Advanced Prostate Cancer

This book was requested by men with prostate cancer as a sequel to 'Localised prostate cancer: a guide for men and their families'. It aims to explain the advanced stages of prostate cancer, its treatments and how men can manage their health and care while dealing with this condition.

A message from the consumer members on the steering committee

When you are told that you have advanced Prostate Cancer, many thoughts flash through your mind. One is that I need to find out more about what is happening to my body and what can I do about it. There are 100s of books available that offer a wide variety of views, some soundly based, some offering cures without any evidence to support their theories. If you search the internet there are millions of references.

For the first time consumers now have a reliable sopurce of information, written and reviewed by some of the nation's leading practitioners in all the modalities of treatment. Being part of the team that has produced this book has been a privilege and a learning expereince. We strongly recommend this book as being the very best source of information on Advanced Prostate Cancer.

Consumer Representatives - Don Baumer-Gold Coast Prostate Cancer Support and Information Network; Bill McHugh - Brisbane Prostate Cancer Support Network; Max Shub - Heidelberg Support Group

To obtain your free copy of the publication, contact Andrology Australia

Advanced Prostate Cancer - a guide for men and their families has been written by APCC and many volunteers. It was published at the end of 2009. Chapter headings include;

Chapter 1: Introduction to advanced prostate cancer
Chapter 2: Following the progress of prostate cancer
Chapter 3: Members of the care team and their roles
Chapter 4: Locally advanced prostate cancer
Chapter 5: PSA rising after treatment for localised prostate cancer
Chapter 6: Complementary Care and Lifestyle
Chapter 7: Metastatic prostate cancer
Chapter 8: Metastatic prostate cancer - unresponsive to hormone therapy
Chapter 9: Clinical trials and emerginf treatments
Chapter 10: Maintaining your wellbeing
Chapter 11: Partners, families and and Carers: your concerns
Chapter 12: Palliative and end of life care


The following sections provide some basic information on advanced prostate cancer:

1. Advanced Prostate Cancer

2. Hormone Therapy Treatment For Advanced Prostate Cancer

3. Treatment For Advanced Prostate Cancer Following Hormone Therapy
4. Chemotherapy Treatment Explained
5. Clinical Trials
6. Glossary of Terms

1. Advanced Prostate Cancer
Although there is a trend toward earlier detection of prostate cancer, unfortunately many men are not diagnosed until the disease has progressed to a later stage, known as advanced prostate cancer. Advanced prostate cancer occurs in two forms: locally advanced prostate cancer; and advanced (metastatic) prostate cancer.

Locally advanced prostate cancer refers to when the prostate cancer has spread to areas outside the prostate gland, but remains in the prostate region (i.e. in the prostate gland and the seminal vesicles). Symptoms can vary between men, and can include:

Loin pain
Blood appearing urine (hematuria)
Bladder control (urinary incontinence)
Blood in seminal/sperm fluid (hemospermina)*

When cancer spreads to neighbouring tissues or to other parts of the body such as the bones, this is called advanced (metastatic) prostate cancer or secondary cancer. It can take many months or years before prostate cancer spreads to other parts of the body. Symptoms experienced in advanced (metastatic) prostate cancer depend on where the cancer has spread to and can include:

Bone pain, lower back or pelvic pain
Weight loss 
Lethargy (e.g. due to anemia or uremia)
Paraplegia caused by compression of the spinal cord
Lymph node enlargement** 
Skin and bowel bleeding (cutaneous and bowel haemorrhage)*

For more information on the different stages of prostate cancer please click here.

* Note: this is an unusual symptom 
** Note: this symptom is dependent on cancer location and spread


2. Hormone Therapy Treatment For Advanced Prostate Cancer
If prostate cancer spreads beyond the prostate region, hormone therapy is usually the first line of treatment. Hormone therapy, also called androgen deprivation therapy (ADT) can slow or stop the growth of prostate cancer by stopping the production of testosterone which prostate cancer cells usually depend on for growth. 

The success of hormone therapy in controlling prostate cancer varies between men, and may be effective for many months or years. In fact, more than 80% of men who receive this treatment benefit, this can be reflected by reduced Prostate Specific Antigen (PSA) levels.

Note: A rise in PSA levels following initial prostate cancer treatment can indicate cancer reoccurrence. PSA levels are measured using a blood test and the results of this test can be used to help determine the stage of prostate cancer, which is evaluated by an experienced doctor. For more information on the PSA test and PSA levels please click here.

There are two main approaches to hormone therapy:

o        A surgical procedure to remove the testicles (orchidectomy)

o        Medication in the form of tablets or injections that minimise the effect or ‘switch off’ of testosterone in the body

The decision about which treatment approach is best is an individual one, and is decided in consultation with a doctor. For more information about hormone therapy (including treatment side effects) please click here.


