Prostate Cancer Requires Aggressive and Early Treatment

Health-System Edition, November 2021, Volume 10, Issue 6

More medication options mean a greater chance for patients to survive and enjoy a better quality of life.

Cancer in the prostate begins in the glands of the walnut-sized organ, which is found only in men. The prostate gland produces the seminal fluid that helps nourish and transport sperm. Prostate cancer is one of the most common types of cancer in the United States and the most common cancer diagnosed in men of all races, aside from nonmelanoma skin cancer.1,2

In 2018, about 212,000 cases of prostate cancer were reported, and 31,000 of these patients died. However, when prostate cancer is discovered early and confined to the prostate gland, it is often treatable and the prognosis is positive.

Prostate cancer symptoms vary. There may be no signs or symptoms in the early stages of the disease, but more advanced stages may include blood in the semen or urine, decreased force in the urine stream, trouble urinating, and weight loss. The causes of prostate cancer are not entirely understood. It is thought, however, that the cells’ DNA changes and that they then divide more rapidly than they normally would.1

Several risk factors are associated with prostate cancer occurrence. These include being Black, being older than 50 years, having a family history of prostate cancer, and being obese.1

Complications from prostate cancer can include the cancer metastasizing to other parts of the body, such as the bladder, bones, and lymph nodes. Once metastasis
is advanced, the cancer can still be treated, although it becomes harder to cure. Erectile dysfunction can result either from prostate cancer itself or the treatments, such as hormone or radiation therapy and surgery. Prostate cancer can also cause incontinence, which for some patients improves over time but for others worsens. Treatment options for incontinence may include catheters, medication, and surgery.1

Screening tools for prostate cancer include a digital rectal exam, magnetic resonance imaging, a prostate-specific antigen test, and an ultrasound. Treatment options include cryotherapy, heating prostate tissue, orchiectomy, and radiation therapy. The next option would be hormone therapy, which helps stops the body from making testosterone. Stopping testosterone helps stop the growth of cancer cells. Hormone therapy medications may include luteinizing hormone-releasing hormone (LHRH) or gonadotropin-releasing hormone (GnRH) agonists and antagonists, which prevent the body’s cells from receiving messages to make testosterone.

Other medications that block testosterone from reaching cancer cells include antiandrogens, which are sometimes given with LHRH agonists. LHRH drugs may include goserelin (Zoladex), histrelin (Vantas), leuprolide (Lupron), leuprolide mesylate (Camcevi), and triptorelin (Trelstar).3

Androgen receptor blockers that are approved in the United States include first-generation drugs such as bicalutamide (Casodex), flutamide, and nilutamide (Nilandron), as well as second-generation ones including apalutamide (Erleada), darolutamide (Nubeqa), and enzalutamide (Xtandi).3 Chemotherapy options for prostate cancer include cabazitaxel (Jevtana), docetaxel (Taxotere), enzalut- amide (Xtandi), estramustine (Emcyt), and mitoxantrone (Novantrone).4

Immunotherapy options include sipuleucel-T (Provenge), a cancer vaccine that can boost the immune system to help it attack prostate cancer cells.4 Pembrolizumab (Keytruda) is a drug that targets programmed cell death protein 1 and by blocking it boosts the immune response against prostate cancer cells. Pembrolizumab is given as an intra- venous infusion every 2 or 3 weeks. Rucaparib (Rubraca) is an inhibitor of poly (ADP-ribose) polymerase (PARP) enzymes, including PARP-1, PARP-2, and PARP-3, for the treatment of patients with deleterious BRCA mutation–associated metastatic castration-resistant prostate cancer. Similarly, olaparib (Lynparza) is another PARP inhibitor, given to patients with prostate cancer after orchiectomy. Relugolix (Orgovyx) is a GnRH receptor antagonist, indicated to treat advanced prostate cancer, and comes in 120-mg tablets.5

Conclusion

Paying attention to prostate cancer and treating it as aggressively and early as possible is the key to surviving the disease. With the myriad medication options available, patients with prostate cancer have an increased chance of survival and having a better quality of life.

Saro Arakelians, PharmD, is a vice president of pharmacy operations, population health management, and chronic health conditions in the Los Angeles, California, area.

References

1. Prostate cancer. Mayo Clinic. June 4, 2021. Accessed October 5, 2021. https://www.mayoc- linic.org/diseases-conditions/prostate-cancer/symptoms-causes/syc-20353087

2. Cancer statistics at a glance. CDC. June 2021. Accessed October 5, 2021. https://gis.cdc.gov/ Cancer/USCS/#/AtAGlance/

3. Hormone therapy for prostate cancer. National Cancer Institute. February 22, 2021. Accessed October 5, 2021. https://www.cancer.gov/types/prostate/ prostate-hormone-therapy-fact-sheet

4. Immunotherapy for prostate cancer. American Cancer Society. Updated August 1, 2019. Accessed October 5, 2021. https://www.cancer.org/cancer/prostate-cancer/treating/ vaccine-treatment.html

5. Rubraca. Prescribing information. Clovis Oncology Inc; 2021. Accessed October 5, 2021. https://clovisoncology.com/pdfs/RubracaUSPI.pdf