Is Chemotherapy Used for Prostate Cancer Treatment

Is Chemotherapy Used for Prostate Cancer Treatment


Farshid Dayyani, MD: In certain circumstances,
chemotherapy might be appropriate to treat prostate cancer. Conventional chemotherapy has been tested
for decades in the treatment of early stage and advanced stage prostate cancer. So far,
we don’t have any evidence that using chemotherapy earlier in the disease, meaning before the
cancer has spread, will change anything in the patient outcomes meaning they don’t live
longer. Therefore, the majority of the use of conventional chemotherapy in prostate cancer
has been in the advanced setting when the cancer does not respond to hormone deprivation
anymore. This so called castration resistant state was very difficult to treat until about
2004. As a matter of fact, the only FDA approved chemotherapeutic drug until then was mitoxantrone
which did not prolong the patient’s life, but improved the pain level of the patient
and that’s how it was approved. In 2004, we had two large randomized trials showing us
an effect on overall survival with a drug called docetaxel which improved by about three
to four months the survival of the patients, so this was our main treatment for patients
with advanced prostate cancer over the past decade. More recently, a second drug cabazitaxel
which is related to docetaxel was approved for patients whose cancer does not respond
to docetaxel anymore. Again in this setting, the patients who received cabazitaxel lived
longer than those who received placebo. Now, we have more and more drugs coming in that
are not traditionally regarded as chemotherapeutic drugs. They are more biologic drugs that affect
testosterone signaling in the prostate cancer cells and are highly effective, so in 2013
we tended to use chemotherapy drugs later and later in the disease course given the
better tolerability of the newer drugs. Some prostate cancers are high risk, aggressive,
and more likely to spread. Others are low risk, least likely to have bad outcomes. The
biopsy says cancer, but current diagnostic tools provide limited information about how
aggressive a man’s individual disease is, so most men decide to treat prostate cancer
immediately. Once treated, many men experience serious long-term side effects like incontinence
and sexual impotence. Immediate treatment is not always needed, but right now a man
can’t be sure if his cancer is the kind that is likely to require treatment or if he is
okay to wait for now. What if there was a test that could determine how aggressive prostate
cancer is. Genomic health is developing a new test to do just that. By reviewing the
underlying biology of the tumor and using genes from multiple biologic pathways, the
test can predict the aggressiveness of prostate cancer when diagnosed, allowing a man to make
a more informed treatment decision with confidence, taking care of himself with more information
and greater peace of mind.

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