Some prostate cancer treatments reach cancer cells throughout the body. They are called systemic therapies, and mainly include:
- Hormone therapy
These treatments are mostly for metastatic prostate cancer. This is cancer that has spread, or metastasized, to other parts of the body.
Sometimes these therapies are used for prostate cancer that has not spread from the prostate gland. In this case, the treatments are combined with surgery or radiation if there are signs your tumor is aggressive.
Our doctors have extensive prostate cancer experience and will choose the treatments that will work best for you. They base their decision on how fast the cancer is growing, its location, your risk for the disease, and if it relapses (comes back). We match the intensity of your treatment to your risk.
Hormone therapy works by slowing or blocking prostate cancer cells from growing. Testosterone is a male sex hormone. It is made when hormones from your pituitary gland (a gland in your brain) cause your testes (testicles) to make sperm. Testosterone can cause prostate cancer cells to grow.
Hormone therapy lowers the amount of testosterone your testicles make. It also blocks the action of testosterone and other male hormones. These drugs can lower testosterone to a level similar to someone who had their testicles removed, a procedure called castration.
Your doctor may recommend hormonal therapy to:
- Decrease the size of your prostate before you start radiation therapy. This will help reduce the amount of healthy tissue that gets radiation.
- Make it easier for radiation to kill prostate cancer cells.
- Relieve pain.
- Slow the spread of the disease in advanced prostate cancer.
Types of Hormone Therapy for Prostate Cancer
Hormone-Sensitive Prostate Cancer Treatment
If you have a new diagnosis of hormone-sensitive prostate cancer, it means hormone therapy will work well. There are treatment options, including a mix of therapies, that can lengthen the lives of people with this disease.
Castration-Resistant Prostate Cancer Treatment
Some prostate tumors, however, become resistant (stop responding) to these drugs after months or years of treatment. This is called castration-resistant prostate cancer. There are more treatment options for castration-resistant prostate cancer than ever before.
A hormone therapy drug called abiraterone acetate (Zytiga™) can lengthen the lives of people with metastatic castration-resistant prostate cancer. MSK oncologists (cancer doctors) led a large, international research study, also called a clinical trial, to study the drug. They found that the drug blocks an important enzyme (protein) that helps make testosterone. It lowers the amount of testosterone in the tumor and in the blood.
MSK oncologists also led the first clinical trial of a drug called enzalutamide (Xtandi®). It blocks testosterone from binding to cancer cells. The U.S. Food and Drug Administration (FDA) approved enzalutamide for people with castration-resistant prostate cancer. It’s used both for cancers that are metastatic and non-metastatic.
Immunotherapy harnesses the power of the immune system to selectively target cancer cells. MSK has been a leader in developing immunotherapy treatments for many cancers.
The first immunotherapy treatment for men with advanced metastatic prostate cancer approved by the U.S. Food and Drug Administration (FDA) was sipuleucel-T (Provenge®). The drug is made by removing a person’s immune cells and then engineering them to fight prostate cancer cells. The immune cells are then put back into the body. This drug can help people with metastatic prostate cancer live longer.
More recently, MSK led a clinical trial of a type of immunotherapy called checkpoint inhibitors. Researchers studied the checkpoint inhibitor pembrolizumab (Keytruda®). They found that a small number of people whose metastatic prostate cancers have a specific genetic alteration respond to Keytruda. Genetic testing of the tumor can tell us if someone with prostate cancer is likely to respond to the drug.
We also are leading the development of new types of immunotherapy treatments. We are identifying different types of prostate cancer cells and activating the immune system against them. These drugs are available for people who joined our clinical trials.
Chemotherapy is medication that kills cancer cells, given by mouth or intravenous (put into your vein). It’s an important treatment option for prostate cancer that has metastasized (spread). Chemotherapy can lengthen life and reduce pain for people who have cancer that has spread to the bones. Docetaxel (Taxotere®) is considered the standard of care in chemotherapy for prostate cancer that is resistant to hormone therapy. It works by damaging the structure of prostate cancer cells.
The FDA also approved the chemotherapy drug cabazitaxel (Jevtana®) for treating castration-resistant prostate cancer. It’s also used by people with metastatic prostate cancer that has grown while they are taking docetaxel.
Many other systemic therapies are in the late stages of development. New drugs for prostate cancer are being developed at a quick pace. MSK medical oncologists are developing these new treatments. Our patients can join our clinical trials to access them.