Radiation Therapy Plus Androgen Ablation Therapy
Androgen ablation has been shown to improve survival in men with localized disease who are treated with external radiation. DAmico et al reported higher overall survival with the combination of radiation therapy and 6 months of ADT in men with intermediate-risk prostate cancer. Median follow-up was 7.6 years.
A study by Jones et al found that for patients with stage T1b, T1c, T2a, or T2b prostate cancer and a PSA level of 20 ng/mL or less, short-term ADT increased overall survival in intermediate-riskbut not low-riskmen. The 10-year rate of overall survival was 62% with combination therapy, versus 57% with radiation therapy alone 10-year disease-specific mortality was 4% and 8%, respectively. In this study, ADT was given for 4 months, starting 2 months before radiation therapy.
In a study by Pisansky et al of 1489 intermediate-risk prostate cancer patients, disease-specific survival was not significantly different whether total androgen suppression was given for 8 weeks or for 28 weeks prior to radiation therapy. Patients in the study were randomized to 8 or 28 weeks of TAS with LHRH agonist, along with a daily nonsteroidal antiandrogen, prior to radiation treatment. This was followed in both groups by an additional 8 weeks of androgen suppression, administered concurrently with radiotherapy.
Taken together, radiation therapy is generally given for 4-36 months, depending on the risk group of the patient.
Using Complementary Or Traditional Healing
Sometimes people with cancer might think about using complementary therapies or traditional healing.
Some alternative, complementary and traditional healing methods may react with the treatment you receive and cause harmful side-effects.
It is important to talk to your treatment team about any other therapies youre using or thinking about because they may interfere with hospital treatment.
Side Effects Of Prostate Surgery
The major possible side effects of radical prostatectomy are urinary incontinence and erectile dysfunction . These side effects can also occur with other forms of prostate cancer treatment.
Urinary incontinence: You may not be able to control your urine or you may have leakage or dribbling. Being incontinent can affect you not only physically but emotionally and socially as well. These are the major types of incontinence:
- Men with stress incontinence might leak urine when they cough, laugh, sneeze, or exercise. Stress incontinence is the most common type after prostate surgery. It’s usually caused by problems with the valve that keeps urine in the bladder . Prostate cancer treatments can damage this valve or the nerves that keep the valve working.
- Men with overflow incontinence have trouble emptying their bladder. They take a long time to urinate and have a dribbling stream with little force. Overflow incontinence is usually caused by blockage or narrowing of the bladder outlet by scar tissue.
- Men with urge incontinencehave a sudden need to urinate. This happens when the bladder becomes too sensitive to stretching as it fills with urine.
- Rarely after surgery, men lose all ability to control their urine. This is called continuous incontinence.
After surgery for prostate cancer, normal bladder control usually returns within several weeks or months. This recovery usually occurs slowly over time.
There are several options for treating erectile dysfunction:
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Advanced Treatment Options For Prostate Cancer
The prostate is a small gland that is located in the lower abdomen in men, just under the bladder and surrounding the urethra. The hormone testosterone is responsible for regulating the prostate. The prostate gland is also responsible for producing semen. When there is an abnormal and malignant growth of cells, known as a tumor, in the prostate, it leads to prostate cancer. Prostate cancer is one of the most commonly diagnosed forms of cancer in the world in males. If left untreated, prostate cancer can also spread to other parts of the body.
There are many different ways of treating prostate cancer, and the treatment is determined by factors like how advanced the cancer is, whether it has spread outside of the prostate, your age, as well as your overall health. Here are some of the new advances in the treatment of prostate cancer.
Radiopharmaceuticals That Target Psma
Prostate-specific membrane antigen is a protein that is often found in large amounts on prostate cancer cells.
Lutetium Lu 177 vipivotide tetraxetan is a radiopharmaceutical that attaches to PSMA, bringing radiation directly to the prostate cancer cells.
This drug can be used to treat prostate cancer that has spread and that has already been treated with hormone therapy and chemotherapy. The cancer cells must also have the PSMA protein. Your doctor will order a PSMA PET scan before you get this drug to make sure the cancer cells have PSMA.
This drug is given as an injection or infusion into a vein , typically once every 6 weeks for up to 6 doses.
Possible side effects
Some of the more common side effects of this drug include:
- Feeling tired
- Constipation
This drug can lower blood cell counts:
- A low red blood cell count can cause tiredness, weakness, pale skin, or shortness of breath.
- A low blood platelet count can lead to bleeding or bruising more easily than normal, or bleeding that is hard to stop.
- A low white blood cell count can lead to an increased risk of infections, which might show as a fever, chills, sore throat, or mouth sores.
