Throw us a bone

by Donna Canada, RN, CURN

Chemotherapy in prostate cancer is the use of powerful drugs to either kill prostate cancer cells or interfere with their growth.

Many different types of chemotherapeutic agents work at different times in the growth cycle of the cell, and combinations of agents are often used to maximize the effects on the cancer cells. Several different drugs have been shown to improve symptoms and decrease the PSA level or the amount of cancer, though no drug has been shown to kill all of the prostate cancer cells present.

Ongoing clinical trials continue to look at new prostate chemotherapy drugs, combinations of drugs, or different doses in hopes of finding more effective and less toxic options.¹ If prostate cancer returns despite surgery and hormone therapy, you should consult your medical oncologist to discuss the risks, benefits, and expected results of chemotherapy.

Chemotherapy for treatment of prostate cancer has evolved in recent years. Previously it was given to men of poor performance status who were in pain, often debilitated, who had lost weight, and were too weak to tolerate strong doses of anything. Today's drugs are more targeted, with far fewer side effects than the devastating "scorched earth" drugs of old. This means that instead of being stuck on the sidelines, waiting to be used in case the "A team" treatments (radical prostatectomy and radiation therapy) and "B team" treatment (hormonal therapy) were not successful; chemotherapy for prostate cancer is getting into the game sooner than ever.³

Radical prostatectomy cures many men but unfortunately, about one third will suffer from the symptoms caused by metastasis and die of their disease according to Eisenberger.³ Hormone therapy and chemotherapy are not considered "curative" because they do not eliminate the prostate cancer cells. These treatments are considered "palliative" with the goal to slow down the progression or spread of the prostate cancer.

Most common chemotherapy drugs for prostate cancer

The following are the most common chemotherapy type drugs:

• Oral estramustine plus intravenous vinblastine
• Oral estramustine plus VP-16
• Mitoxantrone plus prednisone
• Suramin
• Taxanes
• Cabazitaxel (Jevtana, Sanofi-Aventis) has been approved in the U.S. for second line use in advanced hormone refractory prostate cancer.⁵

Advantages:

• Kills and or reduces growth of cancer
• Provides palliation (symptom relief)
• Improved outcomes and significantly prolonged survival
• Improved quality of life and better pain control

Disadvantages:

• Potentially significant side effects, such as nausea, gynecomastia (breast enlargement or tenderness), fatigue, kidney damage, nerve damage and skin rash
  
  

Provenge

Second Line Treatment Options:
Provenge, a new therapeutic class known as autologous cellular immunotherapies (a therapy that uses the patient's own immune system) was just approved by the FDA in April 2010.. This expensive new therapy is covered in more detail under investigational treatments.

References:

1. Ellsworth P. 100 Questions & Answers About Prostate Cancer.2nd ed. Sudbury, MA: Jones and Bartlett Publishers; 2009.
2. American Cancer Society, Bostwick D, Crawford ED, Higano C, Roach M, eds. Complete Guide to .Atlanta, GA: ACS Health Promotions; 2005.Prostate Cancer
3. Walsh PC, Worthington JF. Dr Patrick Walsh's Guide to Surviving Prostate Cancer" 2nd ed. New York, NY: Wellness Central; 2007.
4. Scholz, M. Newly Diagnosed Prostate Cancer: Evaluating The Options -- Part 2 Of 3. CRI Insights [online] August 2003 vol. 6, no. 3, Available at: http://www.prostate-cancer.org/pcricms/node/141#ADT. Accessed on September 11, 2010.
5. Vogelzang, 2010 American Society of clinical Oncology Annual Meeting. August 2010 article: Cabazitaxel New Chemo Approved for Advanced Prostate Cancer. Available at: http://www.ustoo.org/PDFs/HotSheets/HotSheet082010.pdf . Accessed on September 11, 2010.
6. Warde, 2010 American Society of clinical Oncology Annual Meeting. July 2010 article: RT Shown Beneficial for Prostate Cancer Subset. Available at: http://www.ustoo.org/Hot_Sheets.asp. Accessed on September 11, 2010.
7. Crouzet, 2010 American Urological Association Annual Meeting Retrieved from July 2010 article: High Intensity Focused Ultrasound Noninferior to External Beam RT for Prostate Cancer. Available at: http://www.ustoo.org/Hot_Sheets.asp. Accessed on September 11, 2010.
8. MSNBC. FDA approves new drug for prostate cancer (press release). Available at: http://www.msnbc.msn.com/id/36853649/ns/health-cancer/. Accessed September 14, 2010.  

This article has been reviewed by a member of the Wellness Partners Editorial Board.

Posted September 201