Monday, May 19, 2014

Managing salvage treatments for advanced prostrate cancer

Prostrate Cancer Research Institute featured an interview  on “Living with advanced prostrate cancer” with Dr Mark Scholz from Prostate Oncology Specialists. Dr Scholz’s approach to salvage treatments are precise and effective.

Below are some extracts of the interview.

Men with advanced prostate cancer tend to live longer than men with other types of cancer. One major reason is because prostate cancer doesn’t usually spread to critical organs like the brain, the liver or lungs.  Another reason is the availability of so many effective treatments.
Men with ROYAL BLUE (advanced prostrate cancer) who have never had hormone therapy should start testosterone inactivating pharmaceuticals (TIP) beginning with Lupron and Casodex in combination.
Men who have become resistant to Lupron should take Provenge to boost their immune system. Studies show that Provenge works better when treatment is started as early as possible.
Potent medications to strengthen the bones —Xgeva and Zometa—are  routine treatment for bone metastases. There have three benefits: Inhibiting cancer growth in the bones, reducing bone pain; and counteracting calcium loss caused by hormonal therapies.
After Provenge men in ROYAL BLUE the first step should be to stop Casodex and start one of the following three options:
1. Second-line TIP such as Zytiga or Xtandi
2. Chemotherapy with Taxotere or Jevtana
3. Xofigo, a form of injectable radiation
Three additional treatment options can be considered if these first three options are no longer effective:
1. Combination chemotherapy using Carboplatin or Xeloda with a Taxane or the combination of both Revlimid and Avastin added to a Taxane.
2. The “off label” use of XL-184, a medication being researched for prostate cancer but already FDA-approved to treat thyroid cancer
3. Other investigational medications
Fatigue is one of the biggest challenges faced by men in ROYAL. Stimulants such as Provigil or Nuvigil may be helpful, but the most important priority is consistent, diligent exercise. An aggressive and imaginative treatment plan should be designed that has the specific goal of attaining and maintaining a complete remission.
The above extracts are taken from Prostrate Cancer Research Institute. Read the whole interview here.

Take care

Allen Lai

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