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How Many Chemo Treatments For Prostate Cancer

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How Does Chemotherapy Work

Prostate Cancer Chemotherapy Basics | Ask a Prostate Expert, Mark Scholz, MD

Healthy cells in your body divide and grow. Each cell divides in half to make another cell just like itself. Cancer cells do not divide and grow, as they should. Instead of making just one cell like itself, the cancer cell makes many copies of itself. After a while, your body becomes overworked because of all the cancer cells. Chemotherapy medicine keeps cancer cells from copying themselves. By killing the cancer cells, chemotherapy medicine tries to keep the cancer from moving to other parts of your body.

Questions To Ask Your Doctor

These questions may be useful to you when you talk to your doctor about your chemotherapy treatment:

About Chemotherapy

  • Why do I need chemotherapy?
  • How can chemotherapy help me?
  • What are the risks of chemotherapy?
  • Are there any other possible treatments for my prostate cancer?

About Your treatment

  • How many chemotherapy treatments will I get?
  • What medicine or medicines will I take?
  • How will the medicines be given to me?
  • How long will each treatment I get last?

About Side Effects

  • What side effects may I get from my chemotherapy medicine?
  • When will these side effects happen?
  • Are there any side effects I should tell you about right away?
  • What can I do to manage my side effects?

About Contacting Your Doctor

  • How do I get in touch with you or my health care team after your office is closed?

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-only or biochemical recurrence.

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Neoadjuvant Chemotherapy Prior To Radical Prostatectomy

The majority of patients with localized PCa who undergo radical prostatectomy are cured but as many as one-third experience recurrence. Recently, there has been a growing interest in neoadjuvant treatment in an attempt to eradicate micrometastases and improve surgical outcomes in patients with varying cancers. Given the lack of mature Phase III trials evaluating the role of neoadjuvant chemotherapy in PCa and the availability of a multitude though limited number of patients in Phase II trials that utilizes different chemotherapy agents,,,,,,,,,,,,,,,, , there remains to be a limited role of neoadjuvant chemotherapy with or without ADT in the management of localized PCa prior to radical prostatectomy.

Pencil Beam Scanning Proton Therapy

New Treatments For Metastatic Prostate Cancer

Pencil beam scanning is one of the most common ways to deliver proton therapy for prostate cancer. Another common method is double-scattered beam therapy.

With pencil beam scanning proton therapy, medical professionals are able to manipulate and focus the proton beams to a greater extent. This results in a more precise dose of radiation than double-scattered therapy, sparing surrounding tissue even more.

However, the difference in outcomes is minimal, according to

Side effects may include fatigue and skin redness or soreness where you had treatment. You may also have issues with incontinence or gastrointestinal side effects. Erectile dysfunction is another risk of radiation treatment.

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Side Effects Of Treatment

Treatments for prostate cancer can cause side effects, which might carry on after your treatment has finished. Some side effects can even start several months or years after treatment finishes.

Side effects will affect each man differently you may not get all the possible side effects from your treatment.

Read more about:

Managing side effects

Side effects can affect your day-to-day life, but there are treatments for them, as well as things you can do to manage them yourself. Its important to speak to your doctor, nurse or GP about them.

If youre having problems with a side effect, you might have a meeting with your doctor or nurse to work out what support you need. They may refer you to someone who can give you more advice and support.

Read more about managing the side effects of prostate cancer treatment.

Are There Side Effects With Chemotherapy

Yes, there can be side effects or unwanted changes in your body when you have chemotherapy. Side effects are different from person to person, and may be different from one treatment to the next. Some people have no or very mild side effects. The good news is that there are ways to deal with most of the side effects. The strong anticancer medicines used in chemotherapy are made to kill cells in your body that grow and divide very quickly. This is why you may have side effects with chemotherapy. Along with your prostate cancer cells, chemotherapy also kills healthy cells in your body that grow and divide very quickly. Some kinds of these healthy cells that may be affected by your chemotherapy treatment include: cells that make your hair grow, cells that make new blood cells, and cells that cover the inside of your mouth, stomach, and intestines. Most of the side effects slowly go away after you finish your chemotherapy. There are ways to make the side effects easier to deal with while you are having chemotherapy.

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History Of Chemotherapy Use In Pca From Palliative To Survival Advantage

In the 1940s, Dr. Charles Huggins and Dr. Clarence Hodges were the first to demonstrate that bilateral orchiectomy or estrogen therapy resulted in shrinkage of prostate tumors by decreasing testosterone levels and inducing castration. Since then, androgen ablation therapy has been the mainstay of treatment of PCa. Initially, most patients responded to androgen-ablative therapy or androgen deprivation therapy , but became resistant with time and developed fatal disease. At that time, there were no clear methods to measure tumor burden. Most patients would have soft tissue diseases involving the prostate and lymph nodes where they could not be easily measured, along with extensive bone metastases. They mostly suffered from bone pain which when localized usually transiently responded to radiation therapy. Obstructive symptoms were treated with transurethral resection. It was the patients with generalized bone pain in whom effective palliation was difficult, and so came the need for clinical trials of chemotherapy in these selected patients.

Satraplatin, the first oral 4th generation platinum analog found to be effective against cisplatin- and carboplatin-resistant cell lines, held a lot of promise in castration-resistant PCa, and while it showed improvement in time to pain progression, it failed to improve overall survival in the Phase III SPARC registration trial.

