What Treatment Can I Have
There are different ways to treat pain. Whats best for you will depend on a number of things, including whats causing the pain, your general health, how you are feeling emotionally and what sort of things you do in your daily life. Because pain involves all of these things, treating it often means using a few different approaches.
You might need treatment for the pain itself, such as:
Pain might be a sign that your prostate cancer treatment isnt working as well as it was. A different treatment for your cancer may help the pain. Possible treatments include:
- hormone therapy
- a type of radiotherapy called radium-223.
There are other things that may also help with pain, including:
- complementary therapies
- emotional support
- treatments for other causes of pain, such as antibiotics to treat infection.
A Goal Of Sparing Healthy Tissue To Help Speed Recovery
Proton therapy is a powerful treatment for cancer and a highly effective alternative to standard X-ray radiation therapy. Due to improved dose distribution with proton therapy, doctors can better conform radiation to the tumor site, which means less healthy tissue is exposed to radiation, and which in turn is expected to result in fewer short- and long-term side effects.
Evidence About Hormone Therapy And Prostatectomy
Gleave ME, La Bianca S, Goldenberg SL. Neoadjuvant Hormonal Therapy Prior to Radical Prostatectomy: Promises and Pitfalls. Prostate Cancer and Prostatic Diseases 2000 3:13644. PMID: 12497089.
Hurtado-Coll A, Goldenberg SL, Klotz L, Gleave ME. Preoperative Neoadjuvant Androgen Withdrawal Therapy in Prostate Cancer: The Canadian Experience. Urology 2002 60:4551. PMID: 12231047.
Kumar S, Shelley M, Harrison C, et al. Neo-adjuvant and Adjuvant Hormone Therapy for Localized and Locally Advanced Prostate Cancer. Cochrane Database of Systematic Reviews 2006 CD006019. PMID: 17054269.
Soloway MS, Sharifi R, Wajsman Z, et al. Randomized Prospective Study Comparing Radical Prostatectomy Alone Versus Radical Prostatectomy Preceded by Androgen Blockade in Clinical Stage B2 Prostate Cancer. The Lupron Depot Neoadjuvant Prostate Cancer Study. Journal of Urology 1995 154:4248. PMID: 7541859.
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When To Contact Your Team
Your doctor, nurse, or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects arent getting any better
- your side effects are getting worse
We haven’t listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.
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
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Degarelix Injection May Cause Side Effects Tell Your Doctor If Any Of These Symptoms Are Severe Or Do Not Go Away:
- pain, redness, swelling, hardness, or itching in the place where the medication was injected
- excessive sweating or night sweats
- difficulty falling asleep or staying asleep
- enlargement of the breasts
- painful, frequent, or difficult urination
- fever or chills
Degarelix injection may cause your bones to become weaker and more brittle than they were at the beginning of your treatment. Talk to your doctor about the risks of taking this medication.
Degarelix injection may cause other side effects. Call your doctor if you have any unusual problems while receiving this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administrations MedWatch Adverse Event Reporting program online or by phone .
About Dr Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
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What Is Advanced Prostate Cancer
When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.
Prostate cancer is often grouped into four stages, with stages III and IV being more advanced prostate cancer.
- Early Stage | Stages I & II: The tumor has not spread beyond the prostate.
- Locally Advanced | Stage III: Cancer has spread outside the prostate but only to nearby tissues.
- Advanced | Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs.
When an early stage prostate cancer is found, it may be treated or placed on surveillance . Advanced prostate cancer is not curable, but there are many ways to treat it. Treatment can help slow advanced prostate cancer progression.
There are several types of advanced prostate cancer, including:
Biochemical Recurrence
With biochemical recurrence, the prostate-specific antigen level has risen after treatment using surgery or radiation, with no other sign of cancer.
Castration-Resistant Prostate Cancer
Non-Metastatic Castration-Resistant Prostate Cancer
Prostate cancer that no longer responds to hormone treatment and is only found in the prostate. This is found by a rise in the PSA level, while the testosterone level stays low. Imaging tests do not show signs the cancer has spread.
