Treatments

Medical Oncology for Prostate Cancer

Medical oncology uses non-surgical therapies such as hormone therapy, chemotherapy and genomic-based therapies to treat people with prostate cancer.

If you have been diagnosed with prostate cancer, call 216-844-3951 today to schedule an appointment with a prostate cancer expert. We offer both initial consults and second opinion appointments.

Hormone Therapy

Androgens like testosterone can stimulate prostate cancer cells to grow and spread. The standard hormone therapy for prostate cancer is androgen deprivation therapy (ADT), which can reduce, stop or block the production of androgens so that prostate cancers shrink or grow more slowly.

Hormone therapy alone does not cure prostate cancer and can become less effective over time. It is often combined with radiation treatments and/or surgery or is used to treat cancers that recur after other treatments have failed or if the cancer has spread. Hormone therapy is sometimes used to shrink the tumor before other types of therapy are given.

Androgen Deprivation Therapy

ADT is included in most treatment plans for advanced and metastatic prostate cancer. Standard ADT can stop testosterone production or directly block it from prostate cancer cells. Without testosterone, most prostate cancer cells stop growing and die as a result.

Prostate cancer that can be controlled with standard ADT is referred to as hormone-sensitive prostate cancer (HSPC). However, some prostate cancer cells can eventually learn how to survive and grow in the low-testosterone environment created by ADT.

Types of standard (ADT) include:

Lutenizing-Hormone Releasing Hormone (LHRH) Agonists: LHRH is one of the key hormones released by the body to produce testosterone. LHRH agonists are drugs that block the release of LHRH to prevent the body from producing testosterone. One of the most common hormone therapies for prostate cancer, it is given as regular shots once or more a year. The drugs cause a temporary rise in testosterone for a week or two after the first treatment, called a testosterone flare, with symptoms ranging from bone pain to urinary issues.
Lutenizing-Hormone Releasing Hormone (LHRH) Antagonists: Unlike agonist drugs, which block the release of LHRH, antagonist drugs block the hormone’s effect, preventing it from stimulating testosterone production. This therapy has the advantage of not causing an initial testosterone flare. It is given as a monthly injection and, for some men, is an acceptable alternative to orchiectomy or LHRH agonists.
Orchiectomy: Because about 90 percent of testosterone is produced by the testicles, the most effective way to block production of the hormone is to surgically remove the testicles – a procedure called orchiectomy. The procedure is typically done on an outpatient basis at the urologist’s office. Since recovery tends to be fast and no further hormone therapy is needed, this is an option for men who prefer a low-cost, one-time procedure. Orchiectomy may also have a lower risk of cardiovascular complications and fractures compared with drug-based hormone therapy. However, the procedure permanently alters the body and can be psychologically difficult for some men. If this treatment option is chosen and cosmetic appearance is a concern, artificial testicles can be inserted into the scrotum.

Androgen Receptor Pathway Inhibitor

Androgen receptor pathway inhibitor (ARPI) refers to hormone-based therapies that can be used in combination with ADT or used in patients with prostate cancer that is resistant to traditional ADT. The focus of ARPI is to stop the body from making testosterone and/or prevent testosterone from stimulating cancer growth.

ARPI agents include a number of anti-androgens, also called androgen receptor antagonists and androgen receptor blockers, which are drugs that help block the action of testosterone in prostate cancer cells. These drugs include:

Abiraterone: Used in combination with prednisone to treat patients with localized high-risk disease, mCRPC and mCSPC.
Apalutamide: Used to treat patients with mCRPC and nmCRPC.
Enzalutamide: Used to treat nmCSPC, mCRPC and mCSPC.
Darolutamide: Used to treat patients with mCSPC; can also be used in combination with a drug called docetaxel to treat mCSPC.

Other ARPIs currently under clinical investigation for treating prostate cancer include cabozantinib used with atezolizumab.

In a number of clinical trials, ARPI have been shown to help prolong the lives of patients with certain types of advanced-stage prostate cancer, including:

Metastatic Castration-Resistant Prostate Cancer (mCRPC)

Prostate cancer that has spread to other parts of the body and is resistant to other medical or surgical treatments designed to lower testosterone.

Metastatic High-risk Castration-sensitive Prostate Cancer (mCSPC)

Prostate cancer that has spread to other parts of the body and can respond to hormone therapy or surgical treatment to lower testosterone.

Non-metastatic castration-resistant prostate cancer (nmCRPC)

Prostate cancer that has not spread to other parts of the body and is resistant to other medical or surgical treatments designed to lower testosterone.

Non-metastatic Castration-sensitive Prostate Cancer (nmCSPC)

Prostate cancer with rising PSA and has no spread to other parts of the body and can respond to medical or surgical treatments designed to lower testosterone.

