Review of advanced prostate cancer treatments

The authors analyzed  treatment options available for advanced prostate cancer. 

At the first St. Gallen Advanced Prostate Cancer Conference leading experts met to determine the most up-to-date guidelines for the treatment of advanced prostate cancer. Advanced prostate cancer is cancer that has spread outside of the prostate gland into other areas of the body. Numerous treatment options are available to treat this type of cancer, including hormone therapy (HT, targets the male sex hormones active in prostate cancer, such as testosterone), chemotherapy and radiotherapy. In some cases patients can become resistant to HT. This is known as hormone-resistant prostate cancer and will require different treatment.

The aim of this review was to highlight the updated guidelines for the best treatments available for advanced prostate cancer.

Continuous HT was recommended for the majority of patients who still respond to hormone therapy over intermittent HT (on-again, off-again treatment). The average overall survival (patients who were still alive following treatment) in patients on continuous HT was 5.8 years compared to 5.1 years in the intermittent group.

In patients with hormone-resistant cancer, HT with docetaxel (Taxotere, a chemotherapy drug), abiraterone acetate (Zytiga) and enzalutamide (Xtandi) are standard treatment options available. Docetaxel was not recommended for patients with few or no symptoms, but was recommended for patients experiencing numerous prostate cancer symptoms.

Zoledronic acid (Zometa) and denosumab (Prolia) were identified as treatments that reduce skeletal-related side effects (SREs, side effects affecting the bones) in patients with hormone-resistant prostate cancer that has spread to the bones. Denosumab has been shown to increase metastases-free survival (patients who did not experience tumor growth after treatment) in hormone-resistant patients with bone tumors compared to patients without bone tumors. Patients who received treatment with docetaxel and radium-223 (Xofigo) also experienced a significant delay from treatment until first SREs.

These are general guidelines for the treatment of advanced prostate cancer. Every patient is different, and the best course of treatment will depend on the specifics of the situation.