Systemic Therapies

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Medical oncologist Dana Rathkopf (right) cares for men with advanced disease.

Medical oncologist Dana Rathkopf (right) cares for men with advanced disease.

Metastatic prostate cancer is cancer that has spread to other parts of the body. We have more treatment options for metastatic disease than ever before. There are treatments for prostate cancer that already has metastasized (spread) at the time you are diagnosed. There also are options if it metastasizes after treatments, such as radical prostatectomy surgery or radiation therapy.

Drugs that treat metastatic prostate cancer are called systemic therapies. These drugs move throughout your body to attack cancer cells wherever they are. There are now 11 systemic therapy drugs that help people who have metastatic prostate cancer live longer lives. Other treatments can reduce the side effects of metastatic disease. Given together, these systemic therapies help people with metastatic prostate cancer live longer, better lives.

Our medical oncologists expertly determine which systemic treatments, or mix of treatments, are best for you. The most common treatments include:

 

Hormone Therapy

Hormonal therapy slows or blocks prostate cancer cells from growing. Testosterone is a male androgen sex hormone. It’s 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 normal 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.

If you have a new diagnosis of hormone-sensitive prostate cancer, it means hormone therapy will be effective. There are many options for treatment, including a mix of therapies, that have been shown to lengthen life spans.

Some prostate tumors, however, become resistant 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.

For example, MSK oncologists led a large, international research study (clinical trial) of a very strong hormone therapy drug called abiraterone acetate (Zytiga). This drug blocks an important enzyme (protein) involved in making testosterone. It lowers the amount of testosterone in the tumor and in the blood. The drug has been shown to lengthen the lives of people newly diagnosed with hormone-sensitive prostate cancer. It has the same result in people with metastatic castration-resistant prostate cancer.

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 approved enzalutamide for men with castration-resistant prostate cancer. It is used both for cancers that are metastatic and non-metastatic.

Our doctors decide which treatments, and in what combination, are best for you. They base their decision on how fast the cancer is growing, its location, and your risk for the disease. We match the intensity of your treatment to your risk.

We may give you some of these drugs when you are first diagnosed with prostate cancer. We may use others only if the cancer came back (relapsed). Our medical oncologists have been involved with these drugs since they were first developed. They understand when it’s most helpful to use each drug.

Immunotherapy

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

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.

Systemic Radiation Treatments (Radiotherapies)

MSK is a leader in the field of radiotherapeutics. Radiotherapy (also called radiation therapy) uses high-energy radiation to damage cancer cells. Nuclear medicine is a type of radiology that uses very small amounts of radioactive materials. MSK medical oncologists (cancer doctors) and nuclear medicine doctors work as a team to offer radiation therapy to our patients.

An older drug called radium-223 (Xofigo®) is used to treat advanced prostate cancer with bone metastases (cancer that has spread to the bones). Radium-223 delivers a very strong form of radiation to bone metastases, which can lengthen life with few side effects.

A Promising New Therapy for Advanced Prostate Cancer
A new treatment that selectively seeks out prostate cancer cells shows great promise for treating advanced forms of the disease.

Newer radiation therapy treatments target prostate cancer cells instead of the surrounding bone. These drugs can treat bone metastases, as well as disease in other areas of the body. One treatment uses a type of radiation called 177Lu-PSMA-617. It is delivered to a prostate cancer protein called prostate specific membrane antigen (PSMA).

To tell if someone has enough PSMA on the prostate cancer for the treatment to work, we use a type of imaging study called a PSMA PET scan. If there is PSMA on the cancer, treatment with 177Lu-PSMA-617 can extend life, preserve quality of life, and prevent bone fractures. In 2022, the FDA approved this treatment for people who already had hormonal treatments and chemotherapy. MSK also has many clinical trials that research new radiopharmaceuticals (drugs that have a radioactive substance) for this disease.  

Other Systemic Treatments

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.