This type of prostate cancer can be very hard to cure, even when doctors catch it early. “This cancer escapes control,” says oncologist Michael S. Cookson, MD, a professor and the chairman of the department of urology at the University of Oklahoma College of Medicine in Oklahoma City. “It’s like a car that keeps moving even though you’re pushing on the brakes in the form of hormone therapy.” It’s common for hormone therapy, known as androgen deprivation therapy (ADT), to stop working after a few years. ADT works by blocking testosterone from stimulating the cancer to keep growing. The term “castration resistant” refers to a cancer that is no longer responding to this type of therapy. According to the American Society of Clinical Oncology (ASCO), many men with prostate cancer eventually develop mCRPC. It’s hard to pin down exact numbers — in part, because newer, more sensitive imaging technologies are now able to find cancer cells that couldn’t be found before, explains Scott T. Tagawa, MD, a medical oncologist at Weill Medicine and New York-Presbyterian Hospital in New York City. “Our scans are getting better,” says Dr. Tagawa. “When we just had X-rays, we missed small things. Then we got MRIs and CT scans, and we still missed some things. But now that we have more specific PET scans, we can see things we couldn’t see before.” This means “that the same man who was non-metastatic before is now metastatic, because we have more sensitive scans [and can find incredibly small tumors],” Tagawa says. And finding cancer sooner means treating it sooner. Since 2004, various new drugs have been approved, with each addition designed to suppress testosterone in new ways, according to the Harvard Medical School. While there have been a lot of promising developments, treatment guidelines still recommend that most people stay on ADT while adding on newer therapies, such as:
Docetaxel A type of chemotherapy, this was the first approved therapy to prolong survival for men with metastatic CRPC.Cabazitaxel This newer type of chemotherapy, given along with prednisone, is an option when docetaxel is ineffective.Sipuleucel-T This treatment processes your immune cells outside of the body to essentially turn them into a vaccine, then the processed cells are returned to your body during treatments several times a week. It’s primarily for men who have few or no cancer symptoms.Hormone therapies like abiraterone and enzalutamide This new generation of hormone therapies for mCRPC targets male hormones in different ways than do traditional hormone therapies. Both of these drugs, which are given in the form of pills, have been shown to lengthen survival.Xofigo (radium-223 dichloride) With this treatment, you’re given an infusion of radioactive material that attacks the cancer cells within bones.
The Role of a Multidisciplinary Care Team in Treatment
Keep in mind that the optimal treatment strategy for mCRPC is different for each person — and that it’s a complicated disease to treat. That’s why it’s important to assemble a team of doctors and specialists to keep your treatment — and you — on track. Your team should include an experienced urologist, advises Cookson, as well oncologists who are comfortable with the newer treatments and know how to use them. A study published in July 2015 in the Journal of Urology agrees, finding that with so many new treatments coming on board, doctors have to juggle a lot of factors when figuring out your best next steps — from what kind of symptoms you have to your personal preferences, as well as any other health conditions that may have to be taken into account when coming up with a treatment strategy. It’s also important for your care team to review the medicines you’ve already taken for prostate cancer, and plan the sequence of the medicines you’ll take next. Getting the order right is important because certain drugs can make subsequent treatments more, or less, effective. Your care team should also watch you closely to determine whether you have any resistance to any medicines, so that they can make changes quickly if necessary. Ideally, your care team should possess “expertise in distinct domains of cancer care,” such as imaging, chemotherapy, radiation, and surgery, according to a study published in the Annals of Oncology in August 2015. You’ll also want key specialists to talk to each other about your treatment options before you start a new therapy — to determine exactly how your cancer is progressing, and to interpret results from imaging tests. Your care team should come up with an individualized treatment plan that considers the different benefits and risks, as well as the costs, of all your options; it should also include any clinical trials you should consider.
Quality of Life With mCRPC
According to a review published in the British Medical Journal in October 2016, you may not experience pain or other symptoms at this stage of cancer, or you may experience many. It’s different for everyone. So along with treating the cancer itself, be sure to talk to your doctors about any symptoms and side effects you’re experiencing in order so that the right ways to alleviate them can be found. You should also ask your care team about options for palliative care. Because it can be very stressful to have advanced prostate cancer, and tough to talk about what it all means for your future, the ASCO urges men to have an open and honest conversation with their care team. Discuss what you’re worried about, and what’s important to you. There are many ways to look for and get emotional support. Additional reporting by Andrea Peirce
