|
|
|
Stephan L. Werner, M.D., F.A.C.S.
Late stage prostate cancer refers to Stage D prostate cancer that has spread widely, and is becoming or has become Hormone Resistant (HRPC) or unresponsive to standard hormone therapy. Sometimes cycling antiandrogen therapy may induce one or several more remissions. This involves stopping the antiandrogen and following the PSA. If a significant drop occurs the drug is excluded until the PSA rises to similar levels, and the it is reintroduced. In some patients several such cycles may occur. Alternatively, changing the LHRH medication may induce a short response. Checking testosterone levels be helpful as some patients do not respond well to LHRH or escape response. If the testosterone level remains high, surgical removal of the testicles, (orchiectomy) may be helpful. Sometimes high dose Casodex (150 mg/day) may block the high testosterone levels. (This dose is NOT FDA approved yet!!) Chemotherapy has in general not had excellent results in late stage prostate cancer, but searches for an active combination continues. Occasional patients respond well. Ketokonazole or Mitoxantrone and prednisone hahave shown some promise in slowing down the disease and/or relieving pain in patients with painful bony metastases. Trials with taxotere or tamoxiphen sometimes combined with estramustine or prednisone have also shown responses in a significant number of patients. Thalidomide is also under study. There are many clinical trials with other drugs being carried out at many centers including ours. An older regimen using DES or estrogens is being revisited, and some patients have had good responses, but there is a risk of cardiovascular complications For patients who have bony metastases several different treatments such as external beam radiotherapy, Strontium 89, Samarium153, or bisphosphonates may be very helpful. A new bisphosphonate, Zometa, can delay bony complications of prostate cancer when administered at the earliest signs of bony metastases, or when the cancer becomes hormone resistant. External beam radiotherapy may be given to specific body areas, especially bones that are involved with prostate cancer and are painful, or are in danger of breaking. Bisphosphonates which act on the rapidly growing bone in metastases are being used to control pain, the newer more potent bisphosphonates may also reduce and delay skeletal complications of metastatic PCa.. Bisphosphonates may also be used to prevent the osteoporosis of long term hormone therapy. Radioactive Samarium 153 (Quadramet) Is an intravenously administered medication that is picked up by the rapidly growing prostate cancer cells in bony metastases. It radiates those cells, killing many of them, and providing relief of pain in many patients. It has the advantage over Strontium89 in that several repeated courses may be given in many patients. Radioactive Strontium 89 is a similar drug to Samarium 153, but frequently only a single course can be given due to bone marrow effects. Immunotherapy, Dendritic cell therapy and Monoclonal antibodies are research tools being used in select centers. PC-SPES A snake oil special!! PC SPES was an alternative therapy made of 8 Chinese and one American herb. It turns out this "miracle" drug was seeded with DES or estrogen, an old and well known treatment for prostate cancer, with blood clotting problems. When someone stopped the estrogen supply, the "successes" disappeared. Recently it was pulled from the market by the FDA as there were traces of blood thinning medications and valium like chemicals in the pills. [See PC-SPES ALERT].
Alternative Treatments: watch out, charlatans are a dime a dozen in cancer treatment. Remember Laetrile and psychosurgery (and now PC-SPES),. However, there are several alternative therapies in the commercial marketplace, that may have some positive effect on prostate cancer. Stephan Werner, M.D., F.A.C.S. Rev 09/04 |
|
[Home] Werner - Francis Urology Associates llc - Mid Atlantic Urology Associates llc Greenbelt - Bowie - Laurel Maryland (301) 441-8900 Fax (301) 982 0453 7500 Hanover Parkway Suite 206 Greenbelt, MD 20770
Rev:03/08 |