People Living with Cancer

Transcription

1 Patient Guide ASCOInformation for People Living with Cancer HORMONE THERAPY FOR ADVANCED PROSTATE CANCER Recommendations of the American Society of Clinical Oncology

2 Welcome The American Society of Clinical Oncology (ASCO) is the world s leading professional society of multidisciplinary physicians who treat people with cancer. ASCO s more than 20,000 members from the United States and abroad set the standard for patient care worldwide and lead the fight for more effective cancer treatments, increased funding for clinical and translational research, and, ultimately, cures for the many different types of cancer that strike an estimated 10 million people worldwide each year. ASCO publishes the Journal of Clinical Oncology (JCO), the preeminent, peer-reviewed, medical journal on clinical cancer research, and produces People Living With Cancer ( an award-winning website providing oncologist-vetted cancer information to help patients and families make informed healthcare decisions. To help doctors give their patients the best possible care, ASCO asks its medical experts to review the latest research on issues in cancer care and develop recommendations called clinical practice guidelines. To help patients understand their cancer care, ASCO created this patient guide, based on the guideline ASCO s experts developed to help men with prostate cancer. As you read this guide, please keep in mind that every person treated for cancer is different. These recommendations are not meant to replace your or your doctors judgment. The final decisions you and your doctors make will be based on your individual circumstances. Information in ASCO s patient education materials is not intended as medical advice or as a substitute for the treating doctor s own professional judgment; nor does it imply ASCO endorsement of any product or company.

3 What is prostate cancer? Prostate cancer is a malignant tumor that begins in the prostate gland of men. More than 95% of prostate cancers are adenocarcinomas, cancers that develop in glandular tissue. Another important type of prostate cancer is known as neuro-endocrine or small cell anaplastic cancer. This type tends to spread (metastasize) earlier, but does not produce prostate-specific antigen (PSA), a tumor marker that can be used to screen for prostate cancer or determine if prostate cancer has recurred (come back) after treatment. The prostate is a walnut-sized gland located behind the base of the penis, in front of the rectum and below the bladder. It surrounds the urethra, the tube-like channel that carries urine and semen through the penis. The prostate s main function is to produce seminal fluid, the liquid in semen that protects, supports, and helps transport sperm. Cancer develops when changes occur in DNA, the genetic material containing instructions for all types of cells. When DNA is altered, cell growth is no longer regulated by the processes that normally control cell birth and death, and tumors can form. Some prostate cancers grow very slowly and do not cause problems for years. Many men with slow-growing prostate cancer do not die from prostate cancer, but rather live with their disease. The cause of death is usually not from prostate cancer, but other causes. However, if cancer does spread quickly to other parts of the body, treatment can help eliminate the cancer, and also control pain, fatigue, and other symptoms, and may prolong life. Prostate cancer is somewhat unusual in that many patients with very advanced, metastatic cancer will respond to treatment and survive in excellent health for many years. 1

4 What is advanced prostate cancer? Advanced prostate cancer includes metastatic, progressive, or recurrent disease. Metastatic cancer is cancer that has spread from its place of origin, such as the prostate, to surrounding structures within the body, including the lungs or the bones. Progressive cancer is cancer that grows and becomes more aggressive. Recurrent cancer is cancer that has recurred (come back) after it has been treated. In the case of recurrent prostate cancer, it may come back in the prostate area again or in other parts of the body. What is androgen-sensitive prostate cancer? When prostate cancer growth can be controlled by hormone therapy, it is called androgen-sensitive, or androgen-dependent. Hormone therapy involves reducing the body s ability to produce male sex hormones (androgens), mainly testosterone. This guide discusses the use of hormone therapy for advanced, androgen-sensitive prostate cancer. If the prostate cancer develops the ability to grow without the presence of male sex hormones and the hormone treatments stop working, it is called androgen-independent, or hormonerefractory prostate cancer, for which radiation therapy or chemotherapy may be able to offer some significant benefit to patients. 2

5 Hormone therapy for prostate cancer Since prostate cancer growth is driven by male sex hormones known as androgens, reducing levels of these hormones can help slow the growth of the cancer. Hormone treatment is also called androgen ablation or androgen deprivation therapy (ADT). The most common androgen is testosterone. The production of testosterone can be reduced either surgically, with removal of the testicles (called surgical castration or orchiectomy), through the use of drugs that turn off the function of the testicles, called luteinizing hormone-releasing hormone (LHRH) agonists, or by using drugs that block the testosterone from interacting with the body, called anti-androgens. LHRH agonists are usually given as injections once every three months and are designed to reduce the body s production of testosterone by interfering with hormonal control mechanisms within the brain, including functioning of the testicles. Anti-androgens are tablets taken by mouth, usually one to three times per day. Hormone therapy is used to treat prostate cancer that has advanced after surgery and radiation therapy. More recently, hormone therapy has been used as the first component of treatment of large prostate tumors that have not spread. In these cases, hormone treatment can shrink the tumor before surgery or radiation therapy begins. 3

6 Side effects of hormone therapy Hormone therapy may cause significant side effects. Side effects generally go away after hormone treatment is finished, except in the case of orchiectomy, in which side effects may be permanent. With hormone therapy, men may commonly experience the side effects listed below. Consult your doctor for more information. Inability to get erections (impotence) Loss of sexual desire (loss of libido) Hot flashes (transient episodes of sweating and feeling hot) Enlarged breasts (gynecomastia); the breasts may be tender if treatment includes anti-androgens Weight gain Tiredness (fatigue) Weaker bones (osteoporosis) Rise in cholesterol (hypercholesterolemia) All men who have received LHRH agonists will have persisting hormonal effects after the drugs are discontinued. Usually it takes months before recovery is first noticed and it can be two years or more for a full recovery to occur. Older men, and those who take LHRH agonists for longer periods of time, usually have a slower and less complete recovery. 4

