New Breakthroughs And Treatment Options For Metastatic Castrate
In recent years, scientists have made some landmark discoveries in how to treat mCRPC. New treatments for this form of cancer are being found. Also, changes are being made to existing treatments so they work better. If you are diagnosed with mCRPC, your doctor may prescribe one of these treatments:
Vaccines or Immunotherapy. Usually, vaccines prevent infections. Lately, researchers have been looking into using vaccines to treat mCPRC. If your prostate cancer returns despite hormone therapy and is metastatic, your doctor may offer the cancer vaccine sipuleucel-T . Sipuleucel-T works by boosting the bodys immune system so it attacks cancer cells. This is the first vaccine that has been shown to help men with prostate cancer live longer. Other prostate cancer vaccines are also being studied.
New Hormone Therapies. Two new kinds of hormone therapies have helped men with mCRPC delay symptoms and live longer.
Androgen synthesis inhibitors. The oral drug abiraterone acetate stops your body and the cancer from making steroids . Because of the way it works, this drug must be taken with an oral steroid known as prednisone. Abiraterone is approved by the FDA for use before or after chemotherapy in men with mCRPC
Side Effects Of Hormone Therapy
Whether through surgery or medication, hormone therapy can cause side effects that include hot flashes, low sexual desire, erectile dysfunction, fatigue, mood changes, muscle loss, weight gain and anemia.
Patients on long-term hormone therapy also have a risk of osteoporosis . To maintain bone health, ask your doctor about taking a calcium or vitamin D3 supplement. Your blood levels should be evaluated, as low vitamin D levels are common, and some individuals require a higher dose of this supplement. You should also participate in weight-bearing exercise regularly, as it helps to maintain bone health and muscle tone as well as reduce fatigue.
In addition, ADT’s effects on metabolism may increase your risk of diabetes and heart disease. We strongly recommend both aerobic and resistance exercise to maintain metabolic health, cardiovascular health, bone strength and quality of life. While treatment for advanced prostate cancer can disrupt your daily routine, it’s important not to abandon the healthy diet and exercise practices that are key to wellness and survival.
ADT’s impact on sex life is as important as the other side effects, and we hope to provide an open, supportive environment for you to discuss your condition and concerns. UCSF offers a program for treating erectile dysfunction.
New Hormone Therapy Drugs
Testosterone drives prostate cancer growth, so medications often target it, says Timothy Daskivich, M.D., urologic oncologist at Cedars-Sinai Cancer in Los Angeles, CA. For many years, patients who progressed on traditional androgen deprivation therapy had few options other than chemo, he says. But new androgen receptor signaling inhibitors can provide excellent cancer control and responses in those patients and have shown improved survival chances in patients with metastatic and castration-sensitive disease when given in conjunction with traditional hormone blockade. These new drugs include abiraterone acetate, apalutamide, enzalutamide, and Orgovyx , the only androgen-deprivation therapy that comes in pill form.
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New Treatment For Metastatic Prostate Cancer
- Date:
- Norris Cotton Cancer CenterDartmouth-Hitchcock Medical Center
- Summary:
- An American hospital has treated three men with a recently FDA-approved treatment for prostate cancer, which offers new options for men whose cancer has spread to their bones. The treatments trade name is Xofigo . It is an alpha particle-emitting radioactive therapeutic agent with an anti-tumor effect.
Dartmouth-Hitchcock Norris Cotton Cancer Center has treated three men with a recently FDA-approved treatment, which offers new options for men whose prostate cancer has spread to their bones. The treatments trade name is Xofigo® . It is an alpha particle-emitting radioactive therapeutic agent with an anti-tumor effect.
Treatment entails an injection each week, up to six injections if needed. When compared with the best existing standard of care, research shows that patients receiving radium-223 injections live longer, said Thomas C. Sroka, MD, PhD, radiation oncologist, Norris Cotton Cancer Center. It is also very tolerable, he said, with few side effects.
Xofigo was approved by FDA in May of 2013 and is the first agent of its kind. Clinical trials of the drug showed an improvement of overall survival time from 11.3 months to 14.9 months versus placebo. The most common side effects are nausea, diarrhea, vomiting, and peripheral edema.
Story Source:
Metastatic Prostate Cancer Comes In Two Forms Which Could Guide Treatment
- Date:
- University of Wisconsin-Madison
- Summary:
- Scientists have identified two subtypes of metastatic prostate cancer that respond differently to treatment, information that could one day guide physicians in treating patients with the therapies best suited to their disease.
