The VA Offers Treatment For Advanced Prostate Cancer
- Military veterans diagnosed with prostate cancer can receive care through the VA healthcare system.
- Prostate cancer that spreads to other parts of your body is also known as metastatic prostate cancer.
- Metastatic castration-sensitive prostate cancer (mCSPC) is a type of cancer where the lesion is fueled by the male hormone, testosterone. Also known as hormone-sensitive, it is typically treated with androgen deprivation therapy (ADT).
- Metastatic castration-resistant prostate cancer (mHSPC) has spread and progressed further and is no longer controlled by hormone blocking medications and may respond to an array of other treatments.
One of the first things you may realize is that not all prostate cancer is the same. Understanding your particular diagnosis is important. This is especially true if you have metastatic cancer, the type of cancer that has spread beyond the prostate to other parts of the body. This type of disease requires more treatment and follow up than cancer that has not spread beyond the prostate.
Read MoreCastration-Sensitive Prostate Cancer (mCSPC)
Metastatic castration-sensitive prostate cancer responds to therapies that lower testosterone levels, the male hormone that fuels cancer growth.“They [the prostate cancer] rely on testosterone,” Garraway explains. “They’re addicted to testosterone in order to grow and survive.”
You may also hear this type of cancer referred to as hormone-sensitive prostate cancer. The two terms essentially mean the same exact thing.
The goal of treatment for this type of cancer is to lower testosterone levels to very low (castrate) levels to slow cancer growth or even shrink tumors.
The backbone of treatment for this diagnosis is usually androgen deprivation therapy (ADT), also known as medical castration. It can be paired with other kinds of therapies depending on factors like where the cancer has spread and how fast it may progress.
“We give patient medications that block the testosterone and the action of testosterone on that tumor. That really works very, very well. And that treatment is effective sometimes for years,” Garraway says.
ADT) is given through injections or oral medications. Injection forms are typically given every one to six months. Oral medications are usually taken daily.
Doctors can also perform surgery to remove the testicles, a procedure known as “orchiectomy” or castration. However, most doctors will recommend trying medications before considering surgery.
Related: Deep Concern For The Nearly Half A Million Veterans Who Have Prostate Cancer
The duration of ADT varies depending on the stage and aggressiveness of prostate cancer. It can go on for a few months to several years — or even a lifetime in some cases.
ADT is effective in slowing down or shrinking prostate cancer tumors, especially in hormone-sensitive cases. However, its effectiveness varies among individuals, and it is often used in combination with other treatments like radiation therapy.
Regular check-ups, PSA blood tests, and imaging studies help monitor how well treatment is working. Potential side effects include hot flashes, fatigue, and loss of libido.
Metastatic Castration-Resistant Prostate Cancer (mCRPC)
While ADT can be highly effective initially, some cancer cells may eventually adapt and become resistant to low testosterone levels. This phase is referred to as castration-resistant prostate cancer. This means that the cancer no longer responds to testosterone-lowering therapies.
“…eventually cancer cells adapt and they learn how to grow in a really low to no testosterone environment. And at that phase,… these cancers are no longer sensitive to testosterone, or they can grow even with really low levels of testosterone in the body,” Dr. Garraway explains.
Usually, doctors will make this diagnosis when a PSA test comes up elevated despite hormone treatment. But it may also show up on scans or through worsening symptoms.
Garraway says it’s important to diagnose castration-resistant prostate cancer because there are specific treatments that can help that aren’t necessarily used for other states of the disease. Treatments may include:
- Androgen Deprivation Therapy: This involves a newer class of medications that further suppress androgen (testosterone) signaling, targeting the androgen receptor directly. It is often prescribed when traditional ADT is no longer effective. Side effects may include fatigue, bone density loss, hot flashes, and potential cardiovascular issues. It can provide extended control of the cancer and improved quality of life.
- Chemotherapy: Chemotherapy drugs like docetaxel or cabazitaxel are used to target rapidly dividing cancer cells throughout the body. Chemotherapy is typically considered when mCRPC has progressed despite hormonal therapy. Potential side effects include fatigue, nausea, hair loss, and an increased risk of infection. Chemotherapy can help slow cancer progression and alleviate symptoms.
- Immunotherapy: Sipuleucel-T is an immunotherapy given by infusion that stimulates the patient’s immune system to target prostate cancer cells. It is considered for patients who have few symptoms of mCRPC but who are not responding to other treatments. Side effects may include fever, chills, and flu-like symptoms. Immunotherapy can extend survival in some patients.
- Targeted Therapies: Targeted therapies like abiraterone and enzalutamide focus on specific molecular pathways involved in cancer growth. These medications are often used when mCRPC progresses after hormonal therapy. Side effects may include fatigue, hypertension, and mineral imbalances. Targeted therapies can delay cancer progression and improve quality of life.
- Radiopharmaceuticals (Radium-223): Radium-223 is a radioactive drug that targets bone metastases, delivering radiation directly to cancer cells in the bones. It is considered for patients with bone metastases and mCRPC. Side effects may include bone pain, nausea, and an increased risk of fractures. Radium-223 can help manage bone-related symptoms and improve survival.
- Pluvicto: A new type of radiation therapy given by injection that targets a molecule called PSMA on the surface of prostate cancer cells has recently been FDA-approved for mCRPC. Pluvicto is used along with a specialized scan that helps identify the cancer cells that are PSMA-positive. It delivers a high dose of radiation to the PSMA-positive cancer cells, while sparing the normal cells, and can improve survival and quality of life.
Related: Pluvicto Provides Hope For Veterans with Metastatic Prostate Cancer
Unfortunately, this is a more advanced form of disease and yields a poorer prognosis. This type of prostate cancer often requires aggressive treatments including chemotherapy.
Clinical trials: What are they and should you consider enrolling?
A clinical trial is a research study that uses real patients to assess the safety and effectiveness of new medical treatments or interventions.
Sometimes, joining a clinical trial is a good decision.
Every life-saving or life-extending treatment that’s available today for cancer was tested in a clinical trial. It helps doctors better understand cancer, and discover safer and more effective ways to treat it. Clinical trials also give patients a chance to try a treatment before it’s approved by the U.S. Food and Drug Administration (FDA).
Clinical trials can give patients access to incredible new therapies or, as some doctors like to say, “tomorrow’s medicine, today”.
If you’re considering a clinical trial, talk to your care team at the VA. They can help you identify and enroll in a study that’s right for you. You can also check out SurvivorNet’s Clinical Trial Finder.
Learn more about SurvivorNet's rigorous medical review process.
