighting cancer. Our team will determine how and if this new option fits in with all the others we offer.
Duke can provide PLUVICTOTM and other novel treatments because it is a Comprehensive Cancer Center with the latest advances in diagnosing and treating prostate cancer. Duke is also recognized as a Comprehensive Radiopharmaceutical Therapy Center of Excellence, which requires strict adherence to safety and treatment criteria that ensures the best care for patients.
How Is Prostate Cancer Treated
Treatment for prostate cancer depends upon the stage of the prostate cancer and an understanding of the pros and cons of treatment. Treatment options include:
- Watchful waiting. No active treatment is started. This may be appropriate for older men with other serious medical conditions
- Active watching. May involve regular PSA tests and prostate biopsies
- Brachytherapy. Small radioactive pellets are placed permanently into the prostate gland
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Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA recurrence or biochemical recurrence.
Surgically Removing The Prostate Gland
A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.
Like any operation, this surgery carries some risks, such as urinary incontinence and erectile dysfunction.
In extremely rare cases, problems arising after surgery can be fatal.
It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.
Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.
You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation .
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What Causes Prostate Cancer
Cancer is the uncontrollable growth of cells. It occurs when a mutation or abnormal change occurs that upsets how our cells multiply and divide. This allows the cell to keep dividing, out-of-control, instead of dying and being replaced by a new cell. Sometimes these out-of-control cells cluster together and form a lump called a tumor. Tumors can form in almost any area of the body.
Experts arent sure why some men develop prostate cancer and others dont however, they have identified a few risk factors that make some men more likely to develop the condition. These include:
How Does Hormone Therapy Work Against Prostate Cancer
Early in their development, prostate cancers need androgens to grow. Hormone therapies, which are treatments that decrease androgen levels or block androgen action, can inhibit the growth of such prostate cancers, which are therefore called castration sensitive, androgen dependent, or androgen sensitive.
Most prostate cancers eventually stop responding to hormone therapy and become castration resistant. That is, they continue to grow even when androgen levels in the body are extremely low or undetectable. In the past, these tumors were also called hormone resistant, androgen independent, or hormone refractory however, these terms are rarely used now because the tumors are not truly independent of androgens for their growth. In fact, some newer hormone therapies have become available that can be used to treat tumors that have become castration resistant.
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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.
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