Treating castration-resistant prostate cancer
As discussed above, after long-term use, hormone therapy loses its effectiveness. Because the cancer continues to grow even where the level of testosterone is comparable to that after castration, this is known as ‘castration resistance’.
In addition to chemotherapy, other, highly effective treatment options for treating this stage of the disease are available. These are aimed at exploiting the cancer’s residual sensitivity to male sex hormones, very low concentrations of which are still present. Once again, recent studies have shown that, in selected cases, early use of these treatments (while the cancer is still at the hormone-sensitive stage) improves the prognosis.
Which drugs are likely to be used?
The drugs used include abiraterone (Zytiga®) and enzalutamide (Xtandi®). These are administered as tablets, which are taken daily. Zytiga has to be combined with prednisolone, a highly effective corticosteroid.
Are there any other treatment options?
Nuclear medicine procedures may also be considered for treating castration-resistant prostate cancer. One option is to use radium-223. This is an alpha emitter which accumulates in bone and kills cancer cells with radiation. Radium-223 treatment is aimed exclusively at treating secondary cancers in the bones.
Another option is lutetium-177 PSMA. This is a beta emitter that specifically accumulates in prostate cancer tissue.
These treatments are only available at specialist nuclear medicine departments in major hospitals, including most university hospitals in Germany.
What other treatments may be useful?
Other drugs (e.g. denosumab, zoledronic acid) are often used to reduce the risk of pathological fractures (fractures caused by secondary cancers in the bones), or to significantly reduce bone pain caused by secondary cancers.
Where there are early signs of a fracture or severe bone pain, radiotherapy treatment to the relevant area may be helpful.
In addition, all patients with castration-resistant prostate cancer should take regular calcium and vitamin D. Calcium levels and bone density should be checked regularly.
