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When Treatment for Advanced Prostate Cancer Fails: What Can Be Done? Prostate Cancer Explained What PSA Really Means for Prostate Cancer

Prostate Cancer

Treating Fast Growing Prostate Cancers

Summary & Participants

All prostate cancers are not the same. Listen as doctors describe treatment options when they believe an early-stage cancer may be particularly aggressive.

Medically Reviewed On: July 05, 2008

Webcast Transcript

DANIEL P. PETRYLAK, MD: The third factor is the extent of the local disease, whether there is a high percentage of the prostate involved with tumor, also whether the prostate cancer has invaded into the seminal vesicles, or whether the prostate cancer has penetrated the capsule and is outside the surgical margins. These are other things that we look for in the pathology after the prostate has been removed.

ANNOUNCER: There are some newer techniques, too. One called PSA velocity, measures how the PSA count changes over time. Some doctors believe if PSA rises quickly, it may signal particularly dangerous disease. So, what can be done when these factors point to an especially aggressive cancer?

DANIEL P. PETRYLAK, MD: Firstly, if their lymph nodes are involved, we generally will recommend that the patient undergo hormone therapy. And there's been evidence that demonstrates that those patients who immediately receive hormone therapy after having their prostates out — and these are the patients with positive lymph nodes — will do much better and will live longer than those patients who do not receive the immediate hormone therapy.

ANNOUNCER: Following surgery or radiation not only with hormonal therapy, but also with chemotherapy and other treatments, may also prove to be effective. Right now, these approaches are under study.

JAMES A. EASTHAM, MD: What the newer trials will likely look at is combining those traditional methods with other strategy very early based on risk, not necessarily based on: Ah, he has cancer. But: He has a high risk of failing, even though we can't find anything with X-rays or even PSA, we're going to treat him with an additional therapy be it hormonal therapy, chemotherapy, biological therapy in order to enhance the cure rate.

ANNOUNCER: One set of preliminary data suggests the possible value of adjuvant chemotherapy.

DANIEL P. PETRYLAK, MD: There is a very small study of 96 patients; 48 of these patients had no evidence of cancer outside of the prostate. And what was done was they randomized patients to receive either hormone therapy or hormone therapy plus mitoxantrone-prednisone chemotherapy. And it seems that there is a better survival in those patients who receive the chemotherapy. But we have to be very cautious because it's a very small study, and we're currently doing a randomized trial of more than 1300 patients to see whether the survival advantage is true or not.

ANNOUNCER: Many doctors and researchers hope the future of prostate cancer treatment might become more similar to the treatment of other types of cancer.

JAMES A. EASTHAM, MD: Certainly the hope in prostate cancer is that we catch up to other cancers. That we learn as they have in breast cancer and in colon cancer that treating with combinations of therapies early on seems to provide the patient with more benefit.

ANNOUNCER: Given the limited knowledge the role of chemotherapy in treating prostate cancer, advances depend on participation in clinical trials.

JAMES A. EASTHAM, MD: My hope is that these results from the chemotherapy trials will encourage urologists, medical oncologists to consider enrolling their patients in these important clinical studies which are the only way to answer these questions. Get your patients, if they're at high risk, involved in one of these trials, so we can address what is the best way for a patient to be treated, to maximize cure and minimize toxicity.

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