Scientists have identified two subtypes of metastatic prostate cancer that respond differently to treatment, information that could one day guide physicians in treating patients with the therapies best suited to their disease.
Building off of earlier studies that discovered clinically relevant subtypes of breast cancer and non-metastatic prostate cancer, researchers identified genetic signatures that can divide metastatic prostate tumors into two types known as luminal and basal.
Luminal tumors responded better to testosterone-blocking treatments, while basal tumors did not benefit as much from this hormone treatment. Basal tumors also included the particularly aggressive form of metastatic disease known as small cell neuroendocrine prostate cancer. Further clinical trials will be required before any new diagnostic-based treatment selection is available.
With colleagues at the University of California, San Francisco and other institutions, Zhao published his findings Sept. 23 in the journal JAMA Oncology. The work was co-led by Rahul Aggarwal of UCSF and Nicholas Rydzewski in the Department of Human Oncology at SMPH.
Story Source:
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Nubeqa Allows Doctors More Flexibility To Treat Prostate Cancer
The ARAMIS trial was a randomized, phase III, multi-center, double-blind, placebo-controlled trial to evaluate the safety and efficacy of oral Nubeqa in men with nmCRPC being treated with androgen deprivation therapy who are at high risk for developing metastatic disease.
It involved 1,509 participants who were randomized to receive 600 milligrams of the oral drug twice a day, or a placebo, along with ADT.
With the approval of Nubeqa, we now have a new therapy that extends MFS and allows physicians greater flexibility to treat men with nmCRPC, Robert LaCaze, member of the executive committee of the pharmaceuticals division and head of the oncology strategic business unit at Bayer, said in a statement.
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The Value Of New Drugs For Advanced Prostate Cancer
Department of Health Policy and Management, Emory University, Atlanta, Georgia
Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia
Corresponding Author: David H. Howard, PhD, Department of Health Policy and Management, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322 .
Ruben G. W. Quek PhD
Pfizer, Inc, San Francisco, California
Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia
Department of Urology, Emory University, Atlanta, Georgia
Department of Health Policy and Management, Emory University, Atlanta, Georgia
Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia
Corresponding Author: David H. Howard, PhD, Department of Health Policy and Management, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322 .
Ruben G. W. Quek PhD
Pfizer, Inc, San Francisco, California
Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia
Department of Urology, Emory University, Atlanta, Georgia
We are grateful to Xin Hu and Nada Boualam for their assistance with data preparation and analysis. Editing support was provided by Clare Smith of CMC Affinity and was funded by Pfizer.
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Research Into Treatment For Prostate Cancer
Before new treatments can be introduced, they need to be tested thoroughly. This is so we can be sure that they work and that they are safe.
Go to Cancer Research UKs clinical trials database if you are looking for a trial for prostate cancer in the UK. You need to talk to your specialist if there are any trials that you might be able to take part in.
Some of the trials on this page have now stopped recruiting people. It takes time before the results are available. This is because the trial team follow the patients for a period of time and collect and analyse the results. We have included this ongoing research to give examples of the type of research being carried out on prostate cancer.
Cancer That Is Thought To Still Be In Or Around The Prostate
If the cancer is still thought to be just in the area of the prostate, a second attempt to cure it might be possible.
After surgery: If youve had a radical prostatectomy, radiation therapy might be an option, sometimes along with hormone therapy.
After radiation therapy: If your first treatment was radiation, treatment options might include cryotherapy or radical prostatectomy, but when these treatments are done after radiation, they carry a higher risk for side effects such as incontinence. Having radiation therapy again is usually not an option because of the increased potential for serious side effects, although in some cases brachytherapy may be an option as a second treatment after external radiation.
Sometimes it might not be clear exactly where the remaining cancer is in the body. If the only sign of cancer recurrence is a rising PSA level , another option for some men might be active surveillance instead of active treatment. Prostate cancer often grows slowly, so even if it does come back, it might not cause problems for many years, at which time further treatment could then be considered.
Factors such as how quickly the PSA is going up and the original Gleason score of the cancer can help predict how soon the cancer might show up in distant parts of the body and cause problems. If the PSA is going up very quickly, some doctors might recommend that you start treatment even before the cancer can be seen on tests or causes symptoms.
