NCCN Guidelines for Patients® | Prostate Cancer - page 69

NCCN Guidelines for Patients
: Prostate Cancer
Version 1.2014
Part 7: Treatment for advanced cancer
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Mitoxantrone is a chemotherapy drug that is given with
prednisone. It may improve your quality of life, but it
isn’t likely to increase how long you will live. Abiraterone
acetate taken on an empty stomach with prednisone or
enzalutamide may also be considered if you can’t take
chemotherapy. However, research on their use prior to
docetaxel among men with symptoms from metastases
isn’t finished.
If you have pain from bone metastases, radiation therapy
used as supportive care may help. EBRT may be used
when pain is limited to a specific area or your bones are
about to fracture. Radiopharmaceuticals 89Sr (strontium)
or 153Sm (samarium) may relieve pain from widely spread
bone metastases that isn’t responding to other treatments.
Be aware that these treatments can cause your bone
marrow to make fewer blood cells, which could prevent
you from being treated with chemotherapy. Besides EBRT
and radiopharmaceuticals, your doctor may suggest other
types of supportive care.
Another option is to take part in a clinical trial. A clinical
trial is a type of research that studies how well a treatment
works. Because of clinical trials, the treatments in this
booklet are now widely used to help men with prostate
If docetaxel fails, there is no strong agreement on what
is the next best treatment. Abiraterone acetate taken
on an empty stomach with prednisone or enzalutamide
has been shown to slightly prolong life when used after
docetaxel. Similar results were found with cabazitaxel
plus prednisone. However, cabazitaxel can cause severe
side effects so close monitoring is needed. You shouldn’t
use cabazitaxel if you have liver problems. New research
also supports the use of radium-223 if you have painful
bone metastases. After docetaxel fails, your doctor may
want you to take docetaxel again. This is called docetaxel
Whether you took docetaxel or not, other
recommendations include chemotherapy and secondary
ADT. If you can’t take a taxane-based chemotherapy like
cabazitaxel, mitoxantrone with prednisone is an option.
Mitoxantrone and other chemotherapy drugs haven’t
extended the lives of men after docetaxel failure but may
help you feel better by reducing symptoms.
Joining a clinical trial is strongly supported. The
recommendations listed in the chart have limited benefits.
A clinical trial may give you access to new treatments.
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