Download Treatment of castration-resistant prostate cancer

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1
Where can I find more
information?
Treatment of
castration-resistant
prostate cancer
Canadian Urological Association
– Patient information
www.cua.org
Prostate Cancer Canada
– Androgen deprivation therapy
and medicines used
www.prostatecancer.ca/Prostate-Cancer/
Treatment/
Canadian Cancer Society
– Treatment of CRPC
www.cancer.ca/en/cancer-information/
cancer-type/prostate/prostate-cancer/
A number of treatment options are
available for castration-resistant prostate
cancer (CRPC) that has spread beyond
the prostate gland to other parts of
the body (metastasized). The goals of
treating metastatic CRPC are to control
the disease, improve symptoms, and help
patients live longer.
What is castration-resistant
prostate cancer?
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How is CRPC treated?
In some men taking hormone therapy for
prostate cancer, their PSA (prostate-specific
antigen) level may rise and keep rising after
repeating the PSA test. Unfortunately, some
prostate cancer cells can change over time
and become resistant to hormone therapy.
Your doctor will consider a number of factors
when recommending a treatment for you. The
following questions will help guide the choice.
When this happens, the current treatment can
no longer control the growth of the prostate
cancer by itself. The cancer is then described
as castration-resistant prostate cancer (CRPC).
In the past this was called hormone-refractory
prostate cancer.
• Do you have symptoms from the prostate cancer and are they mild or severe?
• Has the prostate cancer spread to other parts of the body? (Cancer that has spread is described as metastatic.)
• Do you have other health conditions thatmake
some therapies better choices than others?
• What treatments for prostate cancer have you received so far?
As a first step, your doctor may try changing
your hormone therapy. In recent years, a number
of new treatments have become available for
men with metastatic CRPC. For men with CRPC
that has not spread beyond the prostate (nonmetastatic), there is no standard treatment at
this time.
Ask your doctor about the possibility of entering
clinical trials that can give access to new
treatment options, and help find better ways
to treat this stage of the disease.
The development and production of this material was
made possible through an educational grant provided by
Amgen Canada Inc. and Astellas Pharma Canada, Inc.
© 2014 Canadian Urological Association.
All Rights Reserved.
cua.org
CRPC-10-14
The information in the publication is not intended to convey medical
advice or to substitute for direct consultation with a qualified medical
practitioner. The Canadian Urological Association disclaims all liability
and legal responsibility howsoever caused, including negligence, for the
information contained in or referenced by this brochure.
cua.org
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What are the treatment
options for metastatic CRPC?
A. Abiraterone
Description
B. Enzalutamide
C. Radium-223 continued
Description
Important notes
• Enzalutamide capsules are taken by mouth once a day
• This therapy blocks androgens from signalling cancer cells to grow
• Follow good personal cleanliness and hand-
washing practices while receiving treatment and for at least 1 week after the last injection – this minimizes the potential for radiation exposure by household members and caregivers
• Your healthcare team will give you advice on flushing the toilet and handling any clothes soiled with body fluids, urine, stool, or vomit
• Make sure you keep your appointments for blood tests
• Let your doctor know if you have a fever, chills, or any signs of infection
• Abiraterone tablets are taken by mouth once a day
• This drug prevents the production of androgens (the male sex hormones that can cause prostate cancer cells to grow)
• Prednisone tablets must also be taken to reduce side effects from abiraterone
Possible side effects
Possible side effects
• Enzalutamide is not suitable for men who have had a seizure or have risk factors for seizures
• Blood pressure should be checked regularly
• Carry a list of all your medicines so your pharmacist can check for drug interactions
• Swelling of the feet or legs
• Low potassium in the blood which may cause muscle weakness, muscle twitches,
or a pounding heart beat
• Loss of energy (fatigue)
• Joint and muscle pain
• Hot flashes
• Diarrhea or constipation
• Increase in blood pressure
• Cough
Important notes
• Abiraterone should be taken on an empty stomach (1 hour before eating, or 2 hours after eating)
• Prednisone should be taken with food
• Prednisone is important to reduce side effects of abiraterone, such as swelling of the feet and legs, low potassium level in the blood, and increased blood pressure
• You will need to have regular blood tests
• Carry a list of all your medicines so your pharmacist can check for drug interactions
NOTE: Some men may receive more than one of
the treatment options discussed in this pamphlet.
The best sequence of treatments is still being studied.
The ability for doctors and their patients to gain
access to these treatment options can vary from
region to region. Your treating physician can give you
further advice.
• Loss of energy (fatigue)
• Hot flashes
• Headache
• High blood pressure
Important notes
C. Radium-223
Description
• A radioactive medicine is injected into the blood (intravenous, IV) every 4 weeks for a total of 6 treatments
• Radium-223 goes to where the cancer has spread in the bone; it gives off radiation in the areas where the cancer is causing damage
• Radium-223 therapy can improve patient survival and can also delay and reduce the risk of fractures and severe bone pain
• Currently, Radium-223 is not widely available in Canada; it may be available to men who join a clinical trial
D. Chemotherapy
Examples: Docetaxel and cabazitaxel
Description
• These chemotherapy drugs are given by injection every 3 weeks
• Chemotherapy drugs kill fast growing cells, including cancer cells
• Prednisone tablets are taken by mouth each day as part of the chemotherapy regimen
Possible side effects
• Increase in risk for infections and fever
• Shortness of breath and fatigue
• More bruising or bleeding than usual
• Nausea, vomiting, diarrhea
• Loss of energy (fatigue), weakness
• Mouth sores
• Hair loss, fingernail changes
Possible side effects
Important notes
• More bruising or bleeding than usual
• Diarrhea
• Nausea and vomiting
• Increase in risk for infections
• Pain, redness, or swelling at the injection site
• Docetaxel is the first chemotherapy drug that is tried for metastatic CRPC
• Cabazitaxel is considered later, after docetaxel has been tried and no longer works
• Your healthcare team will provide you with information and also with support medicines to prevent and lessen the side effects from chemotherapy
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What is the role of radiation
therapy?
External Beam Radiation Therapy (EBRT) or
Stereotactic (or pinpoint) Body Radiation
Therapy (SBRT) may be suggested for some men
with CRPC. These types of radiation therapy
can be used to relieve pain, improve mobility,
stop bleeding, and prevent bone fractures and
spinal cord problems. EBRT and SBRT are given
using a machine to focus a radiation beam at a
specific cancer site in the bones or other area of
concern. (The role of Radium-223 is discussed in
the previous section.)
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How will I be monitored
during treatment?
Your doctor will meet with you regularly to
monitor your treatment. During this time, your
doctor will measure your PSA level and look
at other blood test results. CAT (CT) scans and
bone scans may also be needed. During your
appointments, you and your doctor will discuss
ways to manage the symptoms and side effects
you may be experiencing.