`Treatment of Metastatic CastrationResistant Prostate Cancer
`
`Treatment of Metastatic CastrationResistant
`Prostate Cancer
`
`Introduction
`
`To help doctors give their patients the best possible care, the American Society of
`Clinical Oncology (ASCO), along with Cancer Care Ontario, has developed
`recommendations on systemic, or fullbody, treatments for men with metastatic
`castrationresistant prostate cancer. This guide for patients and caregivers is based on
`ASCO recommendations.
`
`Key Messages:
`
`Metastatic castrationresistant prostate cancer is when the cancer has spread to
`parts of the body other than the prostate, and it is able to grow and spread even
`though drugs or other treatments to lower the amount of male sex hormones are
`being used to manage the cancer.
`When deciding on treatments for metastatic castrationresistant prostate cancer,
`it is important to weigh the possible benefits with the risks and costs.
`There are several different treatment options available for this type of prostate
`cancer.
`In addition to treatment for the cancer, relieving symptoms and side effects is an
`important part of cancer care and treatment.
`
`Background
`
`Prostate cancer growth is often driven by male sex hormones called androgens, which
`include testosterone. Because of this, a common treatment option for prostate cancer is
`to lower the levels of androgens in a man’s body. Androgen levels can be lowered by
`surgically removing the testicles or with drugs that stop the testicles from making
`androgens or block how they affect the body. This type of treatment is called hormone
`therapy or androgendeprivation therapy.
`
`If the cancer spreads to other parts of the body beyond the prostate in a process called
`metastasis, hormone therapy is usually continued. Eventually, many men with
`metastatic prostate cancer develop castrationresistant disease. This means that the
`cancer is able to grow and continue to spread despite using hormone therapy. For men
`with this type of disease, additional treatment is needed to help control the growth of
`the cancer. These treatments may include chemotherapy, targeted therapy, and other
`types of treatments.
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`7/24/2015
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`Treatment of Metastatic CastrationResistant Prostate Cancer | Cancer.Net
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`http://www.cancer.net/researchandadvocacy/ascocareandtreatmentrecommendationspatients/treatmentmetastaticcastrationresistantprostatecancer
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`Recommendations for men with metastatic castrationresistant prostate cancer
`
`ASCO recommends that men with metastatic castrationresistant prostate cancer
`continue hormone therapy to keep androgen levels in the body low, regardless of the
`other treatments used. Relieving side effects, also called symptom management or
`palliative care, is also an important part of cancer care and treatment.
`
`The following treatments may be given in addition to continuing hormone therapy:
`
`Abiraterone (Zytiga) and prednisone (multiple brand names)
`Enzalutamide (Xtandi)
`Radium223 (Xofigo) for men with cancer that has spread to the bone
`Docetaxel (Docefrez, Taxotere) and prednisone
`SipuleucelT (Provenge) for men who have few or no symptoms from the cancer
`Cabazitaxel (Jevtana) and prednisone for men with prostate cancer that has
`worsened while receiving docetaxel
`
`The following treatments could be options, as well. However, the research has not yet
`shown that they lengthen men’s lives:
`
`Mitoxantrone (Novantrone) plus prednisone
`Bicalutamide (Casodex), flutamide (Eulexin), nilutamide (Nilandron), which are
`all types of antiandrogens
`Ketoconazole (Nizoral, Xolegel)
`Lowdose corticosteroids
`
`The following treatments are not recommended:
`
`Bevacizumab (Avastin)
`Estramustine (Emcyt)
`Sunitinib (Sutent)
`
`What This Means for Patients
`
`A diagnosis of metastatic castrationresistant prostate cancer often means that
`treatments to slow, stop, or eliminate the cancer are no longer working by themselves.
`This diagnosis is stressful, and it may be difficult to discuss with your health care team.
`There are several promising treatments available, each of which affects a man’s life
`differently. Because of the variety of treatment options, men should talk with their doctor
`about the different treatment options for castrationresistant prostate cancer, including
`the overall goals of treatment, possible benefits, the risks, and the costs. Before
`considering additional treatments, it is important to have open and honest
`conversations with your doctor and health care team to express your feelings,
`preferences, and concerns.
`
`Questions to Ask the Doctor
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`7/24/2015
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`Treatment of Metastatic CastrationResistant Prostate Cancer | Cancer.Net
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`http://www.cancer.net/researchandadvocacy/ascocareandtreatmentrecommendationspatients/treatmentmetastaticcastrationresistantprostatecancer
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`Consider asking the following questions of your doctor:
`
`What type of prostate cancer do I have? What does this mean?
`What is my prognosis (chance of recovery)?
`What clinical trials are open to me?
`What treatment plan do you recommend? Why?
`What is the goal of each treatment? Is it to eliminate the cancer, help me feel
`better, or both?
`How well is this treatment likely to work? What are the risks?
`How will we know the treatment is working?
`How will my quality of life change over time?
`What are the next steps if the cancer worsens or comes back?
`What treatments are available to manage the symptoms of the cancer?
`If I’m worried about managing the costs related to my cancer care, who can help
`me with these concerns?
`Where can I find support for me and my family?
`Whom should I call with questions or concerns?
`
`Helpful Links
`
`Read the entire clinical practice guideline published at www.asco.org/guidelines/mcrpc.
`
`Guide to Prostate Cancer
`
`Hormone Therapy for Advanced Prostate Cancer
`
`Advanced Cancer Care Planning
`
`Navigating Challenges Video Series: Talking with Your Cancer Care Team, Making
`Decisions about Your Cancer Treatment, Managing the Cost of Your Cancer Care, and
`Finding Emotional Support after a Cancer Diagnosis
`
`Shared via Ivy Get yours now free
`
`7/24/2015
`
`Treatment of Metastatic CastrationResistant Prostate Cancer | Cancer.Net
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`http://www.cancer.net/researchandadvocacy/ascocareandtreatmentrecommendationspatients/treatmentmetastaticcastrationresistantprostatecancer
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