This drug might damage the kidneys. Your doctor or nurse will likely advise you to drink plenty of fluids and to urinate often before and after getting this drug, to help protect the kidneys. Tell your doctor or nurse if you start to pass less urine than is normal for you.
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Treatment Options For Advanced Prostate Cancer
Its rare for prostate cancer to metastasize, or spread to other parts of the body. In about 90 percent of all cases, this type of prostate cancer is diagnosed in its early stages, when the disease is confined to the prostate. However, when the disease metastasizes, prostate cancer cells tend to spread to the brain, bones, lungs and liver. Metastatic prostate cancer cells may also be found in lymph nodes outside the pelvis.
In some cases, the treatment options for advanced prostate cancer may be considered palliative, used to relieve symptoms and improve quality of life. Treatment options include:
Certain Factors Affect Prognosis And Treatment Options
The prognosis and treatment options depend on the following:
- The stage of the cancer .
- The patients age.
- Whether the cancer has just been diagnosed or has recurred .
Treatment options also may depend on the following:
- Whether the patient has other health problems.
- The expected side effects of treatment.
- Past treatment for prostate cancer.
- The wishes of the patient.
Most men diagnosed with prostate cancer do not die of it.
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Getting Help With Treatment Decisions
Making such a complex decision is often hard to do by yourself. You might find it helps to talk with your family and friends before making a decision. You might also find it helpful to speak with other men who have faced or are currently facing the same issues. The American Cancer Society and other organizations offer support programs where you can meet and discuss these and other cancer-related issues. For more information about our programs, call us toll-free at 1-800-227-2345 or see Find Support Programs and Services.
Itâs important to know that each manâs experience with prostate cancer is different. Just because someone you know had a good experience with a certain type of treatment doesnât mean the same will be true for you.
You might also want to consider getting more than one medical opinion, perhaps even from different types of doctors. For early-stage cancers, it is natural for surgical specialists, such as urologists, to favor surgery and for radiation oncologists to lean more toward radiation therapy. Doctors specializing in newer types of treatment may be more likely to recommend their therapies. Talking to each of them might give you a better perspective on your options. Your primary care doctor may also be helpful in sorting out which treatment might be right for you.
Watchful Waiting Or Active Surveillance
Your doctor might suggest waiting to see if your tumor will grow or spread before you treat it. Most prostate cancer grows slowly. Some doctors think itâs better not to treat it unless it changes or causes symptoms. In watchful waiting, your doctor will closely track how the disease makes you feel. With active surveillance, youâll also get regular tests to check on the cancer.
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Side Effects Of Targeted Therapy
Some men may experience side effects such as diarrhea, nausea and low red blood cell counts. Other possible side effects include:
- Fatigue
- Skin rash
Liver blood tests may also be abnormal.
One of the targeted therapies for prostate cancer, Lynparza® , may increase the risk for blood clots in the lungs and legs. These drugs may also cause a blood cancer such as myelodysplastic syndrome or acute myeloid leukemia, but this is rare.
What Questions Should I Ask My Healthcare Provider
If you have prostate cancer, you may want to ask your healthcare provider:
- Why did I get prostate cancer?
- What is my Gleason score? What is my Grade Group? What do these numbers mean for me?
- Has the cancer spread outside of the prostate gland?
- What is the best treatment for the stage of prostate cancer I have?
- If I choose active surveillance, what can I expect? What signs of cancer should I look out for?
- What are the treatment risks and side effects?
- Is my family at risk for developing prostate cancer? If so, should we get genetic tests?
- Am I at risk for other types of cancer?
- What type of follow-up care do I need after treatment?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Prostate cancer is a common cancer that affects males. Most prostate cancers grow slowly and remain in the prostate gland. For a small number, the disease can be aggressive and spread quickly to other parts of the body. Men with slow-growing prostate cancers may choose active surveillance. With this approach, you can postpone, and sometimes completely forego, treatments. Your healthcare provider can discuss the best treatment option for you based on your Gleason score and Group Grade.
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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.
Drug Therapy For Prostate Cancer
Drug therapy may be given to patients to fight prostate cancer cells throughout the body by killing them or stopping their growth and spread. These drugs include:
- Hormone therapy: blocks the production or activity of hormones particularly testosterone and dihydrotestosterone which fuels most prostate cancer growth
- Chemotherapy: targets all rapidly dividing cells, including prostate cancer cells
- Targeted therapy: selectively attacks prostate cancer cells based on specific characteristics, such as a gene mutation
- Immunotherapy: stimulates the patients immune system to attack cancer cells
Your doctor may also prescribe drugs to treat conditions related to prostate cancer, such as weakened bones and sexual dysfunction common side effects of hormone therapy or bone loss from metastasized prostate cancer. The drug or drug combination used depends on the prostate cancer type and stage, previous treatments used, and the patients health and overall treatment goals. Molecular or genetic testing can further enhance this personalized medicine approach. Testing can identify more effective treatments that cause fewer side effects.
