Men with advanced prostate cancer that has spread beyond the prostate may benefit from nonhormonal treatments, including chemotherapy drugs such as Enzalutamide or Sipuleucel-T (Provenge), as well as radiotherapies like Radium 223. Such nonhormonal approaches can increase survival even when cancer has become resistant to hormone manipulation.
Current treatments for advanced prostate cancer that no longer responds to hormone therapy include the tumor-killing drug abiraterone; however, new research funded by you could offer more options.
1. Chemotherapy
Chemotherapy drugs may provide effective nonhormonal therapies for advanced prostate cancer patients to delay progression and extend lifespan, though this form of therapy will likely not cure their disease. They work differently than hormone therapy by decreasing levels of androgens – male sexual hormones – in the body. Chemotherapy drugs may also target cancer cells directly for destruction – although this approach is less often employed.
Hormones such as testosterone and dihydrotestosterone play an integral part in prostate cancer’s progression, driving growth and spread. Hormone deprivation therapy (ADT), however, reduces androgen levels to stop tumor expansion – whether alone or combined with radiation therapy or surgery treatments.
Taxanes, such as docetaxel (Taxotere) or cabazitaxel (Jevtana), can be administered either orally or intravenously to reduce androgens in your blood. Injection or oral administration usually helps minimize side effects; multiple sessions with rest periods between sessions make up one cycle.
Other drugs used alone or with hormone therapy treatments to treat prostate cancer include abiraterone (Zytamax) and enzalutamide (Xtandi), which block enzymes responsible for producing androgens. This treatment typically combines radiation to the pelvic region as well as hormone therapy treatments to achieve maximum effectiveness.
Some newer drugs, including immunotherapy, utilize the patient’s own immune system to combat cancer. These medicines direct their patient’s immune system towards attacking engineered cancer cells that appear more like normal cells than they should.
Studies conducted on advanced prostate cancer showed that an anticancer medication called Nivolumab (Opdivo) could prevent its growth even when resistant to hormone therapy and other drugs, by blocking signaling pathways cancer cells use to cope with stressors like high temperatures. Researchers also observed that those with higher levels of heat shock protein protein experienced worse outcomes from treatment.
Some men with low-risk prostate cancer may opt not to undergo active surveillance; instead opting instead to monitor the disease through regular PSA tests and biopsies to monitor progression; should further treatment become necessary, active surveillance may become the preferred approach.
2. Ablative Therapy
Ablative therapy employs heat or cold treatments to destroy prostate tissue instead of extracting or radiating it – the goal being to stop cancer cells from spreading or growing further.
Focal laser ablation (FLA) is an innovative treatment option for low-risk prostate cancer. FLA involves using an MRI and special machine that emits targeted beams of high intensity ultrasound energy to heat and destroy prostate tissue, as well as prevent future recurrences of cancer cells.
For this procedure, you’ll lie on your back with legs spread apart. This treatment can take place either while asleep or awake – you need only remain still for 1 to 4 hours for it to take effect properly. Anesthesia options available to you for this treatment may include spinal anesthesia or general anesthesia.
Your healthcare provider will insert a probe into your rectum, connected to a computer that creates 3D images of the prostate that can then be fused together with images from other tests such as an MRI scan.
A probe is moved around the urogenital tract until it identifies an area that appears suspicious in the prostate, then using laser light to create a small spot of heat to damage cancerous cells and stop their further growth and spread.
High-intensity focused ultrasound (HIFU) therapy is another form of ablation therapy used for prostate tissue ablation. HIFU treatments utilize a ring-shaped probe that can be positioned anywhere along the urinary tract and used to focus high-intensity ultrasound beams that heat and destroy prostate tissues, similar to IRE but potentially more precise and with reduced risks of nerve injury.
Both IRE and HIFU have proven their effectiveness for patients suffering from hormone-refractory conditions; however, more research needs to be conducted into when hormone therapy should resume following either procedure.
3. Radiation Therapy
If your prostate cancer no longer responds to hormone therapy, other treatments might be used instead. These could include chemotherapy drugs like docetaxel (Taxotere) or cabazitaxel (Jevtana), as well as ablation therapy using extreme heat or cold to shrink tumors; they might even be combined with sipuleucel-T (Provenge), which acts like a prostate cancer vaccine and reduces androgen levels that encourage prostate cancer cells growth; hormone therapy could also be employed – keeping cancer at bay while improving symptoms such as weak erections;
Radiation therapy utilizes high-energy rays to destroy cancer cells, either alone or combined with hormone treatment. It has proven particularly successful at eliminating localized prostate cancer that hasn’t spread beyond the prostate gland and could provide the same cure rate as surgery.
Your doctor may use a prostate-specific antigen (PSA) scan to map out your prostate, rectum and bladder before devising a radiation treatment plan. After which, radiation treatments could last anywhere between 5 and 45 days with each session lasting less than an hour.
If you are receiving brachytherapy, your doctor may insert radioactive seeds that deliver high doses of radiation over short time periods. These implants are usually temporary and removed during brief treatments or when their radioactive material runs out; alternatively, you might opt for high-dose-rate (HDR) brachytherapy in which case seeds remain for a shorter duration.
External beam radiation therapy, or EBRT, involves targeting your prostate using a machine placed outside your body. Your doctor might use image-guided radiation therapy (IGRT) to make sure the machine is targeting its precise location on your prostate. You could also receive stereotactic body radiation therapy (SBRT), in which imaging tests create pictures of your prostate prior to each radiation session; this allows your doctor to adjust radiation sessions as necessary due to changes in prostate or cancer position over time.
4. Surgery
Whenever cancer has already metastasized beyond the prostate gland, surgery or radiation may be required to stop its spread and limit growth and spread. This is known as advanced stage prostate cancer. Hormone therapy might also be employed alongside these treatments in order to decrease testosterone production in order to slow tumor growth; this treatment method is known as androgen deprivation therapy or hormone therapy.
Radical prostatectomy, the surgical removal of an entire prostate gland, may involve radiation therapy and one or more newer hormone medications (abiraterone, enzalutamide or apalutamide).
People living with advanced prostate cancer may benefit from taking nonhormonal therapies that block or reduce testosterone. Although nonhormonal therapies aren’t as effective in managing PSA levels as hormone therapies do, they can still provide some help and are associated with fewer side effects like urinary incontinence or erectile dysfunction.
Cryotherapy can also be effective at controlling small tumors and preventing their regrowth. Doctors administer this therapy by inserting a long probe into the tumor to freeze it, after which they monitor its progress with imaging tests such as X-rays to ensure no growth has taken place.
All prostate cancer treatments come with some side effects. If the side effects of your treatment cause you any concern, be sure to communicate this to your physician so they can help manage them so you receive optimal care for you.
Hormone therapy with newer hormone drugs seems to be the best treatment choice for most men diagnosed with localized prostate cancer, yet more research needs to be conducted in order to establish what would be an ideal approach based on individual risk levels.
If your prostate cancer has returned or spread to other parts of the body, it is imperative that further treatments are initiated immediately. Yours could differ from someone else’s due to differences between cancer types. Your doctor might order blood tests or imaging studies to detect where in your body the cancer has spread, and could recommend chemotherapy drugs or vaccines as possible treatments.
