What is advanced prostate cancer?
This is a somewhat broad term. I consider a patient to have “advanced prostate cancer” once their disease has progressed to a systemic, incurable state. This could range from biochemical recurrence following local treatment (i.e., PSA elevation as the only manifestation of disease) to diffusely metastatic castration-resistant disease.
What are the treatment options for advanced prostate cancer?
Androgen deprivation therapy (ADT) (i.e.,GnRH analogs); first generation anti-androgens (bicalutamide, nilutamide, etc.); next generation AR-directed agents (enzalutamide, abiraterone); chemotherapy (docetaxel, cabazitaxel); radiopharmaceuticals (Ra-223; samarium, etc.); immunotherapy (sipuleucel-t); and clinical trials involving experimental agents.
What are the common side effects for each treatment?
Any drug targeting the Androgen Receptor-axis (i.e., ADT, AR-antagonists, etc.) will result in a similar constellation of side effects. These include: hot flashes, loss of muscle mass, decreased bone health, decreased energy, breast tenderness/swelling, weight gain, increased risk of cardiovascular disease and increased risk of other metabolic derangements (e.g., diabetes).
Abiraterone can cause electrolyte disturbances, liver test abnormalities and edema. Enzalutamide has been associated with rare seizures. Taxane (i.e., docetaxel, cabazitaxel) can result in decreased blood counts, increased risk of infections (potentially life threatening), fatigue, neuropathy (numbness, tingling or burning) of the hands and feet, loss of appetite, edema and hair loss. Radiopharmaceuticals like Ra-223 mostly affect the blood cell counts, but can also cause some GI side effects. Sipuleucel-t is generally well tolerated. It can cause flu like symptoms around the time of the infusion (fevers and chills).
What are your recommendations for reducing or minimizing side effects?
Since all of the drugs affecting the AR-axis can increase the risk of cardiovascular disease, it is important to engage in aerobic exercise and eat a healthy diet. Working out with weights can also be helpful to combat the associated loss in muscle mass. Nothing has been shown to be very effective at controlling hot flashes. These do, however, typically get better over time. Keeping a fan on when you sleep can be helpful.
What can I do to maintain bone health in advanced prostate cancer?
Take vitamin D and calcium supplements. Weight bearing exercise can also be helpful. If you have more advanced prostate cancer, sometimes bone strengthening drugs are used to decrease the risk of fractures.
Are there dietary changes that I could or should make to optimize my treatment?
I typically recommend a heart healthy diet.
Should I consider joining a clinical trial?
Yes, this is the only way that new, better treatments are discovered.