Other Treatment Options for Prostate Cancer
Recently approved newer medications also affect the male hormones in the body, which can have a positive effect treating prostate cancer. These agents (enzalutamide and abiraterone) now have proven effectiveness in improving survival and delaying progression in advanced metastatic disease. These agents may be used after failure of standard hormonal therapies and are generally well tolerated. Side effects may include fatigue, electrolyte abnormalities, high blood pressure and swelling in the legs. These agents are not currently used in men who have newly diagnosed or localized prostate cancer.
Sipuleucel-T is the first immunotherapy or vaccine therapy approved by the FDA for advanced prostate cancer treatment. In certain men with advanced prostate cancer, who have progression despite hormonal therapies, this therapy has been demonstrated to improve survival. It is an option for select men who have demonstrated progression of metastatic disease after failure of initial hormonal therapy but remain relatively asymptomatic.
Radium-223 is a radiopharmaceutical, which is a medical form of radiation treatment administered intravenously. It circulates throughout the body and into the bone. It has proven advantages for men who have advanced metastatic prostate cancer to the bone and are symptomatic (have pain) related to their bone lesions. This therapy is a proven method for improving survival and decreasing pain for patients in this situation.
Chemotherapy is drug therapy administered to the entire body to kill cancer cells. Currently, chemotherapy is most commonly used for prostate cancers that have spread beyond the prostate. These drugs are very powerful and work by killing cancer cells, which tend to be fast-growing cells.
Unfortunately, chemotherapy is not very selective and also kills other cells in the body that grow and divide quickly. The resulting side effects include anemia, weakness, fatigue, nausea, diarrhea, etc. While chemotherapy rarely cures prostate cancer, recent research has found particular chemotherapy regimens (docetaxel-based) can improve survival in certain patients with advanced disease. Recently, second line chemotherapy (cabazitaxel) has been approved as a result of studies demonstrating effectiveness in men who fail first line therapy.
With high-intensity focused ultrasound (HIFU), acoustic energy is used with ultrasound focusing to generate heat within the prostate to either kill focal areas of the prostate or the entire prostate gland. This type of therapy can be repeated. Side effects may include fistula, urinary leakage, urethral stricture, perineal pain and erectile dysfunction. Currently, HIFU is not FDA approved for the treatment of prostate cancer in the United States, and there is insufficient information to recommend it as a standard therapy. However, some men have chosen to have HIFU treatment with the understanding that it should be considered experimental at this time.
Like HIFU, with radiofrequency interstitial tumor ablation, heat is used to selectively kill prostate cancer cells. At this time, long term results and information regarding complications and cancer control are not available.