Prostate Cancer 6

Question 1

What are the rates of progression of prostate cancer to advanced stages?

Answer 1

• It takes approximately 8 to10 years for men to develop metastases after unsuccessful treatment of the primary tumor
  
  • depends on Gleason grade and PSA doubling time
• With a rapid PSADT (3-6 months) metastases may become apparent within 2-5 years
• In men with a rising PSA after androgen-deprivation therapy, the average time to bone metastases is 2 years and time to death is 4 years

Question 2

What is androgen-deprivation therapy (ADT)?

Answer 2

• Mainstay for treating advanced prostate cancer, because prostate cancer cells are stimulated to proliferate by the androgens produced by the testes, adrenal glands, and other body tissues, including the tumor
• Frequently used as an adjuvant to radiotherapy in men with a high Gleason grade tumor
• Androgenic stimulation can be largely eliminated by surgical or medical castration (LHRH agonists or antagonists)
• The effects of extragonadal androgens can be substantially reduced with antiandrogens that block the androgen receptor, androgen biosynthesis inhibitors, and drugs that target the androgen receptor within the cell

Question 3

What are some side effects of ADT?

Answer 3

• Sexual dysfunction
• Menopausal symptoms
• Osteoporosis
• Loss of energy
• Possible increased risk for metabolic syndrome, diabetes, and cardiovascular disease
• Although some prostate cancer patients have a long-term remission of disease, the tumor ultimately becomes “castrate resistant.”
  
  • ADT may be given intermittently to men who do not have metastases but should be given continuously to those with metastases

Question 4

What are some methods of treating castrate-resistant prostate cancer?

Answer 4

• Chemotherapy
  
  • docetaxel
  • cabazitaxel
• Immunotherapy
  
  • sipuleucel-T
• Alpha-particle emitting agents
  
  • radium-223
• Expensive and clinical trials show a 4-month survival benefit