Coping with Metastasized Prostate Cancer

Metastasized prostate cancer (which is more commonly referred to as metastatic prostate cancer or prostate cancer metastasis), means that the cancer has spread from its original site (the prostate gland) to the lymph nodes, other organs of the body, or the bones (such as the spine, pelvis, ribs or bones of the arms or thighs).

Some use the term advanced metastatic prostate cancer, but generally the word “advanced” is used to describe locally advanced cancer, which is cancer that has grown through the outer rim of the prostate and into nearby tissue. But others may use the word advanced to describe any cancer that has spread beyond the prostate gland. So the terms advanced metastatic prostate cancer and advanced prostate cancer can be a little confusing. When we refer to metastatic disease, we mean prostate cancer that has spread beyond the gland and nearby tissue.

Treatments for metastasized prostate cancer

The most common or “mainstay” treatment for metastatic prostate cancer has been hormone therapy (often called androgen suppression therapy or ADT, which stands for androgen deprivation therapy). While this is not considered to be a curative treatment for metastatic disease, it has been shown to extend survival in men. Unfortunately, at some point the cancer usually “learns” to grow again and no longer responds to hormone treatment. This is known as hormone-refractory prostate cancer or androgen-independent cancer.

Because of the eventual resistance to hormone treatment, there has been much debate over the years about whether men should start ADT right away (even before a man has any evidence of metastasized prostate cancer) or whether he should wait until he definitely has metastatic disease. Laboratory studies have suggested that early hormone therapy does not mean a man will experience early resistance, but the jury is still out on this (and more research is needed).

However, a very early study by Crawford et al showed a benefit of early hormone therapy in men with distant metastases (which means cancer has spread from the prostate gland to distant organs or distant lymph nodes). More recently, Moul et al suggested the potential benefit of early hormone therapy in delaying clinical metastasis, based on their database analysis of 5,382 men who underwent primary radical prostatectomy. But as we said, more clinical research is needed in this area, particularly since many men find the side effects of ADT to be difficult to live with.

Other treatments for prostate cancer metastasis

• External beam radiation: this is sometimes is used to treat prostate cancer metastasis, particularly when men experience bone pain
• Chemotherapy: such as the use of docetaxel (Taxotere®), which is often used along with prednisone
• Radiopharmaceuticals: drugs that are used to fight bone pain caused by prostate cancer metastases. Sometimes other pain medications are also used
• Bisphosphonates: these drugs are used to keep bones from breaking down and to treat bone pain

New therapies on the horizon

An exciting development for metastasized prostate cancer is emerging immunotherapies, such as vaccines. While they are still considered to be experimental, these vaccines appear to offer promise as future treatment.

Recently, the investigational treatment PROVENGE® (sipuleucel-T) was shown to extend median survival by 4.1 months compared to placebo (25.8 months versus 21.7 months) and increased 3-year survival by 38% (31.7% versus 23.0% for placebo). Provenge is the first in a new class of active cellular immunotherapies, and is designed to engage a man’s own immune system against cancer.

In a Phase I clinical study of the of the Ad/PSA vaccine, 40% of men with D2 or D3 prostate cancer developed immune responses to PSA, and anti-PSA antibodies were produced in 42% of patients and anti-PSA T-cell responses in 71%. More than half of the men (57%) survived longer than predicted. The longest survival time was nearly six years.

6/09

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Metastasized prostate cancer references:

American Urological Association. AUA 2008: THERAPEUTIC VACCINE PROLONGS SURVIVAL AND IMPROVES QUALITY OF LIFE IN PATIENTS WITH METASTATIC PROSTATE CANCER. www.auanet.org/content/press/press_releases/article.cfm?articleNo=62. Accessed June 4, 2009.

Bone and Cancer Foundation brochure. Questions and answers about prostate cancer, bone metastasis, and treatment-related osteoporosis.

Crawford ED, Eisenberger MA, McLeod DG, Spaulding JT, Benson R, Dorr FA, Blumenstein BA, Davis MA, Goodman PJ. A controlled trial of leuprolide with and without flutamide in prostatic carcinoma. N Engl J Med. 1989;17;321(7):419-24.

Early versus deferred androgen suppression in the treatment of advanced prostatic cancer. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD003506. DOI: 10.1002/14651858.CD003506.

Dendreon Corporation press release. http://investor.dendreon.com/releasedetail.cfm?ReleaseID=380042. Accessed June 4, 2009.

Moul JW, Wu H, Sun L, McLeod DG, Amling C, Donahue T, Kusuda L, Sexton W, O'Reilly K, Hernandez J, Chung A, Soderdahl D. Early versus delayed hormonal therapy for prostate specific antigen only recurrence of prostate cancer after radical prostatectomy. J Urol. 2004;171(3):1141-7.

Terris, MK, Rhee A, Qureshi SM. Prostate Cancer - Metastatic and Advanced Disease. http://emedicine.medscape.com/article/454114-overview. Accessed June 4, 2009.