Before going into the treatment, it's important to know who treats prostate cancer.
The main types of doctors who treat prostate cancer include:
Urologist: A surgeons who treat diseases of the urinary system and male reproductive system (including the prostate)
Radiation oncologist: A doctor who treats cancer with radiation therapy.
Medical oncologist: A doctor who treats cancer with medicines such as chemotherapy, hormone therapy, and immunotherapy.
Many other health specialists may be involved in prostate cancer care as well, including nurse practitioners, nurses, nutritionists, social workers, rehabilitation specialists, Pharmacists and other health professionals.According to the American cancer society, treatment options for prostate cancer includes:
Active Surveillance:
Active surveillance is often used to mean monitoring the cancer closely. Usually this includes a doctor visit with a prostate-specific antigen (PSA) blood test about every 6 months and a digital rectal exam (DRE) at least once a year. Prostate biopsies and imaging tests may be done every 1 to 3 years as well. If your test results change, your doctor would then talk to you about other treatment options to try and cure the cancer.
Surgery for prostate cancer:
Surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the prostate gland.
The main type of surgery for prostate cancer is a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles.
Radiation Therapy for Prostate Cancer:
Radiation therapy uses high-energy rays or particles to kill cancer cells. Depending on the stage of the prostate cancer and other factors, radiation therapy might be used:
✅As the first treatment for cancer that is still just in the prostate gland and is low grade. Cure rates for men with these types of cancers are about the same as those for men treated with radical prostatectomy.
✅As part of the first treatment (along with hormone therapy) for cancers that have grown outside the prostate gland and into nearby tissues.
✅If the cancer is not removed completely or comes back (recurs) in the area of the prostate after surgery.
✅If the cancer is advanced, to help keep the cancer under control for as long as possible and to help prevent or relieve symptoms.
Cryotherapy for Prostate Cancer:
Cryotherapy (also called cryosurgery or cryoablation) is the use of very cold temperatures to freeze and kill prostate cancer cells as well as most of the prostate. Even though it is sometimes being called cryosurgery, it is not actually a type of surgery.
When is cryotherapy used?
Cryotherapy is sometimes used if the cancer has come back after radiation therapy. It may be an option to treat men with low risk early-stage prostate cancer who cannot have surgery or radiation therapy. However, most doctors do not use cryotherapy as the first treatment for prostate cancer..
Hormonal therapy for prostate cancer:
It's also called androgen suppression therapy. The goal is to reduce levels of male hormones, called androgens, in the body, or to stop them from fueling prostate cancer cells.
Androgens stimulate prostate cancer cells to grow. The main androgens in the body are testosterone and dihydrotestosterone (DHT). Most androgens are made by the testicles, but the adrenal glands (glands that sit above your kidneys) as well as the prostate cancer itself, can also make a fair amount.
Lowering androgen levels or stopping them from getting into prostate cancer cells often makes prostate cancers shrink or grow more slowly for a time. But hormone therapy alone does not cure prostate cancer.
When is hormone therapy used?
Hormone therapy may be used:
If the cancer has spread too far to be cured by surgery or radiation, or if you can’t have these treatments for some other reason
If the cancer remains or comes back after treatment with surgery or radiation therapy
Along with radiation therapy as the initial treatment, if you are at higher risk of the cancer coming back after treatment (based on a high Gleason score, high PSA level, and/or growth of the cancer outside the prostate)
Before radiation to try to shrink the cancer to make treatment more effective
Chemotherapy for Prostate Cancer:
Chemotherapy (chemo) uses anti-cancer drugs injected into a vein or given by mouth. These drugs travel through the bloodstream to reach cancer cells in most parts of the body.
When is chemotherapy used?
Chemo is sometimes used if prostate cancer has spread outside the prostate gland and hormone therapy isn’t working. Recent research has also shown that chemo might be helpful if given along with hormone therapy.
Chemo is not, however, a standard treatment for early prostate cancer.
For prostate cancer, chemo drugs are typically used one at a time. Some of the chemo drugs used to treat prostate cancer include:
✅Docetaxel (Taxotere)
✅Cabazitaxel (Jevtana)
✅Mitoxantrone (Novantrone)
✅Estramustine (Emcyt)
In most cases, the first chemo drug given is docetaxel, combined with the steroid drug prednisone. If this does not work (or stops working), cabazitaxel is often the next chemo drug tried (although there may be other treatment options as well).
