Stage IV prostate cancer is cancer that has spread or metastisized. Cancer metastases results from a primary prostate cancer tumor that has spread to other parts of the body such as the brain, lungs and liver via varying routes including circulatory, lymphatic system, or skeletal structure. Bone metastases causes severe pain and is characterized by a dull, constant ache with periodic spikes of pain. Prostate cancer frequently spreads to the bones. Watch our expert medical oncologist, Alicia Morgans, discuss treatment options for advanced prostate cancer.
Traditional treatment for metastatic prostate cancer has not included direct treatment of the primary tumor in the prostate. For men with new or recurrent metastatic prostate cancer, research from the CHAARTED trial found that men lived longer if they were treated with chemotherapy when they started hormone shots. Read more about the study here. Visit the ZERO newsroom for more prostate cancer news.
Watch as ZERO’s CEO, Jamie Bearse, discusses new prostate cancer treatment news:
Treatments for patients with metastatic prostate cancer are very new, with most of all have been approved within the last five years. These drugs work to control the cancer and include:
- Zytiga (abiraterone) —
- A treatment used with steroids to shut the adrenal glands while avoiding the effects of the adrenal glands being shut down and prolongs life. This drug can be used in men before chemotherapy.
- Xtandi (enzalutamide) —
- A treatment for use after chemotherapy or for men who are not candidates for chemotherapy. It’s able to block androgen receptors to slow the production of testosterone without the use of a steroid. A recent study (January 2014) showed that Xtandi prolonged lives and delayed tumor progression when used before chemotherapy.
- Xgeva (denosumab) —
- Developed from federal funds secured by ZERO, Xgeva is a fully human monoclonal antibody that targets RANKL or proteins in the skeletal system that acts as a primary signal for bone removal. In many bone loss conditions, RANKL overwhelms the body’s natural defenses against bone loss and destruction.
- Xofigo (radium Ra 223-dichoride) —
- A recently approved drug for use in patients with metastatic prostate cancer, Xofigo delivers a punch of radiation intravenously. The therapy is attracted to the cancer cells in the bone and operates on a short-wave alpha stream that causes less damage to healthy tissue during treatment while slowing progression and giving some relief to bone pain for a certain length of time.
- Provenge (sipuleucel-T) —
- To date, only one immunotherapy has been developed and approved by the FDA for prostate cancer, Provenge. Men with asymptomatic metastatic hormone resistant prostate cancer are the main candidates for this treatment that aims to weaken cancer cells and enables the patient’s immune system to attack them. Specifically, Provenge stimulates the immune system to recognize certain proteins that are found in the vast majority of all prostate cancer cases. Doses of Provenge need to be prepared for each individual patient. Studies show a 4.5 month avenge life-span extension with the treatment.
- Rubraca (Rucaparib) —
- A recently FDA approved, first in its class PARP inhibitor for metastatic, castration-resistant prostate cancer patients. It has shown positive results in studies for patients with deleterious BRCA mutations. As a PARP inhibitor, Rubraca works to block cancer cells from repairing their damaged DNA. Rubraca is the first drug of its kind for prostate cancer, and is authorized for patients with highly advanced disease. Patients that have been treated with no or limited success via androgen receptor-directed therapy and chemotherapy have another option.
- Olaparib (Lynparza)–
- The FDA recently approved this PARP inhibitor for patients with metastatic castration-resistant prostate cancer (mCRPC). Olaparib is targeted to patients who have deleterious or suspected deleterious germline or somatic homologous recombination repair (HRR) gene mutations and have progressed following prior treatment with a new hormonal agent.
To learn more about the types of treatment, such as hormone and radiation, available for prostate cancer, visit the treatment section of our website.
Listen to our archived webinar Managing Advanced Prostate Cancer as Dr. Beer from Oregon Health & Science University addresses a range of topics including defining advanced prostate cancer, determining disease stages, identifying treatment options, and managing side effects.
Clinical Trials for Advanced Disease
Clinical trials are investigational studies that are conducted to find new treatments in the fight against prostate cancer. The drug development process can take many years and is well regulated by federal agencies. Many times, participation in a clinical trial is a way to receive a promising new drug that has not yet been approved by the FDA. Several new drugs are currently under investigation for advanced prostate cancer. Click here for more information about clinical trials, including those that are recruiting participants.