Systemic Therapies for Prostate Cancer
If prostate cancer metastasizes, or spreads, to different parts of the body, NYU Langone doctors may recommend one or more systemic treatments. Systemic treatments for prostate cancer circulate throughout the body to treat all areas where cancer has spread. Metastatic prostate cancer often appears first in lymph nodes or bones.
In the last decade, there have been major advancements in treatment options for men with metastatic prostate cancer. These advancements were made possible through improved understanding of the biology of prostate cancer, and have led to better treatment outcomes and quality of life than ever before.
NYU Langone medical oncologists specializing in prostate cancer are experts at determining the most effective, individualized treatment, or combination of treatments, for you. As leaders in the development of newer, more effective prostate cancer treatments, our oncologists may recommend that you participate in a clinical trial for treatment.
Prostate cancer cell growth is stimulated by the male sex hormone testosterone, which is an androgen. Hormone therapy for prostate cancer, also known as androgen deprivation therapy, includes a variety of medications that inhibit the growth of cancer cells by decreasing the production of testosterone or blocking the binding of testosterone to the cancer cells.
Hormone therapy is commonly used as the first systemic treatment for metastatic prostate cancer, because it can shrink and slow the growth of the majority of prostate cancers, including those that have spread to other parts of the body.
In addition, hormone therapy is commonly used in combination with radiation therapy for some people who have prostate cancer that is more likely to spread to other parts of the body. This includes locally advanced prostate cancer—which means it has extended through the outer part of the prostate, known as the capsule, or has invaded the seminal vesicles. This treatment may also be used for people who have high-grade cancer when diagnosed.
Hormone therapy is sometimes recommended for people who have a PSA level that is rising quickly after surgery or radiation therapy, which is an indication that the cancer may have spread.
Hormone therapy reduces the blood levels of testosterone and, for most men, is effective in preventing the spread of prostate cancer. However, after a period of months or years, many prostate cancers become resistant to this treatment and additional treatments are needed.
The most significant advances in prostate cancer therapies in recent years have been for cancers that have become resistant to hormone therapy. Two new oral medications have revolutionized the treatment of advanced prostate cancer. Abiraterone acetate (Zytiga®) blocks a key enzyme involved in testosterone production by cancer cells. Enzalutamide (Xtandi®) binds to androgen receptors in cancer cells, blocking the ability of the receptor to drive cancer cell growth.
NYU Langone medical oncologists regularly lead clinical trials investigating other new and promising treatments. They can work with you to determine if one is right for you.
Chemotherapy is a group of medications used to destroy cancer cells throughout the body. Chemotherapy in prostate cancer is administered through a vein with intravenous (IV) infusion. It is given in treatment cycles over the course of weeks or months. Chemotherapy is considered a highly effective option for prostate cancers that have become resistant to hormone therapy.
NYU Langone doctors may use chemotherapy drugs such as docetaxel (Taxotere®), which impairs the ability of cancer cells to divide and replicate. This medication is considered a treatment standard for prostate cancer that is resistant to hormone therapy.
Another chemotherapy drug, cabazitaxel (Jevtana®), has recently been approved for the treatment of metastatic prostate cancers that have progressed in people taking docetaxel.
Immunotherapy is an emerging form of treatment that works with the body’s own immune system to destroy cancer cells throughout the body. Types of immunotherapy include cancer vaccines, antibody-drug conjugates, adoptive T-cell therapies, and biologic approaches.
The first immunotherapy approved to treat prostate cancer was sipuleucel-T, also known as Provenge®. Provenge is a vaccine made by harvesting a person’s immune cells, engineering them to recognize prostate cancer cells, and reinfusing them into the body to train the immune system to fight cancer. Provenge has been shown to improve survival of people with prostate cancer that is resistant to hormone therapy.
Other immunotherapy approaches use antibodies to target immune checkpoints, which are the pathways in the immune system that control the body’s immune response. Also called immune checkpoint inhibitors, these antibodies are used to awaken the body’s immune system against cancer.
Researchers at Perlmutter Cancer Center are working to develop new immunotherapies to improve the lives of people with prostate cancer.
Metastatic prostate cancer often spreads to the bones, where it can cause pain and also lead to fractures. Bone-targeted therapies include medications that alleviate bone pain and others that help prevent fractures by blocking the activity of certain cells responsible for the breakdown of bone.
NYU Langone medical oncologists determine when it is most appropriate to use these treatments in the course of treatment for prostate cancer.