What Are Male Sex Hormones

The 4 Types of Prostate Cancer Treatment | Prostate Cancer Staging Guide

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 semen. 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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Proton Beam Radiati On Therapy

Proton beam radiation therapy capitalizes on a unique physical property of high energy protons generated from a cyclotron. The accelerated charged particles travel through tissue until reaching a depth determined by their energy. Once they reach that depth, the remainder of the radiation dose is deposited in a sharp Bragg peak with no dose going beyond that point. When multiple proton beams are used, a very sharp and tight radiation dose distribution is created. This modality is especially attractive when tumors are in close proximity to sensitive organs. PCa is one of the more common indications in which proton therapy is utilized.

At Washington University in St. Louis we are collaborating with investigators from Massachusetts General Hospital and the Harvard Medical School conducting a randomized clinical trial of IG-IMRT versus proton beam radiation in men with low and intermediate risk PCa. The PARTIQoL trial is seeking to measure and compare relative the impact of the two modalities on patient quality of life after treatment. provides a comparison of these two treatment modalities.

Axial CT slice showing conformality of intensity modulated radiation therapy. Radio-opaque markers are apparent in the anterior aspect of the prostate gland. Axial CT slice showing conformality of proton beam radiation therapy in the same patient as panel a. More sparing of the anterior-lateral rectal wall and less dose to peripheral tissues is apparent.

Intensity Modulated Radiation Therapy

IMRT, an advanced form of 3D-CRT therapy, is the most common type of external beam radiation therapy for prostate cancer. It uses a computer-driven machine that moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the prostate from several angles, the intensity of the beams can be adjusted to limit the doses of radiation reaching nearby normal tissues. This lets doctors deliver an even higher radiation dose to the cancer.

Some newer radiation machines have imaging scanners built into them. This advance, known as image guided radiation therapy , lets the doctor take pictures of the prostate just before giving the radiation to make minor adjustments in aiming. This appears to help deliver the radiation even more precisely and results in fewer side effects.

A variation of IMRT is called volumetric modulated arc therapy . It uses a machine that delivers radiation quickly as it rotates once around the body. This allows each treatment to be given over just a few minutes. Although this can be more convenient for the patient, it hasnt yet been shown to be more effective than regular IMRT.

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Surgical procedures to remove the diseased prostate are usually necessary. Surgical procedures are not always necessary. If the disease is caused by bacterial infections, a doctor can treat the symptoms using alpha-blockers or surgery. Physical therapy, relaxation exercises, and warm baths are all recommended. A physician may also prescribe antibiotics to cure the infection. A bacterial infection can also cause a recurrence of the condition.

An enlarged prostate can be uncomfortable for both men and women. Some of the symptoms of an enlarged male reproductive organ include a weakened urine stream, urgent need to urinate, and urinary tract infections. BPH can also cause damage to the kidneys. A sudden inability to urinate can be life-threatening, as it can lead to bladder and kidney damage. Unfortunately, most men with enlarged prostrates put up with the symptoms for years before they seek treatment. However, many of the men with symptoms finally decide to go to a doctor for proper gynecological evaluation and to begin enlarged prostatic therapy.

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Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. This condition causes pain in the lower back and groin area, and may cause urinary retention. Symptoms include leaking and discomfort. In severe cases, a catheter may be required to relieve the symptoms. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. If these do not work, your symptoms could progress and become chronic.

An acute bacterial infection can cause a burning sensation. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. The symptoms of acute bacterial prostatitis are similar to those of CPPS. Patients may experience a fever or chills as a result of the infection.

A bacterial infection can also lead to prostate issues. Acute bacterial infections can be hard to treat. Some men with a bacterial infection may need to take antibiotics to prevent or treat symptoms. Symptoms of the disease include fever and chills, pain in the lower back and the tip of the penis. Some men may have blood in the urine, frequent urination, and blood in the urine. If you suffer from acute bacterial prostatitis, a medical professional should be able to prescribe you the appropriate treatments to prevent the disease.

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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.

What Are The Side Effects Of Hormone Therapy For Prostate Cancer

Because androgens affect many other organs besides the prostate, ADT can have a wide range of side effects , including:

  • loss of interest in sex
  • Studer UE, Whelan P, Albrecht W, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer Trial 30891. Journal of Clinical Oncology 2006 24:18681876.

  • Zelefsky MJ, Eastham JA, Sartor AO. Castration-Resistant Prostate Cancer. In: Vincent T. DeVita J, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology, 9e. Philadelphia, PA: Lippincott Williams & Wilkins 2011.

  • Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. European Urology 2021 79:150158.

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    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.

    Androgen Receptor And Biosynthesis Inhibitors

    How Does Chemotherapy for Prostate Cancer Work?

    The following treatments are newer treatment options that often work when doesnt work for you:

    • enzalutamide
    • abiraterone
    • apalutamide

    However, there are no studies available yet directly comparing these drugs, and its not clear which is most effective.

    Enzalutamide and apalutamide are in a class of drugs called androgen receptor inhibitors. They block male sex hormones from binding to receptors on your prostate.

    Abiraterone is in a class of drugs called androgen biosynthesis inhibitors. They work by blocking the production of testosterone.

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    Treatments For Prostate Cancer

      If you have prostate cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for prostate cancer, your healthcare team will consider:

      • the type and stage of the cancer
      • the grade or Gleason score
      • prostate-specific antigen levels
      • the risk group
      • possible side effects of treatments
      • your personal preferences
      • your overall health and any existing medical conditions
      • your age and life expectancy
      • whether you have symptoms

      Prostate cancer treatments can seriously affect your quality of life and cause side effects such as erectile dysfunction and incontinence . Many prostate cancers grow slowly and cause no symptoms or problems.

      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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