Prostate cancer usually develops slowly. Most men with this cancer can live for many years without being aware of the disease and die of another cause. However, in 10-20 percent. prostate cancer patients are detected in the advanced stage, and in 40% patients diagnosed with it will eventually develop into an advanced disease with metastases. The treatment method used in this case is hormone therapy - drugs that lower the level of testosterone, which is the main growth factor for prostate cancer cells.
Prostate cancer is the second most common malignant neoplasm diagnosed in men after lung cancer, but it ranks first when considering the developed countries. In 2008, around 900,000 were diagnosed in the world. new cases of prostate cancer, of which in Europe it was approx. 380 thousand. The number of deaths amounted to approximately 260,000, respectively. and 94 thous. In Poland, over 9,000 cases were reported in 2010, which gives prostate cancer the second place among male cancers. He was also the cause of about 4,000 deaths (which also placed him in second place).
ImportantWhy is the incidence of prostate cancer increasing?
Risk factors for prostate cancer are: age, history of prostate cancer in first-degree relatives (father, brother), and black race. It is rare before the age of 40 in men without family risk, but its incidence is increasing among men over 50.
Epidemiologists predict that the number of cases ofprostate cancerwill increase. This is mainly due to the aging of societies, but also to the prevalence of thePSA antigen test(prostate-specific or prostate-specific antigen), which makes it possible to detect even those prostate neoplasms that have never been would endanger the he alth and life of the patient. Among the factors that may contribute to the increase in morbidity, scientists also mention the so-called Western lifestyle, including, for example, lack of physical activity, obesity and certain dietary components.
How to recognize prostate cancer
Stages of prostate cancer development
Prostate cancer is asymptomatic in the early stage, and in the locally advanced stage, the symptoms may include benign prostatic hyperplasia, i.e. frequent urination, a narrow stream of urine, pain when passing it, andsometimes even hematuria. In advanced prostate cancer, i.e. one that has already caused distant metastases, the most common pain is bone metastasis. Organ metastases are less common in organs such as the brain, liver or lungs. Urine stagnation may also occur in the kidneys or in the bladder due to local tumor growth.
Prostate cancer usually develops slowly. Most men with this cancer can live for many years without being aware of the disease and die of another cause. However, in 10-20 percent. prostate cancer patients are detected in the advanced stage, and in 40% patients diagnosed with it will eventually develop into an advanced disease with metastases.
Advanced Prostate Cancer - Treatment
Since testosterone is the main growth factor for prostate cancer cells, in the advanced stage of the disease, drugs are used to lower the level of androgens in the blood. Most often administered for this purpose are drugs known from the 90s of the twentieth century from the group of the so-called synthetic LHRH analogues (i.e. gonadoliberin, which regulates testosterone production and secretion in the testes). Their effectiveness is comparable to surgical castration, i.e. removal of the testicles. However, after some time, on an average of two or three years, standard hormone therapy stops working. It is then said about castration-resistant prostate cancer.
Chemical castration-resistant prostate cancer - new drugs
The last few years have seen an intense developmentof new drugs for advanced prostate cancer . Until recently, patients with the so-calledcastration-resistant prostate cancer , i.e. those in whom standard hormone therapy stopped working, had only one chemotherapy preparation to choose from. Since 2011, patients in Europe have received three new drugs, the latest of which was registered in June 2013.
Until 2010, the only drug that could extend the survival of patients with castration-resistant cancer was the chemotherapy cytostatic drugdocetaxel . In 2011, two new drugs were registered in the European Union for patients with castration-resistant prostate cancer - a cytostatic namedcabazitaxelandabiraterone acetaterepresenting a new type hormone therapy. In June 2013, they were joined byenzalutamide- a drug used to treat metastatic cancer, i.e. one that has spread from the prostate gland to other parts of the body. Enzalutamide is an oral antagonist of the androgen receptor, which is overproduced by prostate cancer cells. By blocking the androgen receptors on the surface of cells in the patient's body, the medicine prevents usetestosterone as a tumor stimulating food. In phase III clinical trials called AFFIRM, enzalutamide increased patients' overall survival by 4.8 months compared with placebo. Importantly, he was also well tolerated by them.
Research into new drugs for castration-resistant prostate cancer is currently underway, and for example, radium 223 chloride, which has already been approved by the US FDA, is waiting for EU registration.
ImportantMechanisms of prostate cancer resistance to hormone therapy
dr n. Far. Leszek Borkowski, clinical pharmacologist, president of the Polish Coalition of Cancer Patients
The "food" for prostate cancer is testosterone produced in the male body, so it might seem that it is enough to block its production to eliminate the problem. However, this is not so. The male body produces testosterone in many ways and even if we cut off one production route with drugs, the cancer immediately opens up another. What makes prostate cancer so "cunning"? First, his ability to resist healing. Prostate cancer increases the concentration of tubulin beta 3, which eliminates the drugs supplied by us from cancer cells; increases the production of the BCL-2 protein that inhibits 'cancer cell death' and blocks the production of the body's guardian angel, HSB-90, a protein that helps fight cancer cells. In addition, this tumor very quickly metastasizes to the skeletal system, the worst, clinically silent, i.e. those that do not show symptoms. Once something is visible on bone scintigraphy, it is usually very advanced, if not terminal, stage. The "cunning" of prostate cancer also consists in accelerated tachyphylaxis, i.e. a tendency to quickly "get bored" with drugs, and that is why these drugs should be changed to avoid immunization of the body.