Metastatic or advanced prostate cancer occurs when prostate cancer cells escape from the prostate and spread to other parts of the body. Prostate cancer can spread to lymph nodes, to bones and organs such as the lungs or the liver. Many patients will be diagnosed after being found to have a high PSA or after presenting with symptoms suggestive of advanced prostate cancer.
Medical oncologist Dr Mark Tuthill talks about treating metastatic prostate cancer and if there are new treatments on the horizon.
What are the various treatment options?
Prostate cancer cells often require the presence of the male hormone testosterone to grow. Therefore, reducing the amount of testosterone can dramatically slow the growth of the cancer. Hormone therapy, sometimes referred to as androgen ablation or androgen suppression therapy is the first go-to treatment. This therapy helps to suppress the hormone testosterone, done through injection or with tablets which are usually given by your GP.
There are several therapies which have been shown to improve outcomes for men with newly diagnosed metastatic prostate cancer. Licenced therapies include docetaxel and abiraterone which have been shown to have dramatically improved the outcome of men with newly diagnosed metastatic prostate cancer.
Chemotherapy with docetaxel has been shown to make men with newly diagnosed metastatic prostate cancer live longer than they would with hormonal therapy. Docetaxel chemotherapy does have side effects including a risk of infection, hair loss, nausea and nerve damage. Most men will have side effects during the treatment period (usually around 18 weeks), but most will have recovered within a year and report a good quality of life after having had chemotherapy for advanced prostate cancer.
Abiraterone is a relatively newly approved drug for the treatment of men with newly diagnosed metastatic prostate cancer. Abiraterone is a tablet-based treatment and has been shown to improve outcomes for men with newly diagnosed prostate cancer. Unlike chemotherapy, men will not lose their hair, but all men will require specialist monitoring including regular blood tests.
What are the side effects of these treatments?
As with any treatment, there is always the risk of unwanted side effects.
Side effects of prostate cancer medication can include:
- Hot flushes
- Loss of sexual potency
- Weight gain
Side effects of chemotherapy include hair loss and risk of infection. The side effect of abiraterone includes changes in blood salts and abnormal liver function tests. Your specialist will go through this in detail with you during your medical assessment.
Are there any new treatments for prostate cancer on the horizon?
New upcoming treatments include drugs that target genetic mutations that are associated with the development of prostate cancer. A new class of drugs has recently been shown to be very effective for the treatment of men with hormone-resistant prostate cancer. This class of drugs is called PARP inhibitors. One such example is olaparib, which has been shown to increase control rates of prostate cancer in men with genes BRCA1 and BRCA2. More studies are underway to test this class of drugs for future treatment of men with advanced prostate cancer.
If you would like more information on prostate cancer for you or a loved one, visit specialist Dr Mark Tuthill who can go through your treatment options with you.