3. Treatments for Advanced Prostate Cancer Following Hormone Therapy
When prostate cancer no longer responds to hormone therapy and growth of the cancer continues, it is called hormone resistant or hormone refractory prostate cancer. This occurs if cancer cells do not need testosterone for growth. If prostate cancer becomes hormone resistant, a range of therapies aimed at treating or slowing the progression of symptoms can be provided.

Like other medicines, treatments for advanced prostate cancer can have both benefits and side effects – and these can vary between men. It is important you speak with your doctor about these, as side effects can often be managed to improve quality of life.

Treatments for advanced prostate cancer resistant to hormone therapy include:

Chemotherapy
Benefit and effect: Shown to reduce PSA levels and significantly extend the lifespan of men with advanced (metastatic) prostate cancer resistant to hormone therapy.

Side effects: Can include hair loss, tiredness, diarrhoea, skin reactions, gastrointestinal problems, a sore mouth and fluid retention.

Palliative radiotherapy
Benefit and effect: This treatment is used to reduce pain, such as pain due to cancer travelling to the bone.1 External beam radiotherapy is usually the type of radiotherapy given and up to 80% of men treated will experience rapid pain improvement. For more information on this treatment please click here.

Side effects: Can include nausea, tiredness, cataracts, vomiting and diarrhoea. Some men can experience long term side effects including erectile dysfunction.

Oestrogen treatment
Benefit and effect: Introducing a low dose oestrogen hormone plus aspirin may lower PSA levels  by suppressing the production of testosterone and having a cytotoxic effect on prostate cancer cells.

Side effects: Can include deep vein thrombosis (DVT) otherwise known as blood clots in the veins, and other serious cardiovascular complications.

Bisphosphonates in cancer
Benefits and effect: Works by delaying loss of bone density.

Side effects: Can include kidney deterioration and very rarely jaw necrosis (an area of jaw bone which loses its blood supply and exposes the bone).

Note: The risk of jaw necrosis is generally limited to people treated with bisphosphonates via an intravenous drip, rather than among people treated with oral bisphosphonates.


4. Chemotherapy Treatment Explained
Chemotherapy works by killing cancer cells, meaning it can help reduce further spread of cancer as well as reduce the cancer where it already exists. As a result chemotherapy is an effective treatment that can extend life and reduce cancer symptoms such as bone pain.

Chemotherapy treatment is usually administered at hospital (i.e. as part of an out-patient or in-patient service) and involves injecting chemicals into the blood stream via an intravenous drip to kill cancer cells throughout the body. Chemotherapy treatment is normally recommended in advanced (metastatic) prostate cancer that is resistant to hormone therapy.

Chemotherapy treatment is managed by an oncologist (cancer specialist) and is tailored for individuals, allowing for improved results and reducing the impact of potential side effects (e.g. tiredness, hair loss, diarrhoea, sore mouth, nerve damage and fluid retention). The impact of side effects from chemotherapy treatment can vary between men.

Clinical trials have found that chemotherapy treatment improves quality of life for men with advanced (metastatic) prostate cancer that is resistant to hormone therapy. In addition, research has found that men treated with chemotherapy not only had improvement in pain, PSA levels and general wellbeing, these men also survived for longer.

Chemotherapy is increasingly being used to treat men with advanced (metastatic) prostate cancer that is resistant to hormone therapy. The decision as to whether or not chemotherapy is right for a particular person is an individual one, and is decided in consultation with your doctor.


5. Clinical Trials
Some men with advanced prostate cancer may be eligible to participate in a clinical trial. By becoming involved in a clinical trial you are able to have access to new treatments that would otherwise not be available. It is important to understand that clinical trials offer experimental therapies and the treatment outcomes are mostly unknown. To enquire about clinical trials please visit the clinical trial website: http://www.anzctr.org.au/trialSearch.aspx

Note: to view clinical trials investigating prostate cancer treatments type  the search word ‘prostate’ into the website search area.


6. Glossary
Seminal vesicles - Glands that lie very close to the prostate and produce secretions which form part of the ejaculate.

Androgen deprivation therapy - Treatment with drugs that minimise the effect of testosterone in the body. This type of therapy can slow or stop the growth of prostate cancer; also called androgen ablation.

Prostate Specific Antigen (PSA) -  A protein produced by the cells in the prostate, which is usually found in the blood in larger than normal amounts when prostate cancer is present. It can be used as a test for prostate cancer or to monitor its recurrence.

Testosterone - The main male hormone, it is produced by the testicles.

Dihydrotestosterone (DHT) - Testosterone is converted into DHT in the prostate cells and is an active hormone in prostate cell function.

Androgen Receptors - Hormone sensors that are located on many organs, including the prostate. These sensors detect male hormones including testosterone and DHT. 

Cytotoxic - Any substance which affects cells in a negative way. This term is commonly used to describe medications used to kill cancerous cells in the body.


References:
Kirby R, Patel M. Fast Facts: Prostate Cancer. Health Press Limited, May 2008; Fifth Edition
This website information has been developed with the support of an educational grant from sanofi-aventis. Control of editorial content was managed by the PCFA and was approved by the PCFA’s Medical Review Working Party.

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