Metastatic Prostate Cancer
- Lymph nodes outside the pelvis
- Other organs, such as liver or lungs
Metastatic Hormone-Sensitive Prostate Cancer
Appendix: Summary Of Fda
The following table shows which treatments are appropriate for treating advanced prostate cancer, depending on whether the cancer is sensitive to androgen deprivation therapy and whether distant metastases are present. Please note that these are general guidelines and final decisions are made by the health care provider in consultation with the patient.
| Disease State |
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Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.
What To Expect During Treatment
Doctors often use hormone therapies, such as Lupron, in combination with radiation therapy or other treatments. They may also use it following surgery.
Healthcare professionals administer Lupron as a depot, which is a small implant that they inject under the persons skin. The individual can often choose an injection site that is suitable for them. Common injection sites include:
The treatment regimen for Lupron will depend on the individuals circumstances, and a person can work with their doctor to determine the best dosage. Some typical dosages include:
- 7.5 mg one injection every 4 weeks
- 22.5 mg one injection every 12 weeks
- 30 mg one injection every 16 weeks
- 45 mg one injection every 24 weeks
When a person first starts treatment with Lupron, they may have a testosterone flare. Later on, they may experience side effects due to having very low testosterone levels in their body. After treatment stops, testosterone levels begin to return to normal.
When a person first takes Lupron, their testosterone levels may rise, or flare, before dropping to very low levels. For some people, particularly those with advanced prostate cancer, a testosterone flare can temporarily cause their symptoms to worsen.
The symptoms of a testosterone flare can include:
- blockage of the ureters, the tubes that carry urine from the kidneys to the bladder
- spinal cord compression
Possible side effects of hormone therapies, such as Lupron, can
- radiation therapy
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What Is The Prognosis For People Who Have Prostate Cancer
Because prostate cancer tends to grow slowly, most men die from something other than the disease. Early detection is key to better outcomes. Almost all men 97% to 98% diagnosed with localized cancer that hasnt spread outside of the prostate live at least five years after diagnosis. When metastatic cancer has spread outside of the gland, one-third of men continue to survive after five years.
Will I Need To Use This Drug Long Term
How long you use Lupron Depot will depend on the condition its being used to treat.
If youre taking Lupron Depot for advanced prostate cancer, youll likely use it long term to ease your prostate cancer symptoms and to stop your prostate cancer tumor from growing.
Lupron Depot is not typically used long term for endometriosis, uterine fibroids, or central precocious puberty. How long its used for these conditions depends on how well it relieves symptoms and how severe the condition is. Your doctor can tell you more.
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What Are The Stages Of Prostate Cancer
Your healthcare provider uses the Gleason score and Grade Groups to stage prostate cancer based on its projected aggressiveness. To get this information, the pathologist:
- Assigns a grade to each type of cell in your sample. Cells are graded on a scale of three to five . Samples that test in the one to two range are considered normal tissue.
- Adds together the two most common grades to get your Gleason score .
- Uses the Gleason score to place you into a Grade Group ranging from one to five. A Gleason score of six puts you in Grade Group 1 . A score of nine or higher puts you in Grade Group five . Samples with a higher portion of more aggressive cells receive a higher Grade Group.
Surgery For Prostate Cancer
In some cases of advanced or recurrent prostate cancer, surgeons may remove the entire prostate gland in a surgery known as “salvage” prostatectomy. They usually do not perform the nerve-sparing form of prostatectomy. Often, surgeons will remove the pelvic lymph nodes at the same time.
Cyrosurgery may be used in cases of recurrent prostate cancer if the cancer has not spread beyond the prostate. Cryosurgery is the use of extreme cold to destroy cancer cells.
To reduce testosterone levels in the body, doctors may sometimes recommend removing the testicles, a surgery called orchiectomy. After this surgery, some men choose to get prosthetics that resemble the shape of testicles.
Doctors may also remove part of the prostate gland with one of two procedures, either a transurethral resection of the prostate or a transurethral incision of the prostate . This relieves blockage caused by the prostate tumor, so urine can flow normally. This is a palliative measure, which means it is done to increase the patient’s comfort level, not to treat the prostate cancer itself.
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Medicines For Treating Side Effects
Hormone therapy can cause loss of sexual desire, hot flashes, enlarged and painful breasts, and erection problems.
