Focused solely on the needs of advanced prostate cancer patients and their families

Androgen deprivation therapy (ADT) may also be called hormone therapy or androgen suppression therapy. ADT reduces the levels of androgen hormones, which are related to the male hormone testosterone, to prevent the prostate cancer cells from growing. For some men, ADT keeps prostate cancer in check for many years; for other men, it does not.

There are several different types of ADT, the most common of which is often called the “hormone shot.” Administered over the course of several years, injections of drugs such as Lupron and Eligard (leuprolide), Zoladex (goserelin), Trelstar (triptorelin), or Vantas (histrelin) shut down the signal from the pituitary gland that tells the testicles to make testosterone. Injections of Firmagon (dageralix) have essentially the same effect. Because 95 percent of the body’s testosterone is produced by the testicles, this treatment is very effective.

However, the adrenal glands make several hormones, including small amounts of testosterone. There are times when urologists need 100% blockade of testosterone, so an oral drug called Casodex (bicalutamide) can be prescribed. In order for any hormone to work, it has to latch on to a receptor on its target cell. Casodex blocks any remaining testosterone from binding onto its receptor. There are also anti-androgen pills such as flutamide and biclutamide that are used for complete androgen blocking.

The goal of ADT in all its forms is to non-surgically reduce a man’s testosterone to the level of someone who has been surgically castrated. For some men, though, surgical castration is a better option for achieving this result.

With lowered testosterone levels come a number of possible side effects. These may include a loss of sex drive, inability to have erections, weakened muscles and bones, fatigue, irritability and memory lapses.

To control these side effects, stay active and get regular physical exercise. Help strengthen bones by taking calcium supplements with Vitamin D—the typical daily dose is 1000mg Calcium and 1000 IU Vit D. The doctor may check your levels and recommend a different dose. Supplementation may be slightly lower if a man consumes a lot of dairy. Our specialists at Central Ohio Urology Center will help guide you through side effects if they occur.

Prostate cancer often travels to the bones, where it may progress for a while without any symptoms. But as bony tumors grow, they can become painful and make the bones more brittle. At the APCC, we help mitigate these complications through bone-strengthening supplements (calcium and vitamin D) and regular exercise. We also offer additional treaments that strengthen bone, decrease risk of fracture and target the cancer in the bone.

At Central Ohio Urology, we are committed to giving prostate cancer patients the best available care, including leading-edge clinical trials for those who are eligible. Trial participants may benefit from the accelerated access to new, improved treatments. Study-related lab and radiology tests are often free. Many times, patients are eager to play a vital role in developing new treatments with the potential to save more lives in the future.

If you’re interested in this option, ask your doctor. He or she will help you determine if there is a clinical trial that’s right for you.

Erleada is a prescription medicine used to treat prostate cancer that has not spread to other parts of the body and no longer responds to a medical or surgical treatment that lowers testosterone. It is an androgen receptor inhibitor for patients with non-metastatic castration-resistant prostate cancer.

If the PSA is rising despite ADT, but there is no visible evidence of cancer anywhere, Erleada may offer a chance to delay the cancer from spreading. A spot of cancer that has spread outside the prostate is called a metastasis, so this treatment is aimed at preventing metastatic spread. Erleada is a pill that is taken every day and continued for as long as it is working, which on average is about two years based on a large clinical trial. While the medication is generally well tolerated, there is always a possibility of a side effect. Fatigue, nausea, falls and hypothyroidism have all been reported. There is also a risk of developing a skin rash.

You can learn more here:  www.erleada.com

Working closely with the Columbus Prostate Cancer Center, our radiation oncologist uses external beam radiation therapy (EBRT) to treat prostate cancer. With EBRT, beams of radiation are focused on the prostate gland or specific metastatic bone cancer areas. This type of radiation can be used early to try and cure the cancer or may be used as a later stage therapy to help relieve symptoms of cancer that has spread to the bone.

As with all treatments, there is a risk of side effects, although they are usually minimal with EBRT. Gastrointestinal side effects are most common.

