New Treatments for Advanced Prostate Cancer

Yumhee Park | Jun 30th 2015 Nov 10th 2016

Reviewed by Todd Gersten, MD

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Patients with advanced prostate cancer historically had little hope for treatment or prolonged survival; however, newer treatments offer new hope for longer survival and a better quality of life.

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Sequencing or layering therapies

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–Androgen deprivation: 1st line treatment in non-metastatic disease.
–Immunotherapy and oral agents: symptomatic or minimally symptomatic chemo-naïve metastatic disease.
–Chemotherapy: symptomatic metastatic in lieu of oral agents.
–Bone agents: patients with bone metastases but no solid organ metastasis.
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Immunotherapy

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–For patients with asymptomatic or minimally symptomatic metastatic castrate-resistant (hormonally refractory) prostate cancer.
–Involves treating your own immune cells, and activates portions of the immune system to fight the cancer.
–Prolongs survival beyond 2 years in patients.
–Not indicated in patients with significant symptoms.
–Trials underway combining this medication with other oral agents.
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Oral agent – Enzalutamide

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–Androgen receptor inhibitor.
–Statistically significant increased survival.
–Taken in conjunction with LHRH medications.
–Indicated for usage prior to chemotherapy.
–Also used in patients who fail chemotherapy.
–Best for patients with minimally symptomatic disease.
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Oral agent – Abiraterone

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–Inhibitor of an enzyme complex needed for testosterone production.
–Statistically significant increased survival.
–Must be administered with prednisone on an empty stomach.
–Taken in conjunction with LHRH medications
–Indicated for usage prior to chemotherapy.
–Also used in patients who fail chemotherapy.
–Best for patients with minimally symptomatic disease.
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IV Medications

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–Inhibits cellular division.
–Used in patients either failing oral therapies as well as prior to their usage in some.
–Side effects potentially more significant than oral agents including hair loss, decreased white blood cell counts, and fatigue.
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Bone agents

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–Used in patients with symptomatic bone disease.
–Radiotherapeutic drug resulting in breaks in DNA.
–Mimics calcium and forms complexes with bone minerals at areas of increased bone turnover.
–Kills cancer cells in metastatic bone lesions.
–Radioactive substance that is administered intravenously.
–Prolongs life by over four months.
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Rank Ligand Bone agents

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–Used in patients with advanced disease who undergo LHRH therapy.
–Decreases bone fracture rates.
–Monoclonal antibody that protects bone from degradation.
–Prevents bone complication such as pathologic fractures, bone surgery, and spinal cord compression in patients with bone metastases.
NEXT: Advanced Prostate Cancer: The Basics and Treatment Options