“Fighting Cancer: It’s All We Do.” ™. Restoring Quality of Life And Managing Side Effects Ulka Vaishampayan M.D. Chair, GU Multidisciplinary team Associate.

“Fighting Cancer: It’s All We Do.”™

Restoring Quality of LifeRestoring Quality of LifeAndAnd

Managing Side EffectsManaging Side Effects

Ulka Vaishampayan M.D.Chair, GU Multidisciplinary teamAssociate Professor Of Medicine

Detroit Medical CenterWayne State University/ Karmanos Cancer Institute,

Detroit MI.

Metastatic Prostate CancerMetastatic Prostate Cancer

• Common site of spread- bones• Incurable, likely terminal condition • Morbidity significant as it can lead

to bone pain,cord compression, fractures, urinary obstruction etc.

• Initial therapy with hormones which is effective, but temporary

Metastatic disease: hormone therapyMetastatic disease: hormone therapy

• Hormone therapy questions:• When to start?• Continuous vs intermittent• Which kind: Lupron/Zoladex with casodex

or casodex alone (50 mg daily) or high dose casodex 150 mg daily

• Should we stop treatment when it stops working?

• What are the risks?

Common Complications of Common Complications of Hormone TherapyHormone Therapy

– Fatigue– Metabolic syndrome- high blood sugar, high cholesterol– Increased risk of heart problems in people who have

heart disease– Hot flashes– Impotence– Osteoporosis– Gynecomastia and breast tenderness– Mood swings– Liver toxicity– Diarrhea, nausea

Strategies to address side effects of Strategies to address side effects of hormone therapyhormone therapy

• Hormone therapy works by suppressing the male hormone/testosterone levels.

• Fighting the side effects: -Increased Awareness -Stay active - Healthy diet- Ask for medication therapy for hot flashes if

bothersome.- Consider intermittent hormone therapy if feasible- Monitor cholesterol, blood sugars periodically.

Supportive Care in Advanced Supportive Care in Advanced Prostate CancerProstate Cancer

• Bone strengthening therapy

• Radiation

• Pain control therapies

• Chemotherapy/novel agents

Zometa vs. Placebo in Hormone Zometa vs. Placebo in Hormone Refractory Metastatic Prostate CancerRefractory Metastatic Prostate Cancer

Berruti et al, JNCI 2003Berruti et al, JNCI 2003

Bisphosphonates for TreatmentBisphosphonates for Treatmentof Bone Metastasisof Bone Metastasis

• Frequency of skeletal complications due to bone metastasis

• Median time to first skeletal-related event compared with placebo

0

10

20

30

40

50

Zoledronic acid Placebo

0

20

60

80

100

40

0 50 100 150 200 250 300 350 400 450

321 daysP=0.011

Not reached

Days After Start of Therapy

Pat

ien

ts W

ith

ou

t E

ven

t (%

)

33%33%

44%44%

Dietary factorsDietary factors

• Lycopene: A minimum of 2 servings (1 cup) per week of tomato sauce can reduce the risk of development and progression of prostate cancer.

• Cruciferous vegetables: at least five servings per week can decrease the risk of developing prostate cancer by 20%.

• Green Tea may have possible protective effects• A large study showed that too much calcium (over

2000mg daily) can increase metastatic prostate cancer risk fivefold compared with those consuming <500 mg daily- Health Professionals Follow Up study

Dietary factorsDietary factors

• Vitamins within the recommended daily intake are recommended

• Overdosage of vitamins maybe potentially harmful• Male smokers study in Finland showed that Vitamin E

supplementation decreased the incidence of prostate cancer by 32% and the mortality related to prostate cancer by 41%. Beta carotene (Vit A) increased risk of lung cancer

• Finasteride/Proscar prevented prostate cancer and reduced the risk by 25%

• Selenium and Vit E trial completed and no benefit noted.

Systemic Therapy in Treatment of Systemic Therapy in Treatment of Prostate CancerProstate Cancer

– Discuss use of systemic therapy in metastatic prostate cancer toa} Prolong lifeb}Palliation or symptom control

– In locally advanced prostate cancer, the goal is to improve cure rate and keep long term toxicity to a minimum

Development of Hormonal EscapeDevelopment of Hormonal Escape

Prostate Cancer. London, England: Times Mirror International Publishers Ltd;1996:143.

Depriveandrogen

Cel

l num

bers

Time

Androgen-independentcells take over

Responsive

Dependent

Independent

Metastatic DiseaseMetastatic Disease

• Therapy in hormone refractory disease

• Supportive care and palliation options: Currently approved–Chemotherapy–Bisphosphonate therapy–Radioisotope therapy

“Fighting Cancer: It’s All We Do.”™