Medical treatment of prostate cancer – Part 2

Medical treatment of prostate cancer

Here are more modalities of care for prostate cancer management:

Hormone Therapy

Hormone therapy help in reducing the serum levels of testosterone in the body, as high testosterone levels are associated with enlargement and excessive growth of prostatic cells. Cutting off the source of growth and nutrition via limiting the availability of testosterone helps a great deal in the symptomatic improvement of prostate cancer.

The choice of medications/ hormonal supplements vary according to individual case. Some hormonal agents include:

I. Use of testosterone inhibiting medications

Use of LHRH (luteinizing hormone-releasing hormone) agonists, helps is decreasing the sensitivity of cells that are responsible for the secretion of testosterone. The declining testosterone production helps in shrinkage of malignant prostate tissue. Most popular agents in this category are;

• Triptorelin (trelstar)
• Goserelin (zoladex)
• Ketoconazole etc.

II. Use of medications which inhibits testosterone from reaching to cancerous cells:

These medications (also referred to as anti-androgenic agents) exerts their action by inhibiting the transport of testosterone to the effector cells. Most popular preparations include;

• Flutamide
• Enzalutamide etc.

Hormone therapy has been successfully used to shrink the tumor size and is generally helpful in early-staged prostate cancers.

Side effects of hormone therapy

The most characteristic side effects of hormone therapy is andropause (also known as male menopause). Classic symptoms include:

• Hot flashes
• Weight gain
• Reduced sex drive
• Erectile dysfunction

Chemotherapy

Chemotherapy includes the use of chemical agents to kill the cancerous cells. This therapy can be taken in the intravenous or/and oral form. Chemotherapy is generally recommended for patients with advanced metastatic disease and widespread involvement.

Biological therapy

This therapy is also referred to as immunotherapy and involves inoculation of active immune cells (produced as a result of genetic engineering to fight prostate cancer cells. These immune cells). Biological therapy is mostly recommended for recurrent prostate cancers.

It is imperative to mention that in most cases, a combination therapy is utilized to achieve early remission. Although, the rate of complications or severity of side effects may increase significantly with multi-drug/ multi-intervention regimen; the remission can be achieved earlier.

For example, study publish in Journal of Clinical Oncology (3) suggested that combination therapy with androgen deprivation agents and Docetaxel has better efficacy and survival benefit than either of these agents alone.

According to a study reported in Endocrine Reviews (4), investigators suggested that the combined androgen blockers are effective at curing 90% of the prostate cancer at 6.5-year follow-up. The morbidity and mortality can be further improved by incorporating a pure antiandrogen with a GnRH agonist.

The response to therapy determines what combinations are best for the patient.

References:

1. Heidenreich, A., Bellmunt, J., Bolla, M., Joniau, S., Mason, M., Matveev, V., … & Zattoni, F. (2011). EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. European urology, 59(1), 61-71

2. Resnick, M. J., Koyama, T., Fan, K. H., Albertsen, P. C., Goodman, M., Hamilton, A. S., … & Penson, D. F. (2013). Long-term functional outcomes after treatment for localized prostate cancer. New England Journal of Medicine, 368(5), 436-445.

3. Sweeney, C., Chen, Y. H., Carducci, M. A., Liu, G., Jarrard, D. F., Eisenberger, M. A., … & DiPaola, R. S. (2014, May). Impact on overall survival (OS) with chemohormonal therapy versus hormonal therapy for hormone-sensitive newly metastatic prostate cancer (mPrCa): An ECOG-led phase III randomized trial. In ASCO Annual Meeting Proceedings (Vol. 32, No. 15_suppl, p. LBA2).

4. Labrie, F., Belanger, A., Labrie, C., Simard, J., Cusan, L., Gomez, J., & Candas, B. (2013, July). Gonadotropin-releasing hormone agonists in the treatment of prostate cancer. Endocrine Society.