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Fighting Cancer Its All We Do.
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Restoring Quality of LifeAndManaging Side
Effects

• Ulka Vaishampayan M.D.
• Chair, GU Multidisciplinary team
• Associate Professor Of Medicine
• Detroit Medical Center
• Wayne State University/ Karmanos Cancer
  Institute, Detroit MI.

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Metastatic Prostate Cancer

• Common site of spread- bones
• Incurable, likely terminal condition
• Morbidity significant as it can lead to bone
  pain,cord compression, fractures, urinary
  obstruction etc.
• Initial therapy with hormones which is effective,
  but temporary

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Metastatic disease hormone therapy

• Hormone therapy questions
• When to start?
• Continuous vs intermittent
• Which kind Lupron/Zoladex with casodex or
  casodex alone (50 mg daily) or high dose casodex
  150 mg daily
• Should we stop treatment when it stops working?
• What are the risks?

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Common Complications of Hormone Therapy

• Fatigue
• Metabolic syndrome- high blood sugar, high
  cholesterol
• Increased risk of heart problems in people who
  have heart disease
• Hot flashes
• Impotence
• Osteoporosis
• Gynecomastia and breast tenderness
• Mood swings
• Liver toxicity
• Diarrhea, nausea

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Strategies to address side effects of hormone
therapy

• Hormone therapy works by suppressing the male
  hormone/testosterone levels.
• Fighting the side effects
• -Increased Awareness
• -Stay active
• - Healthy diet
• Ask for medication therapy for hot flashes if
  bothersome.
• Consider intermittent hormone therapy if feasible
• Monitor cholesterol, blood sugars periodically.

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Supportive Care in Advanced Prostate Cancer

• Bone strengthening therapy
• Radiation
• Pain control therapies
• Chemotherapy/novel agents

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Zometa vs. Placebo in Hormone Refractory
Metastatic Prostate Cancer
Berruti et al, JNCI 2003
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Bisphosphonates for Treatmentof Bone Metastasis

• Frequency of skeletal complications due to bone
  metastasis

• Median time to first skeletal-related event
  compared with placebo

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Dietary factors

• Lycopene A minimum of 2 servings (1 cup) per
  week of tomato sauce can reduce the risk of
  development and progression of prostate cancer.
• Cruciferous vegetables at least five servings
  per week can decrease the risk of developing
  prostate cancer by 20.
• Green Tea may have possible protective effects
• A large study showed that too much calcium (over
  2000mg daily) can increase metastatic prostate
  cancer risk fivefold compared with those
  consuming lt500 mg daily- Health Professionals
  Follow Up study

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Dietary factors

• Vitamins within the recommended daily intake are
  recommended
• Overdosage of vitamins maybe potentially harmful
• Male smokers study in Finland showed that Vitamin
  E supplementation decreased the incidence of
  prostate cancer by 32 and the mortality related
  to prostate cancer by 41. Beta carotene (Vit A)
  increased risk of lung cancer
• Finasteride/Proscar prevented prostate cancer
  and reduced the risk by 25
• Selenium and Vit E trial completed and no benefit
  noted.

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Systemic Therapy in Treatment of Prostate Cancer

• Discuss use of systemic therapy in metastatic
  prostate cancer to
• a Prolong life
• bPalliation or symptom control
• In locally advanced prostate cancer, the goal is
  to improve cure rate and keep long term toxicity
  to a minimum

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Development of Hormonal Escape
Androgen-independentcells take over
Depriveandrogen
Responsive
Cell numbers
Dependent
Independent
Time
Prostate Cancer. London, England Times Mirror
International Publishers Ltd1996143.
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Metastatic Disease

• Therapy in hormone refractory disease
• Supportive care and palliation options Currently
  approved
• Chemotherapy
• Bisphosphonate therapy
• Radioisotope therapy

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Fighting Cancer Its All We Do.