Dr. Richard Frank—

There is good news on the prostate cancer front. Whereas men first diagnosed focus on whether or not to treat the disease and if so, whether to use surgery or radiation, many will also have to receive treatment when the PSA rises or the disease turns metastatic years down the road. This is where the new progress has been.

Within only the past year, the FDA has approved a new cancer vaccine (Provenge), a new chemotherapy drug (Jevtana) and a new hormone therapy (Zytiga) to treat the advanced stages of prostate cancer, which typically involves metastases to the bones and abdominal lymph nodes. Previously, oncologists prescribed chemotherapy when hormone therapies stopped working. Now, they can prescribe Provenge if the cancer is not causing pain and hope to stave off the initiation of chemotherapy for some time. Once chemotherapy is needed, the main drugs previously available were docetaxel (Taxotere) and mitoxantrone (Novantrone). Now, most oncologists will use Zytiga and then Jevtana after Taxotere stops being effective. These new advances will undoubtedly lead to prolonged survivals for many men battling stage IV prostate cancer.

Another recently announced advance affects even more men, the 30% of men treated for local prostate cancer who will subsequently experience a rise in the PSA years before the development of metastatic disease. Traditionally, urologists have administered testosterone blocking medicines such as Lupron, which can lower the PSA for years. Unfortunately, the big side effect of these medicines is impotence; other side effects include hot flashes, bone thinning, loss of muscle mass, loss of body hair, increased risk of heart disease and gynecomastia (growth of breast tissue in men). A recent study showed that when the PSA rises after initial therapy and androgen blockade is used, these injections can be given intermittently rather than continuously without interruption. This means that  testosterone can rise at times, allow potency and improved quality of life, but not affect overall survival. Intermittent hormone ablation therapy will greatly improve the quality of life of men with prostate cancer.

Richard C. Frank, M.D., is director of cancer research at the Whittingham Cancer Center of Norwalk Hospital, medical director of Mid-Fairfield Hospice, and Clinical Assistant Attending at Weill Cornell Medical College. He has been appointed cancer expert for WebMD and was named a “Top Doc” in the New York Metro area by Castle and Connelly.

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