Approximately 14% of all prostate cancer is hereditary. Hereditary cancer occurs when a gene mutation is passed down in the family from parent to child. Individuals with hereditary cancer are more likely to have relatives with the same type or related types of cancer. They are also at a higher likelihood of developing more than one cancer. Both men and women can inherit and pass down genetic mutations. Men with a family history of cancer, including breast and ovarian, should consider genetic testing.

By understanding your family history and pursuing hereditary cancer testing when appropriate, you and your healthcare provider can personalize your current screening/treatment, and additional advanced treatments may become available.

If you have a gene mutation, your children, brothers and sisters have a 50% chance of having the same gene mutation. Knowing whether or not they carry a gene mutation can allow family members to make more informed decisions that may drastically reduce their risk of developing certain cancers.

You can learn more here: www.MySupport360.com

PROVENGE® (sipuleucel-T) is an innovative autologous cellular immunotherapy generally employed as an advanced prostate cancer treatment option. Provenge activates the body’s immune system to seek out and attack the prostate cancer. This is not chemotherapy, nor is it a hormone therapy. Provenge is an immunotherapy that reprograms the body’s ability to fight the cancer. This treatment is usually given to someone who does have known metastases (cancer that has spread outside of the prostate).

The treatment begins by filtering your blood to remove some of your white blood cells, the primary fighters within your immune system. Those white blood cells are then mixed with prostate cancer proteins and drugs that help the white blood cells multiply. These white blood cells are now “supercharged” to recognize and fight prostate cancer, wherever it may be in your body. Those cells are put back into your body via an IV infusion three days after they are withdrawn. This process is repeated for a total of three infusions scheduled over a four- to five-week period. During the infusion, it is common to experience chills, fatigue, a mild fever and perhaps some nausea. Because of this, we strongly recommend you have someone else drive you for these treatments.

Once you are done with the treatment, you can forget about it. However, there is a limit to how much your immune system can do to fight cancer. It can take up to six months for the white blood cells to get to work and to recruit other cells, so the cancer can progress in that time span. We therefore prefer to use Provenge early in the advanced prostate cancer process. If there is too much cancer, the immune system can simply be overwhelmed. Sometimes it may be appropriate to combine Provenge with other treatments. Unlike other treatments, the PSA value can still rise even when the treatment is working. Even if the cancer appears to be growing after Provenge, evidence shows the cancer grows more slowly than if you hadn’t received the treatment. There is evidence that the immune system continues to have anti-cancer activity even after 10 years.

You can learn more here:  www.provenge.com

Prostate cancer often travels to the bones. Many times this does not cause immediate symptoms, but as the disease progresses, bony tumors can become painful and put the bones at risk of fracture. We seek to be proactive to prevent these complications and may use Xgeva or Prolia, which are the same drug given at different doses depending on your situation.

Prolia is used for adult patients who have prostate cancer who are taking ADT or have been surgically castrated. The decrease of testosterone in a patient decreases the bone density causing osteopenia and osteoporosis. Prolia is used to strengthen the bones and prevent fractures. It is administered once every six months.

Xgeva is used for adult patients who have prostate cancer in their bones. This treatment contains denosumab, a protein (monoclonal antibody) that slows the destruction caused by bone metastasis. Xgeva prevents such serious complications as fracture or pressure on the spinal cord, and it does it without the need for radiation therapy or surgery.

Xgeva is administered once every four weeks as a single injection under the skin. It is a safe therapy; it does not affect the kidneys, liver or heart. However, it may lower calcium levels in the blood, and there’s a very low risk of damage to the jaw. Patients who have extensive dental work while on this drug may develop a serious condition called osteonecrosis of the jaw (ONJ), which causes an abscess that never completely heals. We ask all patients to get a full dental checkup and schedule any dental surgeries before starting Xgeva.

You can learn more here:  www.xgeva.com

If prostate cancer spreads to the bone, your doctor may recommend Xofigo®. This intravenous radiation treatment is for symptomatic bone metastatic disease. As the bone disease progresses, patients may begin to have pain, difficulty sleeping, loss of appetite and decrease in the activities they enjoy. Xofigo helps to relieve these symptoms. Because its radioactive particles are delivered through a vein, they can travel to any bone tumor site in the body. Xofigo can actually attack cancer in the bone. Treatments are given once a month for six months by the radiation oncologist, and symptoms can start to subside in as few as two or three treatments. Each injection takes just a few minutes.

