NCCN Guidelines for Patients® | Prostate Cancer - page 67

NCCN Guidelines for Patients
: Prostate Cancer
Version 1.2014
Part 7: Treatment for advanced cancer
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For treatments other than sipuleucel-T, a drop in PSA levels or improvement
in imaging tests occurs if treatment is working. Be aware that these signs
don’t occur during sipuleucel-T. Thus, don’t be discouraged if your test
results don’t improve. After sipuleucel-T, the next treatment should be based
on any new symptoms and test results.
Besides sipuleucel-T, another treatment option is secondary ADT. Secondary
therapy includes abiraterone acetate that is taken on an empty stomach with
prednisone. This drug has been shown to slow cancer growth.
Compared to abiraterone acetate, other secondary ADT options have only
minor benefits. If your first ADT was surgical or medical castration, starting
CAB or switching to a new antiandrogen may help. If you’re already on
CAB, stopping your use of the antiandrogen—known as antiandrogen
withdrawal—may help if the cancer cells are using the antiandrogen to grow.
This effect is called the antiandrogen withdrawal response and usually lasts
several months. Ketoconazole, steroids, DES, and other estrogens may
help stop cancer growth by lowering testosterone levels. Enzalutamide is
a newer antiandrogen that may be more effective than currently available
antiandrogens. Enzalutamide is listed in the chart since it has been shown to
lower PSA levels and extend survival by an average of about 5 months.
The third and fourth options for metastatic castration-recurrent cancer
without symptoms are docetaxel and a clinical trial. Docetaxel is not often
used when there are no symptoms. However, your doctor may suggest it if
the cancer is growing fast or may have spread to your liver.
The sum of a list
of numbers divided by how
many are in the list
Clinical trial:
comparing new and current
treatments to find out which
is better
Imaging test:
A test that
makes pictures of the
insides of the body
Spinal cord suppression:
The bundle of nerves in the
spine is squeezed causing
Read Part 4 for more
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