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When Treatment for Advanced Prostate Cancer Fails: What Can Be Done?

Summary & Participants

New research shows some men with very late-stage prostate cancer may benefit from chemotherapy. Learn why doctors are changing their minds about the value of this type of treatment.

Medically Reviewed On: July 05, 2008

Webcast Transcript

ANNOUNCER: When disease returns after a man has been treated for prostate cancer, hormonal therapy is usually effective. This involves the removal of the testicles to shut down the production of testosterone. Or the use of drugs that have the same effect.

JAMES A. EASTHAM, MD: Traditionally, the approach to advanced disease has been hormonal therapy. Prostate cancer is driven by the male hormone testosterone. So by taking testosterone away, in many ways, you stop one of the promoting factors for cancer growth.

ANNOUNCER: Hormonal therapy, however, is likely to fail after a period of time. Tumors will eventually spread to bone or soft tissue. The first sign of the return of advanced disease is likely to be a rise in blood levels of a protein called PSA, which signals tumor growth and resulting damage to the prostate.

DANIEL P. PETRYLAK, MD: In the advanced prostate cancer patient, the median duration of response to hormones is generally about 18 to 24 months.

The first evidence that a patient is failing hormone therapy is usually a rise in the PSA. This usually precedes changes in the tumor that we can visually see on a bone scan or a CAT scan.

JAMES A. EASTHAM, MD: When someone has a rising PSA despite being on hormonal therapy, there are several additional hormonal manipulations or hormonal changes that can be made. If a patient is on what is called an antiandrogen, which is a medicine that actually blocks testosterone from binding its binding site or receptor, you can manipulate that. You can actually stop the antiandrogen.

DANIEL P. PETRYLAK, MD: There is almost a paradoxical withdrawal effect by stopping these medications, we sometimes, in about 20 to 30 percent of patients, see a PSA decline.

ANNOUNCER: But even among those patients, the effect will likely be temporary. At this stage, depending on a variety of factors, a patient may have only one or two years to live. Doctors traditionally could do little beyond helping prevent bone fractures, and managing pain. And there wasn't much of a role for chemotherapy in prostate cancer, until recently.

JAMES A. EASTHAM, MD: Probably the initial advance in chemotherapy was a drug called mitoxantrone, which, while it did not prolong survival, did help with symptoms of pain. And men who were on the drug had greater pain relief than men who did not receive mitoxantrone.

More recently, the taxanes, primarily Taxotere, which is a chemotherapy drug, has been shown to actually not only help with pain, but also prolong survival in prostate cancer. Again, these are men with advanced, what we would call hormone refractory prostate cancer.

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