Deferred hormone therapy (ADT) for in relapsing M0 (negative scans) prostate cancer patients is associated with prolonged overall survival (OS) measured from the time of local treatment, comparable to OS with salvage ADT in the contemporary experience.
Prostate cancer treatments, particularly hormone therapy (ADT) can have a significant effect on speeding up the process of thinning and weakening the bones. There are some available treatments (Zoledronic acid aka Zoladex and denosumab aka Xgeva) which are designed to slow down or reverse this process; however, they are known to have many adverse side effects themselves. These side effects can include severe fractures of the femur which could limit survival and cataracts. For this reason, these treatments are usually used later, when men become castrate resistant and metastatic.
The standard dose of abiraterone acetate (Zytiga) is 1,000 mg. taken on an empty stomach, however, when just 250 mgs are taken with food, it seems that for many men this lower dosage has the same activity as Zytiga at 1,000 mg without food.
Recently presented data has shown that there is a clinical improvement in median radiologic progression-free survival (rPFS) when olaparib (Lynparza) is used in combination with abiraterone (ZYTIGA) compared to abiraterone alone in men with metastatic castration-resistant prostate cancer (mCRPC).
The European Medicines Agency (EMA) has recommended that the use of Xofigo (Radium-223) be restricted. The restrictions, because of safety and efficacy concerns in men with castrate resistant prostate cancer (mCRPC), include that Xofigo can be used only after two other treatments have been taken; when other therapies cannot be used and not in combination with other 2nd line hormone therapies.
Initially being diagnosed with metastatic, or advanced prostate cancer is not great. Metastatic prostate cancer is not curable and will be terminal if you don’t die from another cause.
We now have a number of what we consider second-line treatments for prostate cancer, drugs like Zytiga, Xtandi and Taxotere (chemotherapy).
We are beginning to recognize the value of the early use of these second line drugs along with first line ADT for men who are initially diagnosed with metastatic prostate cancer.
Men with metastatic prostate cancer (mCRPC) who do not respond to hormone therapy (ADT) or who experience early progression (≤1year) have a poor prognosis. There is no consensus regarding the proper next therapy for these men.
There was a large meta-analysis recently published that compared the efficacy of abiraterone acetate (Zytiga), enzalutamide (Xtandi), cabazitaxel (Jevtana) and Radium-223 (Xofigo) in the treatment of castration-resistant, docetaxel-resistant metastatic prostate cancer.
Since abiraterone acetate (Zytiga) was approved for men with metastatic prostate cancer, it is well known that taking the drug with food in your stomach as opposed to having an empty stomach enhances the amount of drug that becomes active. Given the very high cost of Zytiga, many men have been tempted to take fewer pills along with a meal.
The European Medicines Agency (EMA) has recommended halting the use of the Xofigo (radium-223 dichloride) in combination with Zytiga (abiraterone acetate) and prednisone due to a possible increased risk of death and fractures.
The Food and Drug Administration approved the use of abiraterone acetate (Zytiga) with prednisone for men with high-risk, castration-sensitive, chemotherapy-naive metastatic prostate cancer, but there are some hitches and hurdles.
One of the most puzzling questions faced by men with advanced prostate cancer has to do with deciding which drug to take first, Zytiga (abiraterone) or Xtandi (enzalutamide)?
The FDA has been asked to expand Zytiga's label to allow its use to treat men with earlier stages of metastatic prostate cancer.