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Bayer Looks To Prostate Cancer Drug For Next Blockbuster
Bayer has high hopes of driving its prostate cancer drug into blockbuster status, meaning over $1 billion in annual sales. This weeks ARASENS trial results should help pave the road.
Already approved in non-metastatic castration-resistant prostate cancer, Nubeqa just proved its worth in metastatic hormone-sensitive prostate cancer too. In the trial, the drug improved overall survival for patients when administered in addition to standard of care, compared to those who received standard of care alone. Increased OS was the primary goal of the trial.
The standard of care in men with mHSPC is a hormone deprivation therapy with a strong chemo drug. Nubeqa comes alongside these treatments to attach to the androgen receptor on the prostate cells to block testosterone from connecting to it, thereby delaying cancer growth.
Men with metastatic prostate cancer have a dismal 30% 5-year survival rate. While the specific numbers have not been released, Bayer called the increased over all survival significant.
Nubeqa is also in a Phase III for men with mHSPC receiving ADT without the chemo. The trial hopes to prove radiological progression-free survival.
As other big names in life sciences likeJohnson & Johnson, GE and smaller company bluebird bio have decided to split their companies to refocus, Bayer has already determined thats not for them.
Full results of the ARASENS trial will be shared at an upcoming meeting.
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Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.
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Conflict Of Interest Disclosures
David H. Howard received research funding from Pfizer, Inc, to conduct this study. Ruben G. W. Quek was an employee of Pfizer at the time of the analyses and reported ownership interest in Pfizer and Amgen. Kathleen M. Fox is an employee of Strategic Healthcare Solutions, LLC, and was a paid consultant to Pfizer in connection with the development of this article. Bhakti Arondekar is an employee of and owns stock in Pfizer. Christopher P. Filson reports a grant from the American Cancer Society to Emory University and acted as an expert witness for Rushton and Stakely as well as Leader Law PLC.
A New Treatment For Advanced Prostate Cancer Improves Survival In Phase 3 Clinical Trial
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Radiation therapy is getting more precise, enabled by technologies that make it easier to kill tumors while sparing their surrounding tissues. Some newer therapies are even given intravenously instead of by machines, and they deliver radiation particles directly to the cancer cell itself. One of these new therapies a sort of smart bomb targeted at malignant cells is now generating promising data for men with the most aggressive prostate cancer.
In early June, investigators reported results from a phase 3 clinical trial showing that among men who received the experimental treatment, there was nearly a 40% reduction in deaths over the course of the study, compared to men who did not.
The treatment is called lutetium-177-PSMA-617, or LuPSMA, and it has two components: a compound that targets a cancer cell protein called prostate-specific membrane antigen, or PSMA, and a radioactive particle that destroys the cells. Healthy prostate cells dont contain PSMA, or do at very low levels. And some men with prostate cancer have more of the protein than others. Doctors can detect the protein using a specialized imaging scan.
Results after 21 months showed that cancer progression was delayed for longer among the LuPSMA-treated men: 8.7 months on average versus 3.4 months among the controls. The treatment was also associated with better overall survival: 15.3 months versus 11.3 months.
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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.
Newer Drugs Are Improving Survival For Men With Metastatic Prostate Cancer
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Treatments for advanced prostate cancer thats metastasizing, or spreading in the body, are getting better, and men with the disease are living longer because of them, new research has found.
For years, the only available treatments for these aggressive tumors were androgen-deprivation therapies that block testosterone, the male sex hormone that makes prostate cancer cells grow faster. Giving ADT slows cancer progression, but tumors typically develop resistance against it within three years and start growing again.
But then newer treatments for metastatic prostate cancer started showing up. A drug called docetaxel was approved by the FDA in 2004, followed by cabazitaxel in 2010, sipuleucel-T in 2011, abiraterone in 2011, and enzalutamide in 2012. Each of these drugs targets metastatic prostate cancer in different ways, and men who took any one of them in clinical trials lived longer than men who took ADT by itself.
For the current study, researchers set out to answer a unique question. They wanted to know if the combined market availability of these drugs was making a survival difference for men being treated for metastatic prostate cancer in the general population.
About the Author
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
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Research Into Hormone Therapy
Prostate cancer depends on the male hormone testosterone for its growth. Hormone therapies block or lower the levels of testosterone. You might have it to lower the risk of your cancer coming back after treatment or to shrink or slow the growth of prostate cancer.
Researchers are looking into:
- the best time to have hormone therapy
- having hormone therapy in combination with other treatments