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Prostate Cancer (cont.)

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Monoclonal antibody therapy

Denosumab (Xgeva) is a monoclonal antibody agent that inhibits the work of osteoclasts in a manner different from bisphosphonates. The medication inhibits a protein that tells the osteoclasts to remove bone. This drug is useful as a treatment for all of the conditions for which bisphosphonates are used. Given as an injection under the skin at intervals, it has a better side effect profile than the bisphosphonates. It does not require dose adjustments if kidney function deteriorates. It can still cause osteonecrosis of the jaw to occur. It is considered an important new drug in the treatment of bone metastases in prostate cancer patients. In some studies it appears to be more effective than Zometa in delaying the initial onset of skeletal-related events in patients with bone metastases.


The use of substances that are radioactive as a treatment for bone metastases has been tried for years. Strontium-89 and samarium-153 have been used in the past. They decrease pain in patients with prostate cancer with bone metastases but they do not prolong life; these medications lower levels of healthy blood cells in patients who receive them.

Recently a form of radium called Ra-223 (Xofigo) has been approved for use in prostate cancer patients with metastases to bone but not to other internal organs. Radium is like calcium and it migrates to bone where it acts locally. As an alpha emitter, radiation from radium does not travel far enough in the body to damage other healthy tissues. Unlike the bisphosphonates, the use of this agent reduces pain and can prolong survival. It is administered by an injection into a vein. It can cause nausea, diarrhea, and low blood counts.

Metastatic-castrate resistant prostate cancer

A patient is noted to have metastatic castrate resistant prostate cancer if the individual has progressive prostate cancer with metastases while on ADT. The individual should have a serum testosterone level obtained to make sure that it is at castrate level (< 50 ng/dL while on ADT). If the testosterone level is > 50 ng/dL, this would indicate that the source of the progression is inadequate androgen deprivation and alternative ADT should be considered. If the individual is determined to have a castrate level of testosterone on ADT with progression of disease on ADT, the individual is considered to have metastatic castrate-resistant prostate cancer. Over the past several years, a number of therapies have been approved for the treatment of metastatic castrate-resistant prostate cancer, including a new androgen receptor blocker, chemotherapy, immunotherapy/vaccine therapy, as well as bone-directed therapies. Though each of these therapies have unique ways in which they work and different side effects, all have been demonstrated to prolong survival. The sequencing of the various treatments (which should be used first) is not well defined at present. Sipuleucel-T, a vaccine immunotherapy, is approved for use early on in the time frame before one has significant symptoms. Studies are ongoing to evaluate the best sequence of treatments.

Medically Reviewed by a Doctor on 11/9/2016



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