Strategies to Improve Treatment - Stage IV Prostate Cancer

This content has been reviewed and approved by

Daniel P. Petrylak, MD
Associate Professor of Medicine
Director, Genitourinary Oncology Program
Columbia University Medical Center

Researchers are currently investigating new treatments for prostate cancer. Participation in trials of these treatments will lead to improved therapies. If you wish to participate in a clinical trial, please talk to your doctor about the potential benefits and side effects of the treatment.

Chemotherapy -Because hormone therapy is not curative and only controls metastatic (spreading) prostate cancer for a certain amount of time, efforts are under way to discover more effective systemic therapy.

Recently, several chemotherapeutic drugs have demonstrated the ability to kill prostate cancer cells in patients with recurrent cancer. An area of active study is single agent or multiagent chemotherapy drugs as a treatment approach for patients with metastatic prostate cancer.

In particular, the chemotherapy drugs Novantrone® (mitoxantrone), Taxotere® (docetaxel), and Estracyte® (estramustine) are being evaluated in patients with newly diagnosed, high-risk local  prostate cancer. It is important to note that the early or adjuvant use of chemotherapy is investigational and should be used as part of a clinical trial. Certain groups of patients with recurrent prostate cancer have been shown to live longer when treated with docetaxel compared with standard chemotherapy.

Combination therapy - The growth of prostate cancers can be slowed, but not eliminated, by using drugs that block the effect of hormones on prostate cancer cells. Combining hormonal therapy with chemotherapy treatment appears promising.

Vaccines - The purpose of a vaccine is to help the patient's immune system destroy the cancer by activating the patient's immune cells against the cancer. Vaccines are made in a variety of ways. One promising study used white blood cells called "dendritic" cells taken from the patient. The cells were specially treated in the laboratory, then reinfused into the patient, where they "trained" other immune system cells to recognize and destroy cancer cells.

A difficulty in preparing vaccines is that the patient's cancer cells must be processed immediately following surgery. Patients and their surgeon must therefore prepare in advance to ensure the removed cancer cells can be handled properly for vaccine preparation. Other vaccines use prostate cancer cells generated in the laboratory to introduce antigens into the immune system. Vaccines are currently being evaluated in clinical studies.

Phase I trials -The purpose of phase I trials is to evaluate new drugs to determine their safety and tolerability and the best way of administering them to patients. New chemotherapy drugs (vitamin D analogs, monoterpenes, flavopiridol, and anti-angiogenesis drugs) continue to be developed and evaluated in phase I clinical trials for patients with recurrent cancers.

Gene therapy -Gene therapy is defined as the transfer of new genetic material into a cell for therapeutic benefit. This can be accomplished by replacing or inactivating a faulty gene or replacing or adding a functional gene into a cell to make it operate normally. Gene therapy has been directed towards the control of rapid growth of cancer cells, control of cancer death, or efforts to make the immune system kill cancer cells. Gene therapy offers the hope of changing the way cells function and is being tested in prostate cancer patients. No gene therapies are yet approved for the treatment of prostate cancer.