The radiation from Xofigo targets and kills the cancer cells in your bones but does limited damage to surrounding healthy cells. Side effects may occur and include: nausea, vomiting, diarrhea and swelling of the hands and feet. There is a small risk of bone marrow damage, so your blood counts will be checked before each infusion. Many patients like the fact that even though Xofigo contains radioactive material, they can still have personal contact with others after treatments. You can socialize as usual and savor your time with family and friends.

You can learn more here:  www.xofigo-us.com

Enzalutamide (Xtandi®) is a prescription medicine approved to treat men with castration-resistant prostate cancer with or without metastatic disease that works by blocking the androgen receptor. If the cancer mutates to become castrate resistant, it may be because the cancer produces its own androgens. When the cancer produces its own androgens, those androgens need to bond to a receptor to have an effect. Casodex (bicalutamide) can block testosterone outside of the cancer cells, but Xtandi (enzalutamide) can block the receptors inside the cells.

Xtandi is taken orally – four capsules once a day with or without food. It does not need to be taken with prednisone. The drug is very safe, but there is always the potential for side effects. Many patients experience fatigue, some have upset stomachs or other GI side effects, and it can worsen high blood pressure. An extremely rare event is a seizure, but it is not clear in the clinical studies if the drug really caused this or not. Frequent blood work and checkups are necessary when patients first start this medication.

You can learn more here:  www.xtandi.com

Yonsa is a medication that is used in combination with a steroid, methylprednisolone, to treat men with prostate cancer that has metastasized (spread) to other areas of the body. Abiraterone belongs to a class of drugs known as anti-androgens (anti-testosterone). Testosterone, a natural hormone, helps prostate cancer to grow and spread. Abiraterone works by blocking the production of testosterone, which helps slow down the growth and spread of prostate cancer.

Different brands of this medication may have different dosing directions. Do not change brands of this medication without your doctor’s direction. Yonsa is micronized (smaller particle size), so the dosage is different than with other abiraterone products. Yonsa is taken by mouth – 4 tablets once daily with or without food. Swallow this medication whole with water. Do not crush or chew the tablets. It will need to be taken with methylprednisolone as a steroid replacement due to the disruption in the steroid production from the adrenal gland.

Unfortunately, not only does the drug stop androgen production in the cancer cells, but it also stops the adrenal gland from producing certain steroids. This can cause side effects such as high blood pressure and fluid retention. Low potassium levels and abnormal liver enzymes tests can also occur. While low-dose steroids like prednisone can help prevent them, steroids can have their own side effects (easy bruising, puffiness, infections).

When used along with prednisone, this medication can help men whose prostate cancer has spread to other parts of the body and is resistant to medical or surgical treatments that lower testosterone. Frequent blood work and checkups are necessary when patients first start this medication.

You can learn more here:  www.yonsarx.com

Over time, as cancer cells mutate, they learn to produce the testosterone and other androgens they need for continuous growth. Zytiga®, an FDA-approved, once-daily oral prescription medicine, gets inside the cancer cell and directly stops the production of androgens. Cancer cells go into remission and your PSA level should go down.

Zytiga is taken orally – four tablets once a day on an empty stomach. It will need to be taken with prednisone as a steroid replacement due to the disruption in the steroid production from the adrenal gland. Unfortunately, not only does the drug stop androgen production in the cancer cells, but it also stops the adrenal gland from producing certain steroids. This can cause side effects such as high blood pressure and fluid retention. Low potassium levels and abnormal liver enzymes tests can also occur. While low-dose steroids like prednisone can help prevent them, steroids can have their own side effects (easy bruising, puffiness, infections). When used along with prednisone, this medicine can help men whose prostate cancer has spread to other parts of the body and is resistant to medical or surgical treatments that lower testosterone. Frequent blood work and checkups are necessary when patients first start this medication.

You can learn more here:  www.zytiga.com