Docetaxel and cabazitaxel have been shown to help men live longer, on average, than older chemo drugs. They may slow the cancer’s growth and also reduce symptoms, resulting in a better quality of life. Still, chemo is very unlikely to cure prostate cancer.
Other chemo drugs being studied for use in prostate cancer include carboplatin, oxaliplatin, and cisplatin.
How is chemotherapy given?
Chemo drugs for prostate cancer are typically given into a vein (IV), either as an infusion over a certain period of time. This can be done in a doctor’s office, chemotherapy clinic, or in a hospital setting. Some drugs, such as estramustine, are given as a pill.
Often, a slightly larger and sturdier IV is required in the vein system to administer chemo. They are known as central venous catheters (CVCs), central venous access devices (CVADs), or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing.
Immunotherapy for Prostate Cancer:
Immunotherapy is the use of medicines to stimulate a person’s own immune system to recognize and destroy cancer cells more effectively. Certain types of immunotherapy can be used to treat prostate cancer.
Cancer vaccine
Sipuleucel-T (Provenge) is a cancer vaccine. Unlike traditional vaccines, which boost the body’s immune system to help prevent infections, this vaccine boosts the immune system to help it attack prostate cancer cells.
The vaccine is used to treat advanced prostate cancer that's no longer responding to hormone therapy but is causing few or no symptoms.
This vaccine is made specifically for each man. To make it, white blood cells (cells of the immune system) are removed from your blood over a few hours while you are hooked up to a special machine. The cells are then sent to a lab, where they are mixed with a protein from prostate cancer cells called prostatic acid phosphatase (PAP). The white blood cells are then sent back to the doctor’s office or hospital, where they are given back to you by infusion into a vein (IV). This process is repeated 2 more times, 2 weeks apart, so that you get 3 doses of cells. The cells help your other immune system cells attack the prostate cancer.
The vaccine hasn’t been shown to stop prostate cancer from growing, but it seems to help men live several months longer. As with hormone therapy and chemotherapy, this type of treatment has not been shown to cure prostate cancer but prolong the patient lifespan.
Targeted Therapy for Prostate Cancer:*
Targeted therapy is a type of cancer treatment that uses drugs to identify and attack cancer cells while doing little damage to normal cells. These therapies attack the cancer cells' inner workings − the programming that makes them different from normal, healthy cells. Each type of targeted therapy works differently, but they all change the way a cancer cell grows, divides, repairs itself, or interacts with other cells.
The drugs used for targeted prostate cancer therapy includes:
✅PARP inhibitors:
Rucaparib (Rubraca) and olaparib (Lynparza) are drugs known as a PARP (poly(ADP)-ribose polymerase) inhibitors. PARP enzymes are normally involved in one pathway to help repair damaged DNA inside cells. The BRCA genes (BRCA1 and BRCA2) are also normally involved in a different pathway of DNA repair, and mutations in those genes can block that pathway. By blocking the PARP pathway, these drugs make it very hard for tumor cells with an abnormal BRCA gene to repair damaged DNA, which often leads to the death of these cells. If you are not known to have a BRCA mutation, your doctor might test your blood or saliva and your tumor to be sure you have one before starting treatment with this drug.
These drugs are taken twice a day by mouth as pills.
✅Rucaparib (Rubraca) can be used to treat advanced castration-resistant prostate cancer that has grown after taxane chemotherapy (such as docetaxel or cabazitaxel) or anti-androgens have been tried. It can be used in men with a mutation in one of the BRCA genes. This drug is given with a LHRH agonist or to men who have had an orchiectomy.
✅Olaparib (Lynparza) can be used to treat advanced castration-resistant prostate cancer that has grown after the hormone therapy drugs, enzalutamide or abiraterone, have been tried. It can be used in men with a mutation in one of the BRCA genes. This drug is given with a LHRH agonist or to men who have had an orchiectomy.
Treatments for Prostate Cancer Spread to Bones:
If prostate cancer spreads to other parts of the body, it nearly always goes to the bones first. Bone metastasis can be painful and can cause other problems, such as fractures (breaks), spinal cord compression (an area of cancer is pressing on the spinal cord), or high blood calcium levels, which can be dangerous or even life threatening.
