Options for men diagnosed with advanced prostate cancer?

Dr Ahmed El-Modir

For about 20 to 30 per cent of men diagnosed with prostate cancer, by the time they are seen by a doctor, their disease has spread to other parts of the body.

This means their prostate cancer cannot be cured and is known as metastatic disease. The first course of action is to control the progression of the disease by reducing the levels of testosterone in the body. This is because testosterone increases the speed at which cancer cells reproduce.

There are two different ways to lower testosterone levels. Hormone therapy can involve taking tablets every day or injections every month or three months “medical castration”. The surgical option involves removing the testicles, known as “surgical castration” or orchidectomy.

Another approach is called anti-androgen treatment . The main side-effects are gynaecomastia “breast enlargement” and breast pain, although a single radiotherapy dose to the breasts can help this side-effect.

Combining anti-androgens with testosterone reduction is known as Maximum Androgen Blockade (or MAB). This may give a fairly modest advantage in terms of overall survival, but there is an increased risk of side-effects and complications.

Over time, the cancer cells will become resistant to the affects of hormone therapy and the condition will be known as “castrate resistant prostate cancer”. When the cancer starts to return, on average 18–24 months after the commencement of hormone therapy or orchidectomy, your doctor may suggest treatment with chemotherapy or steroids. The aim of chemotherapy and steroids is to reduce the size of the tumour, reduce pain, improve the quality of life and prolong survival.

Other treatment options for castrate refractory prostate cancer include diethylstilboestrol which is a synthetic oestrogen that can reduce the PSA level and help symptoms in castrate refractory prostate cancer. New therapies such as Abriaterone and tyrosine kinase inhibitors have shown promise after failure of chemotherapy.

At The Birmingham Prostate Clinic we offer hormonal treatment and chemotherapy for advanced prostate cancer. Bisphosphonates (Zometa, Zoledronic Acid) which involve an intravenous injection every three to four weeks, have been shown to reduce bone pain and significantly reduce the risk of bone complications from advanced prostate cancer. Two radioactive isotopes are available to reduce pain and complications from advanced prostate cancer; Strontium 89 and Samarium 153 have been found to be successful in pain relief for 70–80 per cent of patients.

If your cancer has spread to the bones and is causing you pain, your specialist may suggest radiotherapy to the affected areas of bone. Radiotherapy for bone pain can work very well to strengthen the bone and relieve pain. The damaged bone begins to repair itself after radiotherapy treatment.