Side Effects of Hormone Therapy

When hormone therapy is effective at controlling prostate cancer growth, the reduction in testosterone can cause a variety of side effects, including:

Anemia
Breast tenderness or enlargement
Depression
Erectile dysfunction
Fatigue
Increased cholesterol levels
Loss of muscle mass
Osteoporosis
Shrinkage of testicles and penis
Weight gain

Clinical Trials

At any given time, the world-class medical oncologists at UH Seidman Cancer Center are hard at work at improving current prostate cancer treatment and developing new therapies. Our ongoing research includes advanced clinical trials that explore novel approaches for treating the disease at all stages. Many of our prostate cancer have access to these trials, which aim to improve survival and quality of life while undergoing treatment.

Learn More

Chemotherapy

Chemotherapy uses powerful anti-cancer drugs that are injected into a vein or taken by mouth. The drugs destroy prostate cancer cells by disrupting the protein structures they require to divide and multiply. Because the drugs enter the bloodstream and travel throughout the body, chemotherapy may be used for prostate cancer that has spread to other organs.

Often, chemotherapy is given to prevent cancer from spreading in the body. It is not usually used for early-stage prostate cancer. Chemotherapy is unlikely to cure prostate cancer, but it may slow the cancer’s growth or reduce symptoms to improve quality of life.

The most common chemotherapy drug used to treat prostate cancer is docetaxel (Taxotere), which is typically given with prednisone, a steroid medication.

Possible Side Effects of Chemotherapy

The side effects of chemotherapy vary depending on the type of drug and length of treatment. Some common side effects include:

Diarrhea
Fatigue
Hair loss
Loss of appetite
Mouth sores
Nausea and vomiting

Precision Oncology

Precision oncology is a new approach to cancer care, in which doctors use the DNA signature of a patient’s tumor to identify treatments that target the specific molecular/genetic changes of their cancer.

Genetic Testing

To date, several genetic mutations have been identified as risk factors for prostate cancer. Some of these mutations may be passed from one generation to the next. In fact, it is estimated that one in ten cases of prostate cancer are hereditary. If you have a family history of the disease, ask your doctor if genetic testing is appropriate for you.

At our Genitourinary Medical Oncology clinics, we offer germline testing (which looks for inherited mutations) and somatic testing (which looks for acquired mutations) to prostate cancer patients. Depending on the test results, we can then refer patients to the University Hospitals Center for Human Genetics for genetic counseling.

Targeted Therapies

The goal of targeted cancer therapies, also called genomic-based therapies, is to target specific genes or proteins in order to kill cancer cells without harming healthy cells. Depending on the results of a patient’s genetic testing, their doctor may recommend certain genomic-based prostate cancer therapies, which include PARP Inhibitors.

Unlike hormone therapy and chemotherapy, which destroy cancer cells or prevent them from growing, PARP inhibitors block an enzyme called poly ADP ribose polymerase that prostate cancer cells need to repair themselves when damaged. When damaged cancer cells are unable to fix themselves, they die. PARP inhibitors can improve survival rates when prostate cancer has not responded to hormone therapy and prostate cancer characterized by certain genetic changes.

See what clinical trials are underway for treating prostate cancer using novel genomic-based therapies.

Immunotherapy

Immunotherapy uses the body’s immune system to recognize and destroy cancer cells. Certain types of immunotherapy are used to treat prostate cancer, including:

Sipuleucel-T (Provenge) Cancer Vaccine

This vaccine boosts the body’s immune system to help it attack prostate cancer cells, similar to how traditional vaccines stimulate the immune system to help prevent infections. Sipuleucel-T is indicated for use in treating advanced prostate cancer that no longer responds to hormone therapy, but is causing few or no symptoms.

Checkpoint Inhibitors

Checkpoint proteins on immune cells act like switches that must be turned on (or off) to initiate an immune response. Cancer cells sometimes use these checkpoints to prevent the immune system from attacking them. Checkpoint inhibitors are drugs that disrupt the signals that allow cancer cells to hide from the immune system. Drugs including pembrolizumab (Keytruda) can be used to treat some forms of advanced prostate cancer.

Radionuclide Therapy

Radionuclide therapy, also called radiopharmaceutical therapy, uses radioactive drugs to target and destroy cancer cells. Like chemotherapy, it’s a systemic treatment that travels through the body via the bloodstream. However, unlike chemotherapy, radionuclide therapy targets cancer cells, reducing side effects.

PSMA Radioligand Therapy

Prostate-specific membrane antigen (PSMA) is a protein found on the surface of prostate cancer cells. PSMA radioligand therapy is a new treatment that destroys prostate cancer cells that produce PSMA. The goal of this treatment is to improve symptoms and reduce the size of the tumor(s).

UH Seidman Cancer Center has been one of the country’s leading users of PSMA radioligand therapy. We also utilize the most advanced PET imaging scanning technology available to accurately detect PSMA-positive mCRPC prior to beginning radioligand therapy.

Patients should ask their oncologist if this breakthrough treatment option is appropriate for them. Visit our clinical trials page to discover what other radiopharmaceutical therapies are under investigation for treating prostate cancer.