If the cancer has grown outside the prostate, preventing or slowing the spread of the cancer to the bones is a major goal of treatment. If the cancer has already reached the bones, controlling or relieving pain and other complications is also a very important part of treatment.
Treatments such as hormone therapy, chemotherapy, and vaccines may help with this, but other treatments specifically target bone metastasis and the problems it may cause.
This may includes:
✅ Bisphosphonates:
Bisphosphonates are drugs that work by slowing down bone cells called osteoclasts. These cells normally break down the hard mineral structure of bones to help keep them healthy. Osteoclasts often become overactive when prostate cancer spreads to the bones, which can cause problems. Bisphosphonates can be used:
▶️To help relieve pain and high calcium levels caused by cancer that has spread to the bones
▶️To help slow the growth of cancer that has spread to the bones and help delay or prevent fractures
▶️To help strengthen bones in men who are getting hormone therapy
Zoledronic acid (Zometa) is a commonly used bisphosphonate for prostate cancer. This drug is given as an intravenous (IV) injection, usually either once every 3 or 4 weeks, or once every 12 weeks. Men given this drug are advised to take a supplement containing calcium and vitamin D to prevent problems with low calcium levels.
Sometimes other bisphosphonates are used to treat prostate cancer that has spread to bone.
✅Bisphosphonates can have side effects, including flu-like symptoms and bone or joint pain. They can also cause kidney problems, so patients with poor kidney function might not be able to be treated with these medicines.
A rare but very serious side effect of these drugs is osteonecrosis of the jaw (ONJ). With this condition, part of the jaw bone loses its blood supply and dies. This can lead to tooth loss and infections of the jaw bone that are hard to treat. Some people develop ONJ when dental work is done during treatment. Many times men are advised to have a dental checkup and have any tooth or jaw problems treated before they start taking a bisphosphonate. Maintaining good oral hygiene by flossing and brushing, making sure that dentures fit properly, and having regular dental checkups may also help prevent ONJ.
✅Denosumab
Denosumab (Xgeva) is another drug that can help when prostate cancer spreads to bone. Like the bisphosphonates, denosumab also blocks osteoclasts, but it does so in a different way. This drug can be used:
▶️To help prevent or delay problems like fractures in men whose cancer has already spread to the bones. It may be helpful even if zoledronic acid is no longer working.
▶️To help strengthen bones in men who are getting hormone therapy
This drug is injected under the skin every 4 weeks. Men given this drug are often advised to take a supplement containing calcium and vitamin D to prevent problems with low calcium levels.
Common side effects include nausea, diarrhea, and feeling weak or tired. Like the bisphosphonates, denosumab can also cause ONJ, so doctors recommend taking the same precautions (such as having teeth and jaw problems treated before starting the drug).
✅Corticosteroids
Some studies suggest that corticosteroid drugs (such as prednisone and dexamethasone) can help relieve bone pain in some men. They also can help lower PSA levels. These drugs are often already a part of prostate cancer treatment that has spread.
✅External radiation therapy
Radiation therapy can help reduce bone pain, especially if the pain is limited to one or only a few areas of bone. Radiation can be aimed at tumors on the spine, which can help relieve pressure on the spinal cord in some cases, and prevent paralysis. Radiation therapy may also help relieve other symptoms by shrinking tumors in other parts of the body.
✅Radiopharmaceuticals
Radiopharmaceuticals are drugs that contain radioactive elements. They are injected into a vein and settle in areas of damaged bones (like those containing cancer spread). Once there, they give off radiation that kills cancer cells. These drugs can be used to treat prostate cancer that has spread to many bones. Unlike external beam radiation, these drugs can reach all the affected bones at the same time.
The radiopharmaceuticals that can be used to treat prostate cancer spread to bone include:
▶️Strontium-89 (Metastron)
▶️Samarium-153 (Quadramet)
▶️Radium-223 (Xofigo)All in all,
A blend of specific wellbeing experts (medical services group) is the key for a compelling therapy of prostate cancer in light of the fact that different methodologies are suggested in the management which requires a particular medical services information.
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