ANNOUNCER: When advanced prostate cancer becomes resistant to initial hormone therapy, it is called hormone refractory prostate cancer or HRPC.
ADAM KIBEL, MD: When patients develop metastatic prostate cancer the first thing that is done is they have their hormones removed either by getting shot that removes the hormones or having their testicles removed. What happens over time is that controls the disease for maybe three, four, five years, but usually the cancer comes back.
SAM CHANG, MD: So the prostate cancer no longer is sensitive to the hormone therapy. Instead of being suppressed by hormone therapy, it begins to grow and regain strength.
ANNOUNCER: Physicians will usually recommend that patients with HRPC continue to receive hormone therapy.
SAM CHANG, MD: Once you are in a hormone refractory state, you would think, "Okay, the cancer isn't really susceptible to this hormone therapy. Take me off the hormone therapy." But what's been found actually is that there is still usually a small subset of cancer cells that are sensitive to hormone therapy. Secondly is that when you stop the hormone therapy, some patients or a significant number can have significant pain associated with that withdraw. You can have actually a flare-up of your prostate cancer cells, so most people recommend very strongly that once hormone therapy is established and started and it's the standard therapy, even when the hormone refractory state has been achieved, the hormone therapy should be continued.
ANNOUNCER: There can be side effects associated with ongoing hormonal therapy.
ADAM KIBEL, MD: Patients complain very frequently of hot flashes or hot flushes. People have different names for it and essentially it's like going through menopause for women. The second thing that can happen is they can lose bone mass and muscle which can be very distressing to men, particularly younger men who are diagnosed with the disease. And then the last thing some patients complain that they actually don't feel as sharp. They don't think as clearly.
ANNOUNCER: Most patients with HRPC will receive chemotherapy in addition to continuing hormonal therapy.
MICHAEL COOKSON, MD: Chemotherapy, currently the role is for patients with hormone refractory disease, those who have failed hormonal therapy we now do have survival benefit demonstrated in two independent studies looking at various forms of docetaxel, which is a particular form of chemotherapy.
ANNOUNCER: In recent studies, a combination of docetaxel plus a steroid called prednisone has proven effective in extending the lives of HRPC patients by as long as two years.
MICHAEL COOKSON, MD: Over the past decade, there have been a few drugs out there, and specifically some drugs that can show palliative benefit, but it was only in the last year-and-a-half to two years that we've seen the studies that have been concluded that have shown survival benefit. So chemotherapy is a new and emerging armament for the treatment of prostate cancer patients, but it hasn't always been there.
ANNOUNCER: But docetaxel may also cause side effects like nausea, fatigue and low white blood cell counts.
ADAM KIBEL, MD: There is clearly side effects associated with the docetaxel arms. Predominantly neutropenia, meaning a low white blood cell count. But it doesn't appear that the patients were more likely to have infectionsâ€¦which is probably the thing that we're most interested in.
ANNOUNCER: HRPC and its treatment will ultimately affect men in different ways.
ADAM KIBEL, MD: I think one of the most interesting things about the trials looking at the chemotherapy and the patients with hormone refractory disease is the quality of life appears to have increased in those patients. Not only pain appears to be better but overall quality of life appears to be better.
SAM CHANG, MD: You have men with hormone refractory prostate cancer that look like they can run a marathon or could run a marathon or do run a marathon. Then you have those men who are basically in a very debilitated hospice type state. And yet those are all in the same category or group of hormone refractory prostate cancer. So you're looking at a very diverse population
ANNOUNCER: There is no cure for HRPC, but good treatment can help patients maintain the best possible quality of life.
ADAM KIBEL, MD: I think that â€“ when you're seeing a patient that has metastatic androgen-independent prostate cancer, one of the things that they really appreciate is a little honesty. They want to know what's going on. They want to know what they should do, what they shouldn't do. They don't want to â€“ they want to do their best, but at the same time they want to enjoy the time they have left with their family. So one of the things that I often â€“ you know, I'll tell patients. I'll say, "Look, you always dreamed about going to Hawaii. Go." "You always dreamed about going to Europe and touring all the capitals. Go." Don't sit around and wait until the cancer catches up with you in order to do that.