Four Categories of Advanced Prostate Cancer [AIPC]
Advanced prostate cancer can be classified into four disease categories ranging from advanced prostate cancer confined to the prostate gland to prostate cancer that has spread to lymph nodes and bones.
1. Locally Advanced Prostate Cancer
Cancer that has grown to fill the prostate or has grown through the prostate and may extend into the glands that help produce semen (seminal vesicles), or the lymph nodes. Occurs in men who have been treated for early prostate cancer, but their PSA is rising. A bone scan and cat scan in these patients is usually shows no evidence of cancer. Cancer that has grown to fill the prostate or has grown through the prostate and may extend into the glands that help produce semen (seminal vesicles), or the lymph nodes. Occurs in men who have been treated for early prostate cancer, but their PSA is rising. A bone scan and cat scan in these patients is usually shows no evidence of cancer.
2. Biochemically Recurrent Prostate Cancer (Rising PSA)
Patients who have a rising PSA after treatment, but do not have any evidence of disease spread to bone or other organs. This can occur after local treatment, or after hormone therapy. The management of such patients is controversial, and may include investigational treatments, radiation therapy, or chemotherapy.
3. Metastatic Prostate Cancer (Hormone Sensitive)
Metastatic cancer is a form of prostate cancer that has spread (metastasized) to the bone, distant lymph nodes or other parts of the body. The growth of these cancers can be controlled with treatment and depletion of the male sex hormone, testosterone, results in an improvement of tumor related symptoms such as bone pain or inability to urinate.
4. Hormone Refractory Prostate Cancer
Hormone refractory prostate cancer is also known as castration-recurrent prostate cancer or androgen-independent prostate cancer. This is a type of prostate cancer that continues to grow despite the suppression of male hormones that fuel the growth of prostate cancer cells.
A team approach is very important for this type of prostate cancer and may include a urologist, a radiation oncologist, a medical oncologist, nurses, your family, patient navigators and others.
Before a diagnosis of advanced androgen-independent prostate cancer:
- Ensure your testosterone level is zero.
- Test your PSA level several times over several months to ensure there is a consistent rise in PSA over time.
- Perhaps adding a secondary hormonal therapy to the hormonal suppression therapy you may already be taking to try and control your PSA.
Secondary hormonal therapies could include:
- Antiandrogen withdrawl (AAW)
- Antiandrogen addition (Low vs. High)
- Estrogens (I.V., oral, transdermal…)
- Ketoconazole (Nizoral)
- Aminoglutethimide (Cytadren)
Bone Directed Therapies
When prostate cancer spreads beyond the prostate, it usually spreads to the bones first. Bone metastasis can be painful and can cause bone fractures, therefore controlling bone cancer and relieving pain and other complications is an important component of treatment. If cancer has spread to the bones, your physician may prescribe bone-directed therapies to slow cancer within the bone, reduce bone pain, and to strengthen bones.
Some drugs that are effective bone-directed therapies slow down a type of bone cell called osteoclasts. Osteoclasts normally break down the hard mineral structure of bones to help keep them healthy, however these cells can become overactive when prostate cancer spreads to the bones. These treatments can relieve bone pain, slow cancer that has spread to bones, and strengthen bones. Below is a list of common bone-directed therapies:
- Zometa (Zoledronic Acid)
- Xgeva (Denosumab)
- Prolia (Denosumab)
Corticodteroids and radiopharmaceuticals have also been shown to be beneficial against bone pain.
Some common side effects for bone-directed therapies include:
- Bone or joint pain