Advanced Prostate Cancer Treatments (Stage III or IV)

If your cancer has grown beyond the prostate gland (Stage III), it cannot be stopped with local therapy – although radiation therapy can help to keep the tumor in check and hormonal therapy may slow its advance. If your prostate cancer is metastatic (Stage IV), it is usually treated with hormonal therapy and/or chemotherapy.

Hormonal therapy combats prostate cancer by cutting off the supply of the male hormones – testosterone - that encourage prostate cancer growth. Hormonal control can be achieved by surgery to remove the testicles (orchiectomy or castration) or drugs.

Hormonal therapy targets cancer that has spread beyond the prostate gland and is thus beyond the reach of local treatment such as surgery or radiation therapy. Hormonal therapy is also helpful in alleviating the painful and distressing symptoms of advanced disease. Although hormonal therapy cannot cure, it will usually shrink or halt the advancement of disease often for years.

A variety of hormonal drugs can produce a medical castration by cutting off the supply of testosterone.

• Luteinizing hormone-releasing hormone (LHRH) analogs, taken as periodic injections, prevent the brain from signaling the testicles to produce androgens. These drugs are the most often-used agents for lowering levels of testosterone in the body.
• Female hormones (estrogens) block the release and activity of testosterone
• Antiandrogens block the activity of any androgens (including testosterone) circulating in the blood.

Studies have shown that the combinations of hormonal therapies have similar effectiveness as of single hormone treatment. Unfortunately, hormonal therapy for metastatic disease works only for a limited time. Remissions typically last 2 to 3 years.

Furthermore, early or neoadjuvant hormonal therapy may be started prior to surgery or radiation in hopes of slowing the growth of cancer that has spread into nearby tissues or of cancer that has invaded the lymph nodes. Given prior to surgery, neoadjuvant hormonal therapy often helps to shrink a tumor. Sometimes hormonal therapy (adjuvant therapy) is used after radiation or surgical therapy to prevent the cancer from coming back.

Possible side effects of hormonal therapies
Either surgical castration or medical castration can produce a striking response. Both approaches cause tumors and lymph nodes to shrink and PSA levels to fall.

However, depending on the type of hormonal therapy, the drug/procedure can cause:

• Hot flashes
• Erectile dysfunction or impotence
• Decreased sex drive (“libido”)
• Breast enlargement/tenderness
• Cardiovascular problems
• Weight gain
• Weakening of bones (osteoporosis)
• Sweats
• Atrophy (shrinkage) of the testes
• Malaise and fatigue (extreme tiredness)
• Dizziness
• Gastroenteritis/colitis (inflammation of stomach and intestine)

Learn about a sanofi-aventis hormonal therapy for the treatment of advanced prostate cancer.

There are many types of chemotherapy drugs. Chemotherapy is a treatment that kills cancer cells and can be taken by pill or put into the body by a needle in the vein or muscles. It is often used to treat advanced prostate cancer after hormonal therapy has failed, but it is currently being studied for use in the early stages of prostate cancer.

• Anemia
• Low white blood cell count (neutropenia)
• Infection
• Fatigue
• Nausea
• Vomiting
• Hair loss
• Loss of appetite
• Mouth sores
• Numbness, tingling of the skin (paresthesia)

Chemotherapy is also being tried in conjunction with hormonal therapy for men whose advanced cancers are no longer responsive to hormonal therapy alone.

Learn about a sanofi-aventis chemotherapy treatment for prostate cancer.

Cryosurgery is a new surgical technique which uses nitrogen to freeze and kill prostate cancer cells. The procedure takes about two hours, requires anesthesia and stay in the hospital for one to two days. This procedure has not been used in enough patients or for a long enough time to prove itself better than conventional treatment.