Download Metastatic disease: hormone therapy

“Fighting Cancer: It’s All We Do.”™
Restoring Quality of Life
And
Managing Side Effects
Ulka Vaishampayan M.D.
Chair, GU Multidisciplinary team
Associate Professor Of Medicine
Detroit Medical Center
Wayne State University/ Karmanos Cancer Institute,
Detroit MI.
Metastatic Prostate Cancer
• Common site of spread- bones
• Incurable, likely terminal condition
• Morbidity significant as it can lead
to bone pain,cord compression,
fractures, urinary obstruction etc.
• Initial therapy with hormones
which is effective, but temporary
Metastatic disease: hormone therapy
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•
•
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Hormone therapy questions:
When to start?
Continuous vs intermittent
Which kind: Lupron/Zoladex with casodex
or casodex alone (50 mg daily) or high
dose casodex 150 mg daily
• Should we stop treatment when it stops
working?
• What are the risks?
Common Complications of
Hormone Therapy
– Fatigue
– Metabolic syndrome- high blood sugar, high cholesterol
– Increased risk of heart problems in people who have
heart disease
– Hot flashes
– Impotence
– Osteoporosis
– Gynecomastia and breast tenderness
– Mood swings
– Liver toxicity
– Diarrhea, nausea
Strategies to address side effects of
hormone therapy
• Hormone therapy works by suppressing the
male hormone/testosterone levels.
• Fighting the side effects:
-Increased Awareness
-Stay active
- Healthy diet
- Ask for medication therapy for hot flashes if
bothersome.
- Consider intermittent hormone therapy if feasible
- Monitor cholesterol, blood sugars periodically.
Supportive Care in Advanced
Prostate Cancer
• Bone strengthening therapy
• Radiation
• Pain control therapies
• Chemotherapy/novel agents
Zometa vs. Placebo in Hormone
Refractory Metastatic Prostate Cancer
Berruti et al, JNCI 2003
Bisphosphonates for Treatment
of Bone Metastasis
50
40
44%
33%
30
20
10
0
• Median time to first
skeletal-related event
compared with placebo
Patients Without Event (%)
• Frequency of skeletal
complications due to bone
metastasis
100
80
Not reached
60
P=0.011
40
20
0
0
Zoledronic acid
Placebo
321 days
50 100 150 200 250 300 350 400 450
Days After Start of Therapy
Dietary factors
• Lycopene: A minimum of 2 servings (1 cup) per week
of tomato sauce can reduce the risk of development
and progression of prostate cancer.
• Cruciferous vegetables: at least five servings per week
can decrease the risk of developing prostate cancer by
20%.
• Green Tea may have possible protective effects
• A large study showed that too much calcium (over
2000mg daily) can increase metastatic prostate cancer
risk fivefold compared with those consuming <500
mg daily- Health Professionals Follow Up study
Dietary factors
• Vitamins within the recommended daily intake are
recommended
• Overdosage of vitamins maybe potentially harmful
• Male smokers study in Finland showed that Vitamin E
supplementation decreased the incidence of prostate cancer
by 32% and the mortality related to prostate cancer by
41%. Beta carotene (Vit A) increased risk of lung cancer
• Finasteride/Proscar prevented prostate cancer and reduced
the risk by 25%
• Selenium and Vit E trial completed and no benefit noted.
Systemic Therapy in Treatment of
Prostate Cancer
– Discuss use of systemic therapy in metastatic
prostate cancer to
a} Prolong life
b}Palliation or symptom control
– In locally advanced prostate cancer, the goal is
to improve cure rate and keep long term
toxicity to a minimum
Development of Hormonal Escape
Cell numbers
Deprive
androgen
Androgen-independent
cells take over
Responsive
Dependent
Independent
Time
Prostate Cancer. London, England: Times Mirror International Publishers Ltd;1996:143.
Metastatic Disease
• Therapy in hormone refractory
disease
• Supportive care and palliation
options: Currently approved
–Chemotherapy
–Bisphosphonate therapy
–Radioisotope therapy
“Fighting Cancer: It’s All We Do.”™