Prostate Cancer Forum Dr. Gina Vaccaro Duke Hematology/Oncology of Raleigh Prostate Gland Gland found only in men Sits below the urinary bladder, in front of the rectum Normal size of the gland is walnut-size Cells in the prostate make fluid contained in seminal fluid which nourishes sperm Anatomy of the Prostate Gland Prostate Cancer Overview Prostate cancer only affects men Most common type of cancer in American men ACS estimates that there will be 230,900 new cases of prostate cancer in 2004 29,900 men will die of the disease in 2004 Prostate Cancer Overview 1 in 6 men will have prostate cancer in their lifetime 1 in 32 men will die of this disease Death rate from prostate cancer is decreasing Prostate cancer is being discovered in earlier stages (70-80% of cases are confined to the prostate) Risk Factors for Prostate Cancer Age (70% over the age of 80) Race (more common in African-American men, 2x more likely to die of the disease) Nationality (North America, NW Europe vs. Asia, Africa, Central and South America) Family History (1st degree relatives, father or brother) Risk Factors for Prostate Cancer Diet (Red Meat, high fat dairy products may increase risk. Diets high in fruits, vegetables, grains may decrease risk.) Exercise (Exercise and maintaining a healthy weight may decrease the risk) Early Detection is Critical Early stages of prostate cancer can be cured Advanced stage of prostate cancer is incurable Early Detection/Screening Digital Rectal Exam PSA (prostate specific antigen) Good screening tests: Convenient Inexpensive Early Detection/Screening Consider annual PSA screening for men (ACS, NCCN, AUA, ACR) >50 yo with estimated survival >10 yrs >40 yo with family history or black men Under Investigation PSA Density PSA Velocity % Free PSA Prostate Cancer Localized vs. Metastatic (Spread to distant site) Localized Prostate Cancer Surgery Radiation Therapy Watchful Waiting No clear cut evidence of superiority of any treatment approach over another Metastatic Prostate Cancer Prostate cancer that has spread to distant sites Considered treatable, not curable #1 Bone #2 Visceral Sites (liver, lung, soft tissues) Metastatic Prostate Cancer (Symptoms) Bone Pain Weight Loss Urinary obstruction Lymph node enlargement Evidence of cancer in liver, lungs Metastatic Prostate Cancer Treatment Metastatic Prostate Cancer Male hormones (testosterone, androgens) are critical to growth of prostate cancer Hormonal therapy is 1st line therapy 60-70% patients will normalize PSA <4 with hormonal therapy 30-50% of measurable tumor masses will decrease by half or more 60% patients will experience improvement in symptoms (bone pain, urinary obstruction) Hormonal Therapy Options Orchiectomy (Surgical Castration)- surgical removal of the testes which produce 95% of the body’s testosterone Medical Castration (LHRH analogs)- prevents testosterone production by the testes Antiandrogens- block the action of testosterone on the prostate (5% androgens produced by adrenal gland) LHRH Analogs Goserelin (Zoladex®) Leuprolide (Eligard™, Lupron®, Viadur™) Available as an injection every month, every 3 months, every 4 months Castrate levels of testosterone attainable in few weeks. Combined Androgen Blockade Blocks androgen production from the testes (95%) and the adrenal glands (5%) LHRH + antiandrogen (flutamide, bicalutamide, nilutamide Have not been shown to be superior to LHRH therapy alone Higher cost and more side effects than LHRH therapy alone Hormonal Therapy Hormonal Therapy is effective for an average of 2 years. Patients may experience new or worsening symptoms, or a consistent elevation of the PSA at some point in the disease course. Other therapies will be needed to improve symptoms of the disease. This is termed Hormone Refractory Prostate Cancer (HRPC). Hormone Refractory Prostate Cancer Some patients may respond to 2nd line hormonal therapy. Response rates vary from 20-60% Improvement is usually temporary. Patients who progress after further hormonal manipulation may be candidates for chemotherapy. Chemotherapy for HRPC Powerful, potentially toxic therapies that kill rapidly dividing cells (cancer and some normal cells) Given orally or intravenously FDA-approved agents prior to 2004: Mitoxantrone Estramustine Main benefit is improvement in pain with limited objective responses and NO Survival Benefit. Hormone Refractory Prostate Cancer Docetaxel (Taxotere®) Chemotherapy widely used for breast, lung, and other cancers Early studies demonstrated activity in HRPC Recent study has shown a SURVIVAL BENEFIT TAX 327 1006 patients in 24 countries with HRPC were randomized to one of three chemotherapy regimens: Docetaxel every 3 weeks (with prednisone) Docetaxel every week (with prednisone) Mitoxantrone every 3 weeks (with prednisone) TAX 327 Patients who received Docetaxel every 3 weeks (with prednisone) experienced: Improvement in median survival of 2 months (18.9 vs. 16.5 months) Greater PSA decline (45% vs. 32%) Improvement in Pain (35% vs. 22%) Side effects were managable with no reported deaths due to the treatment. Conclusions Early Detection of prostate cancer is crucial as for other cancers. Treatment depends on the extent and location of the disease. Surgery, radiation therapy are therapeutic tools for localized prostate cancer. Hormonal therapy is effective for metastatic prostate cancer. Now have a chemotherapy option in HRPC which improves survival and symptoms.