Living and Coping with Advanced Metastatic Prostate Cancer

Understanding Advanced Prostate Cancer

Prostate cancer is one of the most common cancers affecting men. In its early stages, prostate cancer is localized to the prostate gland and can often be treated successfully with surgery, radiation therapy, or active surveillance. However, in some men, prostate cancer can spread beyond the prostate to other parts of the body. This is known as advanced or metastatic prostate cancer.

Advanced prostate cancer most often spreads to the bones and lymph nodes. It can also spread to other organs like the liver, lungs and brain. While advanced prostate cancer remains incurable, the good news is that it can be treated and managed, allowing many men to live for years after their diagnosis.

Treating Advanced Prostate Cancer

There are several effective treatment options available for advanced prostate cancer. The goals of treatment are to slow the spread of cancer, relieve symptoms, and prolong life.

Hormone Therapy

Because prostate cancer growth relies on testosterone, reducing testosterone levels is a cornerstone of treatment. Hormone therapy for prostate cancer uses medications to reduce testosterone production or block testosterone's actions. Options include:

• LHRH agonists - e.g. leuprolide, goserelin
• Anti-androgens - e.g. bicalutamide, flutamide, nilutamide
• LHRH antagonists - e.g. degarelix
• CYP17 inhibitors - e.g. abiraterone

Hormone therapy can shrink tumors and slow cancer progression for 1-3 years. However, eventually prostate cancer can become resistant to further hormonal manipulation.

Chemotherapy

Chemotherapy uses anti-cancer drugs to kill prostate cancer cells. It is often used when hormone therapy stops working. Common chemo drugs used include docetaxel, cabazitaxel, mitoxantrone, and estramustine. Chemotherapy can relieve pain and may modestly extend life.

Immunotherapy

Immunotherapy improves the body's natural defenses to fight cancer. The FDA has approved sipuleucel-T for advanced prostate cancer. This involves collecting and enhancing the patient's own immune cells to activate the immune system against prostate cancer.

Targeted Radionuclide Therapy

Targeted radionuclide therapy uses radioactive particles delivered through an IV to specifically target and kill cancer cells with radiation while sparing normal tissue. Radium-223 is FDA approved for metastatic prostate cancer treatment when hormone therapy stops working.

Bone-Targeted Therapies

Since advanced prostate cancer often spreads to bones, bone-strengthening medication can help prevent bone complications. Options include:

• Bisphosphonates - e.g. zoledronic acid
• RANK ligand inhibitors - e.g. denosumab

These strengthen bones against damage from cancer, prevent fractures, and reduce bone pain.

Clinical Trials

Many men participate in clinical trials studying new prostate cancer drugs and treatment approaches. Clinical trials provide access to promising new therapies.

Living with Advanced Prostate Cancer

Coping with advanced prostate cancer presents many physical and emotional challenges. Side effects of treatments, cancer symptoms, worry for the future, and changes to work, relationships and daily life can be difficult. However, there are many ways to navigate life with advanced prostate cancer.

Managing Side Effects

It's important to work closely with your medical team to prevent and manage treatment side effects. Common side effects like fatigue, pain, hot flashes, nausea, decreased libido, erectile dysfunction, and urinary or bowel changes can often be treated. Speak up about any side effects so they can be addressed.

Staying Active

Staying physically active is important to maintain strength, energy and quality of life. Exercise like walking, swimming or low-impact strength training can help manage fatigue, pain, and bone health. Adapt activities as needed and talk to your doctor before starting new exercise.

Eating Well

A balanced, nutritious diet is vital when living with cancer. Eat a variety of vegetables, fruits, whole grains, lean protein and healthy fats. Stay hydrated, control portion sizes, and address special nutritional needs based on symptoms or treatment side effects.

Seeking Support

Get support from family, friends, and healthcare providers. Join a support group to connect with others facing advanced prostate cancer. Share feelings, seek counseling, or treat depression or anxiety. Social and emotional support makes a difference.

Advocating for Yourself

Learn as much as you can about prostate cancer and latest treatments. Track symptoms, side effects and questions. Be proactive and speak up about your needs, preferences, and goals. You are your own best advocate.

Outlook for Advanced Prostate Cancer

Advanced prostate cancer remains incurable. However, current treatments allow many men to enjoy lengthy remissions and live for years before prostate cancer progresses again. The 5-year survival rate for stage IV prostate cancer is around 30%. However, this varies widely based on individual circumstances.

It's important to remember that most men don't die from advanced prostate cancer itself, but from other age-related illnesses. Optimizing overall health plays a major role in prolonging survival and maintaining quality of life.

Further advances improving hormone therapy, immunotherapy, personalized medicine, and precision treatments offer hope for the future. Clinical trials provide access to emerging therapies. Although prostate cancer will always require diligent monitoring and care, living fully with prostate cancer is possible.

With an arsenal of treatment options, excellent medical care, and a positive outlook, many men power through advanced prostate cancer for years. By communicating openly with your medical team and focusing on aspects of health you can control, it's possible to live well despite a prostate cancer diagnosis.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.