For many years patients with metastatic prostate cancer have been treated in a similar fashion. A new study that was reported last week by Christopher Sweeney from the Dana Farber Cancer Institute at the annual meeting of the American Society of Clinical Oncology may change how we think about this dreaded disease.
When prostate cancer is diagnosed, efforts are made to determine if the cancer is contained within the prostate or has spread to other locations such as the bone or lymph nodes. Patients with localized disease will undergo treatment that is aimed at removing or treating the cancerous prostate by undergoing a radical prostatectomy, radiation therapy, Cryotherapy, high intensity focused ultrasound (HIFU), or Cyberknife therapy. Those patients who have disease that has spread beyond the prostate will undergo treatments that usually involved some form of hormonal manipulation.
In 1966, Charles Huggins was awarded the Nobel Prize in Medicine for his discoveries regarding the hormonal treatment of prostate cancer. Since then the treatment of prostate cancer that is not localized has involved the elimination of the male hormone testosterone. This maneuver for many years was accomplished by performing surgical castration, however over the last 20 years, a series of medications (LHRH agonists and antagonists) were used to accomplish this. However, these medications do not work indefinitely and ultimately many patients will manifest progressive disease while on androgen deprivation therapy.
Currently, the standard of care involves the use of additional oral medications such as Xytandi or Xytiga in addition to the use of the LHRH agents. When these agents fail, then patients usually begin a course of chemotherapy. The use of these newer oral agents in this sequence of treatment does represent some change, as until they were available, patients would begin chemotherapy however, the results of these agents in previously used sequences, was not very effective.
The results of this new study suggest that the addition of the chemotherapeutic agent docetaxel (Taxotere) to the LHRH agonists in patients who have progressive disease on LHRH agonist alone, increases the overall survival in these patients by 17 months. Although further studies are needed, the increase that is seen in the overall survival is very promising and may result in changes to the way that we treat patients with metastatic prostate cancer.
Published On: June 09, 2014