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Understanding Prostate Cancer Treatment Approaches

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Published on February 25, 2019

What treatment options are available for prostate cancer? What can be done if treatment stops working? Esteemed prostate cancer expert Dr. Maha Hussain, fromRobert H. Lurie Comprehensive Cancer Center of Northwestern University, explains what agents are used to treat prostate cancer, how they work and the course of care if patients develop castration-resistant disease. Watch now to find out more.

This is a Patient Empowerment Network program produced by Patient Power in partnership with Robert H. Lurie Comprehensive Cancer Center of Northwestern University. We thank Astellas, Clovis Oncology and Pfizer for their support. These organizations have no editorial control. Patient Power is solely responsible for program content.

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Transcript | Understanding Prostate Cancer Treatment Approaches

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:                     

Dr. Hussain, these are what you call androgen deprivation therapy, did I get it right? Is that the right term?

Dr. Hussain:                

Correct. The intent is to deprive the cancer cells from the androgens, which are the male hormones, essentially, testosterone and testosterone-like products, to starve the cancer. 

Andrew Schorr:          

Okay, now, I have heard the term, castration-resistant, so what does that mean when a doctor says to a patient, well—does that mean that hormonal therapy or anti-deprivation therapy is no longer working? 

Dr. Hussain:                

Correct, and maybe, if we have a minute, let me maybe walk the audience through, why did we come up with this terminology?

Andrew Schorr:          

Sure. 

Dr. Hussain:                

Historically, what we used to call the situation, hormone refractory, and then, over the years, we’ve discovered, just because you’re shutting down the testis, it does not mean that if you are gonna introduce a new hormonal treatment, that the cancer isn't going to respond. A perfect example is what Gary is on, so the medication that he is getting, the abiraterone acetate (Zytiga), is a hormonal therapy. 

In some way, it's intending to shut down sources of androgens, and so several of us in the United States, we actually developed working group type criteria for calling the disease itself as to what it is and essentially, what a castration resistance implies is that a person is on hormonal treatment, their testis is meant to be shut down completely by the leuprolide (Lupron) or the goserelin (Zoladex), whatever hormonal agent they have, or they might have chosen to actually go through surgical removal of their testis. 

Now, despite the fact that they don't have a lot of male hormone in their body, their cancer is actually growing, and that is what we refer to as castration-resistant disease.

Andrew Schorr:          

Okay, so you may be on this, treatments like this for continuing to try to keep that shut down as best you can. Let's go on and understand, though, chemotherapy. Chemotherapy has been used in prostate cancer and across all cancers for a long time. Does it still have a place in prostate cancer?

Dr. Hussain:                

Absolutely. I would point out that, if we're gonna be focusing more so right now on the more advanced stage of the disease, I would point out that the first drug that has ever demonstrated in the history of the disease, of castration-resistant disease, in overall survival improvement in prostate cancer was actually chemotherapy, a drug that's called docetaxel approved by the FDA. 

Prior to that, we had different agents that were potentially palliative, but not necessarily life prolonging, and then subsequent to docetaxel, another drug also was evaluated in patients who've been exposed to docetaxel and also showed an overall survival advantage, which is also a drug approved by the FDA and called cabazitaxel (Jevtana). The good news is we don't have to just have chemotherapy. There are other agents that have had a track record ever since 2004 by demonstrating an effect against the cancer, which we measure by, generally, criteria of prolonging life and overall survival improvement.

Andrew Schorr:          

Okay, and someone could be on chemo with one of these other drugs, as well?

Dr. Hussain:                

Well, it's too early to say at this moment. Right now, the sequence of events is generally if a person has developed castration-resistant disease in general, most of the time outside of clinical trial, patients preference, and a lot of times physician preference, is to offer oral therapy, and the oral therapy would be hormonal agents that are oral agents like the Zytiga, which is abiraterone with prednisone or enzalutamide (Xtandi), which is—these are both drugs, again, FDA-approved for patients with castration-resistant disease. Then there are clinical trials looking at maximizing the anti-cancer effect by combining these types of hormonal agents with chemotherapy. 

What we know is this, is moving chemotherapy earlier in the cycle of disease, before it becomes castration-resistant, and-or agents like the Zytiga into the earlier phases where the cancer, let's say, just became metastatic, but it's not yet resistant to the hormone treatment, that gives a much better return on investment, so to speak, in terms of prolonging life. There's been a stage—a shift, a migration to earlier phases of the disease where we're implementing these types of treatments.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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