Systemic Therapies, Medical Oncology and Clinical Trials
In situations of advanced prostate cancer , where the cancer is no longer contained within the prostate, it is ideal to employ some form of treatment that will go through out the body. The goal is to stop or destroy the cancer with a treatment that will address cancer cells wherever they may be located. This type of treatment includes hormonal manipulation, chemotherapy and immunotherapy. Treatments currently under development include, anti-cancer vaccines and treatment that is specifically directed at prostate cancer cells. This is a rapidly changing field and having a medical oncologist specialist involved can maximize the care you receive.
In cases where there is a late diagnosis or the cancer is very aggressive and is very likely to have left the prostate, hormonal therapy is usually the first step. Hormonal treatment for prostate cancer involves removing or blocking the male sex hormone testosterone from stimulating prostate cancer growth. There are several different drugs and dosage schedules available and the medicine is given as either shots or pills or a combination of the two. Hormonal therapy typically has a dramatically positive effect on PSA levels and can alleviate symptoms caused by the cancer. The downside is that the effect is not permanent (the cancer can become immune to the hormone) and there are side effects such as energy loss, weight gain, decreased libido and osteoporosis. The risks and benefits or hormonal therapy should always be carefully weighed. One way that has been well researched is to use hormone therapy in high-risk tumors (stage T3) in conjunction with radiation therapy. In situations where spread to the lymph nodes is found, hormonal therapy, sometimes in combination with chemotherapy is used to improve survival. Hormonal therapy is also used in advanced cases where the prostate cancer has spread to the bones. Treatment with hormonal therapy can dramatically improve quality of life in that circumstance.
When hormonal therapy becomes ineffective or additional effect is needed with hormonal therapy, chemotherapy can be used. New chemotherapy drugs cause less side effects and are more tolerable than previous treatments. Chemotherapy works differently than hormonal therapy in that it directly kills the cancer cell. Side effects include nausea, fever and an increased susceptibility to infection. A recently approved immunotherapy treatment stimulates the immune system to attack the cancer cells. This treatment is generally used after hormonal therapy becomes ineffective. Enrollment in clinical trials can let patients have access to new drugs or expanded uses of current therapies. Clinical trials generally involve less cost to the patient and are associated with closer monitoring or treatment effect disease status. It is always a good idea to ask if there are any applicable clinical trails if a patient has advanced prostate cancer