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Some Things To Consider When Choosing Among Treatments
Before deciding on treatment, here are some questions you may want to ask yourself:
- Are you the type of person who needs to do something about your cancer, even if it might result in serious side effects?
- Would you be comfortable with watchful waiting or active surveillance, even if it means you might have more anxiety and need more frequent follow-up appointments in the future?
- Do you need to know right away whether your doctor was able to get all of the cancer out ? Or are you comfortable with not knowing the results of treatment for a while if it means not having to have surgery?
- Do you prefer to go with the newest technology , which might have some advantages? Or do you prefer to go with better proven treatments that doctors might have more experience with?
- Which potential treatment side effects might be most distressing to you?
- How important for you are issues like the amount of time spent in treatment or recovery?
- If your initial treatment is not successful, what would your options be at that point?
Many men find it very stressful to have to choose between treatment options, and are very fearful they will choose the âwrongâ one. In many cases, there is no single best option, so itâs important to take your time and decide which option is right for you.
Radiation Therapy In Metastatic Disease
In a study of men with newly diagnosed metastatic prostate cancer, treatment with prostate radiation and ADT led to substantially longer survival compared with treatment with ADT alone. In the study, which included 6,382 men, combination therapy yield superior median survival and 5-year overall survival .
In patients with metastatic prostate cancer, radiation is also applied for palliative purposes. It is used in patients with castration-resistant prostate cancer with painful bone metastases, in patients at risk for fracture, and in patients with impending spinal cord compression.
A meta-analysis of the use of radioisotopes to relieve pain from bone metastases found that over 1-6 months, pain may be reduced without an increase in analgesic use however, severe effects such as leukocytopenia and thrombocytopenia frequently surface.
Radium-223 dichloride , formerly alpharadin, is an alpha particleemitting radioactive therapeutic agent that was approved by the FDA in 2013 for use in men with CRPC, symptomatic bone metastases, and no known visceral metastatic disease. Approval was based on the multinational ALSYMPCA trial , which is the first randomized phase III trial to demonstrate improved survival of CRPC with a bone-seeking radioisotope.
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How Common Is Prostate Cancer
About one in nine men will receive a prostate cancer diagnosis during his lifetime. Prostate cancer is second only to skin cancer as the most common cancer affecting males. Close to 200,000 American men receive a diagnosis of prostate cancer every year. There are many successful treatments and some men dont need treatment at all. Still, approximately 33,000 men die from the disease every year.
Stereotactic Body Radiation Therapy
This technique uses advanced image guided techniques to deliver large doses of radiation to a precise area, such as the prostate. Because there are large doses of radiation in each dose, the entire course of treatment is given over just a few days.
SBRT is often known by the names of the machines that deliver the radiation, such as Gamma Knife, X-Knife, CyberKnife, and Clinac.
The main advantage of SBRT over IMRT is that the treatment takes less time . The side effects, though, are not better. In fact, some research has shown that some side effects might actually be worse with SBRT than with IMRT.
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Choosing To Stop Treatment Or Choosing No Treatment At All
For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. Whether or not you continue treatment, there are still things you can do to help maintain or improve your quality of life.
Some people, especially if the cancer is advanced, might not want to be treated at all. There are many reasons you might decide not to get cancer treatment, but its important to talk to your doctors and you make that decision. Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms.
What Affects My Treatment Options
Your treatment options will depend on whether your cancer is contained within the prostate gland , has spread just outside of the prostate or had spread to other parts of the body .
You may have a choice of treatments. Your doctor or specialist nurse will explain all your treatment options, and help you to choose the right treatment for you.
Your treatment options and which treatment you choose may depend on several things, including:
- how far your cancer has spread
- how quickly your cancer may be growing
- the advantages and disadvantages of each treatment
- what each treatment involves
- the possible side effects of each treatment
- practical things, such as how often you would need to go to hospital, or how far away your nearest hospital is
- your own thoughts about different treatments
- how the treatment you choose now could affect your treatment options later if your cancer comes back or spreads
- your general health
- how long youre expected to live for.
The first treatment you have may affect which treatments you can have in the future, if you need further treatment. Speak to your doctor or nurse about this.
It can help to write down any questions you want to ask at your next appointment. And to take someone to appointments, such as your partner, friend or family member.
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