- For men who have erection problems after surgery, medicines such as sildenafil , tadalafil , or vardenafil may be helpful. Using medicines soon after surgery may help men regain sexual function. Talk with your doctor about your situation.
- Taking a temporary break from hormone therapy can make some side effects go away.
- To relieve breast pain, the anti-estrogen breast cancer medicine called tamoxifen or radiation treatment is commonly used. Tamoxifen can also help reverse breast growth. Also, it causes hot flashes.
- For hot flashes, taking a certain kind of antidepressant may help. Paroxetine or venlafaxine may help with hot flashes. But they have different side effects. So if you are having a problem with hot flashes, talk with your doctor.
- In some cases, cyproterone may be used to treat hot flashes.
Eligard For Prostate Cancer
The Food and Drug Administration approves prescription drugs such as Eligard to treat certain conditions. Eligard may also be used off-label for other conditions. Off-label drug use means using a drug for a purpose other than what its been approved for by the FDA.
Eligard is approved for use as a palliative treatment for advanced prostate cancer in adult males*. Palliative treatment means that the drug works to help manage pain and other symptoms of this condition. It wont treat or cure advanced prostate cancer, but it may help improve a persons quality of life.
* Use of the terms male and female within this article refers to a persons sex assigned at birth.
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When Prostate Cancer Spreads To The Bones
When prostate cancer metastasizes, it most often spreads to the bones, such as the spine, hips, and pelvis, according to the American Cancer Society .
Bone metastases can cause pain in these areas and weaken the bones, leaving men vulnerable to fractures from a fall or other accident. These fractures can cause pain directly, but metastatic cancer can also put pressure on nerves, particularly if it spreads to the spine, which in turn can cause more pain, according to Prostate Cancer UK. If the tumor compresses the nerves in the spine, it can cause symptoms like numbness, tingling, and pain in your arms, legs or back, Prostate Cancer UK says.
Surgery To Remove The Testicles
Surgery to remove your testicles isnt a common way of lowering the amount of testosterone you produce.
You usually only have surgery to remove your testicles if you need your testosterone reduced urgently. For example if your cancer has spread to your bones and is pressing on your spinal cord, your doctors might want to reduce the amount of testosterone quickly.
Your doctors might also suggest surgery as an option if you don’t want to have injections or tablets.
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When Is Brachytherapy Alone The Right Choice
For some patients with disease that is confined to the prostate and not too aggressive , brachytherapy alone is a good option. It is also convenient for the patient as it is done in an outpatient setting and most people can get back to work within a few days.
But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would be preferred. At MSK, our philosophy is that when the disease is caught very early, it is very appropriate to do active surveillance and hold off on treatment.
This philosophy applies to patients with a low PSA level, or nonaggressive disease as reflected by a Gleason score of 6 with evidence of cancer in only a few of the biopsy samples and no evidence from the MRI of a significant amount of disease. There are also very select patients with Gleason 7 disease who may be candidates for active surveillance.
Lupron Depot For Palliative Treatment Of Advanced Prostate Cancer
Lupron Depot is FDA-approved as a palliative treatment for advanced prostate cancer in adults.
Lupron Depot contains the drug leuprolide acetate, which belongs to a class of drugs called gonadotropin releasing hormone agonists. It works by blocking your body from creating certain hormones, like testosterone. This can help stop prostate cancer cells from growing.
Effectiveness for advanced prostate cancer
In four clinical studies, males* with advanced prostate cancer were given Lupron Depot in various dosage schedules:
- 7.5-mg injection every month for 6 months
- 22.5-mg injection every 3 months for 6 months
- 30-mg injection every 4 months for 8 months
- 45-mg injection every 6 months for 1 year
The studies evaluated how much Lupron Depot could lower testosterone levels and stop prostate tumors from growing. In 93.4% to 95% of males, testosterone levels below 50 ng/dL were achieved within 4 weeks of the first injection, regardless of their dosage schedule.
The studies also looked at tumor growth. In 77% to 85% of males taking Lupron Depot, there was no tumor growth during the clinical studies.
* Sex and gender exist on spectrums. Use of the term male in this article refers to sex assigned at birth.
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