Advanced prostate cancer is cancer that has spread from the prostate to other parts of the body such as the bones. This is also known as secondary cancer. This is not curable but can be slowed down and managed with various therapies.
What symptoms can I have with advanced prostate cancer?
Some men with advanced prostate cancer have no symptoms. Other symptoms can vary between men but may include the following:
- Pain in the back, bones or joints
- Weight loss
- Blood in the urine (haematuria)
- Weakness in the legs
How do I know if I have advanced prostate cancer?
Prostate cancer is diagnosed by a prostate biopsy. If this confirms prostate cancer, the presence of advanced prostate cancer may be diagnosed by a very high PSA test, a prostate MRIor a nuclear medicine bone scan.
What treatments are available?
Hormone therapy is the main treatment for advanced prostate cancer. Testosterone, the male hormone made by the testes, is required for prostate cancer to grow. Cutting off the testosterone supply to the cancer causes it to regress and relieves many of the symptoms.
Hormone therapy may be undertaken in several ways:
- Orchidectomy (surgical removal of the testes)
- LHRH agonists (goserelin, leuprorelin) given as 3 or 4 monthly injections
- Anti androgens (bicalutamide, flutamide, cyproterone) as daily tablets
What are the side effects of hormone therapy?
Some side effects of hormone therapy may include:
- Hot flushes
- Weight gain
- Tiredness and lethargy
- Reduced activity
- Loss of libido
- Erectile dysfunction
Hormone therapy also reduces the strength of your bones which may make them more likely to fracture with a fall or accident. There is also some evidence that hormone therapy may increase the risk of heart disease.
How long will hormone therapy work for?
Hormone therapy is very effective in controlling advanced prostate cancer. We can monitor your response by checking your PSA levels, which should fall to a low level. Eventually, some prostate cancers will become resistant to hormone therapy and the PSA will begin to rise again. This is known as hormone refractory prostate cancer. How long hormone therapy will work for is difficult to predict and varies greatly between individual men. Some men live for many years on hormone therapy.
Are any other treatments available?
There are a few other treatment options used in special circumstances:
- Radiotherapy may be used to treat a deposit of cancer in bone that is either causing significant symptoms, or is in a vulnerable area such as the thigh bone or backbone
- Chemotherapy (doxetaxal) may be used to treat symptomatic hormone refractory prostate cancer
- Bisphosphonates (zolendronic acid) may be used to increase the strength of your bones if they are significantly weakened by hormone therapy
Should I participate in a trial?
There are many new treatments for advanced prostate cancer being developed which are not yet readily available. New drugs such as Abiraterone are currently being investigated. Being in a trial is the only way to access these new therapies and your participation will help other men with the condition in the future. To enquire about clinical trials please visit the clinical trial website: http://www.anzctr.org.au/trialSearch.aspx