Advances in Treatment for Prostate Cancer

In the past, hormone therapy for prostate cancer worked … until it didn’t. The cancer became immune to it, causing castrate-resistant prostate cancer (CRPC), or cancer that keeps growing even without testosterone. Three new drugs — abiraterone (Zytiga), darolutamide (Nubeqa), and enzalutamide (Xtandi) — block that resistance and increase survival rates. Enzalutamide and darolutamide also make it less likely that your cancer will spread. 

Treatment vaccines are a growing area of prostate cancer testing and research. Like other forms of immunotherapy, they train your immune system to identify and destroy tumors. Sipuleucel-T (Provenge) is approved for men with metastatic castrate-resistant prostate cancer (CRPC) and few to no symptoms.

Used successfully with many other types of cancer, checkpoint inhibitors make your immune system better at destroying cancer cells by blocking proteins. Approved versions like pembrolizumab (Keytruda) work best on tumors that have spread and have a lot of genetic mutations. This is rarely the case with prostate cancer, which has been resistant to checkpoint inhibitors. Research is being done on combining this form of treatment with others for better results. 
 

Cells have a built-in enzyme called poly-ADP-ribose polymerase, or PARP, that repairs damaged DNA. But damaged cancer cells that can’t heal themselves die, and that’s the goal. PARP inhibitors like olaparib (Lynparza) and rucaparib (Rubraca) stop PARP from repairing cancer cells in cases where your prostate cancer has spread and hormone treatments have stopped working. Niraparib plus abiraterone acetate (Akeega) with prednisone is antoher option, as is talazoparib (Talzenna).

Targeted radiation therapy uses a drug called lutetium Lu 177 vipivotide tetraxetan (Pluvicto) that connects a radioactive compound to a molecule that hunts down and attaches to a protein called PSMA on some cancer cells. Once attached, it delivers radiation that damages the cancer cell's DNA so it can't grow or repair itself. It's approved for men with metastatic prostate cancer that's still responding to hormone therapy, given together with a hormone-blocking drug, as well as for men whose cancer has stopped responding to hormone therapy.  

Compared to a surgeon-led prostate removal, this method involves smaller cuts, more accurate prostate removal, and less nerve damage. That means fewer negative side effects like erectile dysfunction and urinary problems. Other benefits include less blood loss, less post-op pain, and a quicker recovery. 

A common breast cancer treatment that’s still new to prostate cancer, focal laser ablation is a quick procedure that uses a laser to remove a tumor on the prostate instead of removing the entire prostate. 

When prostate cancer cells are frozen, they die. Cryotherapy is often used when other treatments don’t work, or if cancer comes back after a different treatment. To avoid damaging healthy tissue, doctors use an ultrasound to find and isolate the cancerous tissue, then insert metal gas-filled probes to freeze it. New technology has helped sidestep some of the side effects men had after treatments in the past, but sexual dysfunction remains an issue.  

In this noninvasive treatment, an ultrasound transducer uses high-energy sound waves to create heat and kill cancerous prostate tissue found by MRIs. Also called MRI-guided focused ultrasound (MRgFUS) and focused ultrasound (FUS), it earns the high-intensity title because it can heat cancerous tissue to 200 F in just 20 seconds. 

When prostate cancer spreads – for example, to the bones – or hormone therapy doesn’t work, chemo has been successful in killing cancer cells on its own or combined with other therapies. The side effects can be rough, and chemo can kill healthy cells too. New forms of treatment like radium Ra 223 dichloride (Xofigo) destroy cancer cells with reduced alpha particle radiation and don’t harm healthy bone tissue as much.

This medication is an alpha particle-emitting radioactive therapeutic agent. It’s classified as a radiopharmaceutical. If your prostate cancer is resistant to medical or surgical treatments that lower testosterone and has spread to bones with symptoms, but not to other parts of the body, doctors may suggest this treatment option.