7 About the Expert Panel ASCO formed a panel of prostate cancer experts to establish a guideline for the treatment of men with metastatic, recurrent, or progressive (advanced) prostate cancer through the use of various forms of androgen deprivation therapy. The members included experts in medical oncology, radiation oncology, and urology with all representatives working in clinical medicine, clinical research, outcomes/health sciences research, or a related discipline. A patient representative was also included on the panel. The panel worked together using evidence from published medical studies and their own expertise, and formed their opinions by consensus (agreement from everyone in the group). 5

8 What are ASCO s recommendations? ASCO s recommendations for the use of hormone therapy for men with advanced androgen-sensitive prostate cancer are summarized below. 1. Surgical removal of both testicles (called bilateral orchiectomy) or drug treatment with LHRH agonists (called medical castration) are the recommended initial treatments for metastatic prostate cancer. Bilateral orchiectomy is a simple, cost-effective, outpatient procedure; however, the procedure commonly has a high psychological impact and is not reversible. Even though this is surgery, it is called a hormone treatment because it removes the main source of testosterone production, the testicles. Medical castration with LHRH agonists is an equally effective treatment but is costly. A full discussion between patient and doctor should take place in order to determine which treatment method is best for the patient. 2. While both methods mentioned above reduce the production of testosterone (called androgen deprivation therapy), the use of nonsteroidal anti-androgens (drugs that block the testosterone from interacting with the body) may be discussed as an alternative to both treatments (bilateral orchiectomy or medical castration with LHRH agonists). Nonsteroidal anti-androgens, most often taken daily in pill form, have been shown to be just as effective as bilateral orchiectomy or medical castration with LHRH agonists, but with fewer side effects particularly less impact on a man s libido (sex drive). 6

9 3. Combined androgen blockade (CAB) is the use of nonsteroidal anti-androgen therapy with orchiectomy (surgical removal of one or both testicles) or LHRH analogs to more completely reduce male hormones, and may involve small improvements in survival over just orchiectomy or LHRH analogs alone; however, CAB treatment is more expensive and side effects are more likely. Men seeking a potentially more aggressive approach, willing to accept the potential for increased side effects, should discuss the option of CAB treatment with their doctors. 4. Patients are encouraged to discuss their treatment options with their doctor. This includes a discussion about whether or not treatment should be started once the prostate cancer has advanced based on a rising blood test (called early deprivation therapy), or wait until symptoms arise (called deferred deprivation therapy). There is much debate in the medical community about when the treatment should be started, as there is no clear evidence that shows a survival advantage for starting treatment early, especially considering the side effects of the treatment(s). Therefore, patients are encouraged to discuss the risks versus benefits of both approaches with their doctor. 5. Intermittent hormone therapy is hormone therapy that is given for specified periods and then stopped temporarily according to a schedule. This is to prevent the cancer from becoming hormone refractory, or capable of growing without hormones. It has been proposed that intermittent hormone therapy may maintain hormone responsiveness for longer than standard continuous hormone treatment, and have fewer side effects since men can be off treatment for significant amounts of time. However, this concept is currently being tested in randomized clinical trials and is still considered experimental. Men interested in intermittent hormone therapy are encouraged to consult with their doctor regarding participation in a clinical trial. 7

10 Where can I get more information? The full guideline is published in ASCO s Journal of Clinical Oncology (J Clin Oncol Jul ). For a copy of the guidelines, visit call , or send an to: guidelines@asco.org. For more information about cancer, visit People Living With Cancer at ASCO s website for patients, families, and the public. For more information about advanced prostate cancer treatment, patients should speak directly with their doctor. 8

11 Resources Many organizations offer support to people with cancer and their families. Ask your doctor or call your local hospital to find out about such groups in your community. In addition, these organizations can provide information or educational materials about prostate cancer. American Cancer Society 1599 Clifton Road, NE Atlanta, GA ACS-2345 ( ) American Foundation for Urologic Disease 1000 Corporate Boulevard, Suite 410 Linthicum, MD CancerCare 275 7th Avenue New York, NY HOPE (4673) National Cancer Institute NCI Public Inquiries Office, Suite 3036A 6116 Executive Boulevard, MSC8322 Bethesda, MD CANCER ( ) 9

12 National Prostate Cancer Coalition th Street NW Washington, DC Prostate Cancer Foundation 1250 Fourth Street Santa Monica, CA CURE (2873) Us Too International, Inc. Prostate Cancer Education and Support 5003 Fairview Avenue Downers Grove, IL US TOO ( ) 10

13 A Commitment to Service Through charitable giving, friends of The ASCO Foundation can become partners in the effort to reach our goal: the progressive control and ultimate cure of cancer. Types of Giving Philanthropic funding of the educational programs is more important than ever. There are a number of ways to provide support for a better understanding and treatment of cancer. Unrestricted gifts provide the flexibility needed to move quickly in unexpected directions in research and clinical applications, and help to cover the costs of ASCO critical services that are not entirely financed by other support. Restricted gifts benefit specific programs of the donor s choosing in any of the ASCO initiatives in patient care and education. Tribute gifts can be made as memorial tributes, remembrance gifts, or as a way of honoring the Society s membership. For more information, please contact: Julia J. McCormack Executive Director, The ASCO Foundation 1900 Duke Street, Suite 200 Alexandria, VA mccormaj@asco.org 11

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16 1900 Duke Street, Suite 200, Alexandria, VA Phone Fax Toll Free Copyright 2004 American Society of Clinical Oncology For permissions information, contact ASCO s Intellectual Property Rights Manager at permissions@asco.org