Treatments available for advanced, hormone-resistant prostate cancer

The authors aimed to determine guidelines for the treatment of relapsing, metastatic, and hormone-resistant prostate cancer.

Metastatic prostate cancer (advanced cancer) is cancer that has spread outside of the prostate to other organs of the body, despite treatment. Hormone therapy is the standard treatment used in advanced cancer. This treatment targets the male sex hormones active in prostate cancer, such as testosterone. However, in some cases the cancer may become hormone-resistant. This means it has developed resistance against this treatment and will no longer respond to it.

Hormone-resistance can occur after local therapy (targeted to the prostate) has failed. This causes the cancer to relapse (reoccurs) and progress. A relapse can be identified by testing for prostate-specific antigen (PSA; a protein in the blood present in prostate cancer). Local therapy can involve treatment such as surgery (removal of the prostate gland) or radiation therapy. Radiation therapy targets radiation beams at the tumor site to kill the cancer cells. Following recurrence and resistance, other treatment options must be considered to prevent and treat further cancer progression. 

The European Association of Urology gathered a panel of experts to determine guidelines for the treatment of relapsed metastatic hormone-resistant prostate cancer. 

The aim of this study was to identify treatment options available to men with advanced, relapsing, hormone-resistant prostate cancer. Current research on the treatment of advanced prostate cancer was reviewed. 

Hormone therapy is the basis for treatment in men with advanced prostate cancer. Surgical castration (removal of the testicles) is also a possible option. Luteinizing hormone-releasing hormone (LHRH) agonists, such as goserelin (Zoladex) function by rapidly decreasing the production of male sex hormones. This improves progression-free survival (time from treatment until cancer progression). 

Combining both hormone therapy and chemotherapy with docetaxel (Taxotere) has been shown to improve patient survival following treatment. This was compared to hormone therapy alone. This combination therapy has been recommended for men newly diagnosed with advanced symptomatic and non-symptomatic prostate cancer to prevent progression and disease-related complications. 

Treatments such as abiraterone acetate (Zytiga) plus prednisone, enzalutamide (Xtandi), radium-223 (Xofigo), sipuleucel-T (Provenge), or docetaxel have been recommended to treat hormone-resistant prostate cancer. The choice of second-line treatment should depend on what was used as a first-line treatment. For example, if a patient was first treated with abiraterone or enzalutamide, docetaxel might be tried as a second-line treatment. Cabazitaxel (Jevtana) is another taxane chemotherapy that has been effective in patients resistant to docetaxel.

Zoledronic acid (Zometa) and denosumab (Prolia, Xgeva) have been approved for hormone-resistant prostate cancer in men with bone tumors to prevent further damage.

The authors presented guidelines for the treatment of hormone-resistant prostate cancer. They recommended that both survival and quality of life for the patient be taken into account when choosing a treatment.