At Perlmutter Cancer Center, medical oncologists may prescribe systemic medical therapies, such as hormone therapy, immunotherapy, or chemotherapy when prostate cancer has spread or returned after surgery or radiation therapy. Systemic therapy may also be used to boost the effects of radiation therapy.
Doctors may prescribe hormone therapies to affect the levels or activity of testosterone, which fuels prostate cancer, in the body.
Androgen Deprivation Therapies
Doctors may prescribe androgen deprivation therapies, such as Lupron® or degarelix, for prostate cancer that has spread or has returned after treatments.
Androgens are male hormones, such as testosterone. Sometimes, these therapies are prescribed for early prostate cancer in combination with radiation therapy. They work by suppressing the gonadotropin-releasing hormone, or GnRH, preventing it from stimulating the production of androgens. These medications are injected monthly or every three months.
Antiandrogen therapies may be prescribed for men with castration-sensitive or castration-resistant prostate cancer that has spread or returned after treatments. Castration-sensitive means that the prostate cancer has not been treated with or remains vulnerable to androgen deprivation therapy. Castration-resistant prostate cancer grows despite androgen deprivation therapy.
Antiandrogen therapies block the ability of testosterone to fuel tumor growth. One type is abiraterone, a CYP17 inhibitor which prevents certain genes from producing testosterone in the body. It can typically lower testosterone levels more effectively than androgen deprivation therapies. Abiraterone is often prescribed with a low dose of the steroid prednisone to help prevent side effects, such as fluid retention and high blood pressure. Another antiandrogen therapy, enzalutamide, is a potent inhibitor of testosterone’s ability to stimulate prostate cancer growth and proliferation.
For men with advanced castration-resistant prostate cancer with minimal noticeable symptoms, doctors may prescribe an immunotherapy called sipuleucel-T, or Provenge®. This treatment helps your own immune system to attack prostate cancer.
When castration-resistant prostate cancer has spread, doctors may prescribe a radiopharmaceutical agent called radium-223 to deliver an alpha-emitting isotope that targets cancer cells that have spread to the bone. In this treatment, a small amount of a radioactive material is injected into a vein and advances to cancer cells in the bones, where it is absorbed.
Chemotherapy, such as docetaxel and cabazitaxel, may be given to some men with castration-sensitive or castration-resistant prostate cancer. These medications work by disrupting the ability of cancer cells to grow. They are typically administered by injection into a vein every two or three weeks.
Our researchers are developing promising new treatments for prostate cancer through clinical trials. This includes immunotherapies and targeted drugs as well as combinations of these medications. You and your doctor can discuss whether a clinical trial might be right for you.
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