Advanced prostate cancer
When prostate cancer has spread to other areas of the body (metastatic) such as lymph nodes and bones, a curative treatment will not be possible. In this situation it is usually possible to control the symptoms of prostate cancer and slow its progression usually for some years.
Hormonal therapy tends to be the first line treatment for metastatic prostate cancer and is usually able to reduce symptoms and cancer in the areas that may be affected. However the cancer may become resistant to this type of treatment after some time and subsequent treatment will be needed.
This may include:
- Combined Androgen Blockade (CAB) the addition of an anti-androgen tablet to existing hormonal injection therapy;
- the withdrawal of hormone therapy altogether which may cause a favourable response in some men;
- the use of steroid therapy – steroids are substances made naturally in the body. They tend to shrink cancer and stop it from progressing for some time. Common steroids used in prostate cancer treatment are Dexamethasone and Prednisolone.Steroids may increase a man’s appetite and cause water retention which may in turn cause him to put on weight. Steroids will tend to weaken the immune system and it is therefore a good idea to avoid exposure to people suffering from colds or flu. Steroids may also cause irritation to the lining of the stomach and should not be taken on an empty stomach; men may therefore be advised to take a medication to prevent this. They also have some effect on mood and men may find themselves feeling more energetic. For more information on oral steroid treatment from patient.co.uk please click here
- the use of a hormone tablet (diethylstilboestorol)- this is a man-made tablet which is similar to the female hormone oestrogen and can also lower testosterone levels in men. However a common side effect is the formation of blood clots in the legs and aspirin usually has to be taken in combination with it.
- Chemotherapy- The most common type of chemotherapy used to treat prostate cancer is called Docetaxel (Taxotere). Chemotherapy attacks cancerous cells within the body but may also damage normal healthy cells. This may lead to side effects which can be quite severe in some older or less fit men.
- Abiraterone is a new type of hormone therapy. It blocks a substance called cytochrome p17 that the body needs to make androgens (male sex hormones). Without this enzyme the testes and other body tissue can’t make testosterone. Abiraterone can be given to men with advanced prostate cancer and who have already had other types treatment such as chemotherapy
- Enzalutamide is another new type of hormone therapy, also known as MDV3100. It is used in the form of a tablet which can be prescribed after treatment with chemotherapy or in limited instances after abiraterone.
Both Abiraterone and enzalutamide may be effective at improving the life expectancy of men with advanced prostate cancer when given prior to or after chemotherapy.
The use of the above treatments will be discussed carefully with men by an oncologist and will depend on factors such as medical or general health fitness. Men may also be invited to take part in a clinical trial
Last reviewed 27/7/17 Next review January 2018.
References available on request.