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`Patients > Treatment of Metastatic Castration-Resistant Prostate Cancer
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`Treatment of Metastatic Castration-Resistant Prostate Cancer
`
`September 8, 2014
`
`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 full-body, treatments for
`men with metastatic castration-resistant prostate cancer. This guide for patients and caregivers is based on
`ASCO recommendations.
`
`Key Messages:
`
`Metastatic castration-resistant 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 castration-resistant 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
`androgen-deprivation 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 castration-
`resistant 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.
`
`Recommendations for men with metastatic castration-resistant prostate cancer
`
`ASCO recommends that men with metastatic castration-resistant 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:
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`Abiraterone (Zytiga) and prednisone (multiple brand names)
`Enzalutamide (Xtandi)
`Radium-223 (Xofigo) for men with cancer that has spread to the bone
`Docetaxel (Docefrez, Taxotere) and prednisone
`Sipuleucel-T (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 anti-
`androgens
`Ketoconazole (Nizoral, Xolegel)
`Low-dose corticosteroids
`
`The following treatments are not recommended:
`
`Bevacizumab (Avastin)
`Estramustine (Emcyt)
`Sunitinib (Sutent)
`
`What This Means for Patients
`
`A diagnosis of metastatic castration-resistant 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 castration-resistant 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
`
`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?
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`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
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