Chemotherapy for prostate cancer
Treatment with cytotoxic drugs is carried out usually in prostate cancer, which has become androgen independent and has usually metastasized. A distinction is a first and a second-line therapy.
Chemotherapy refers to a treatment with drugs that inhibit pathogens or tumor cells as possible without harming other cells in their growth or kill them. In a narrower sense, the term is often limited to the treatment of malignant tumors by chemical means. The suitable active ingredients are mostly (but not exclusively) to the cytotoxic drugs ("cytotoxins"), which prevent or delay the division of cells. Not to chemotherapy is one treatment with biological agents that fight the tumor mechanisms of the immune system (the body's own defense) such as antibodies and vaccines (see more systemic therapy ).
Use in prostate cancer
Especially because prostate cancer grows very slowly, cytostatics are only slightly effective. A permanent cure so far could not be reached, not even with other chemotherapeutic agents or combination treatments. The aim is therefore particularly an increase in the quality of life by relieving pain and improve the general condition. Because the objective tumor response, his response (regression) is difficult to measure the success of therapy is instead usually assessed in terms of mean survival time of the decline of complaints and the drop in the PSA value.
There are no general recommendations on when the best time to use of chemotherapy is, what means will be used and whether the treatment can be interrupted. These questions, as well as the benefits and possible adverse effects are still to be clarified on the basis of the findings and the individual situation of the person concerned.
In general, the chemotherapy in androgen-independent prostate cancer a (castration-resistant prostate cancer, CRPC) is used, ie when the tumor during hormone therapy despite suppressed androgens progresses (male sex hormones).
For details on such a tumor, the basic features of his treatment, to educate the person concerned and to decide on further therapy (including chemotherapy) can be found in the section "hormone therapy" under Progressive prostate cancer hormone therapy .
First-line therapy
In an androgen-independent prostate cancer, the first-line treatment (first additional therapy) depends on whether the person has symptoms or not. In both cases may occur chemotherapy question must be decided individually on the (see Progressive prostate cancer hormone therapy ).
Patients with complaints that are in good general condition, should be offered chemotherapy consisting of docetaxel (a taxane = active ingredient of yew, 7 mg per square meter of body surface area every three weeks) and prednisolone (a corticosteroid, 5mg, twice daily). After studying here many side effects are possible, but also a pain relief, improved quality of life and prolongation of survival time (on average by 2.9 months compared to treatment with mitoxantrone plus prednisolone).
Second-line treatment
A second-line therapy is eligible if the first-line treatment (see above) shows unsuccessful. The recommendations to be independent from the existence of complaints.
Patients in good general condition (called ECOG status 0-2) with progressive disease after or during chemotherapy should be informed about the possibility of treatment with abiraterone (an inhibitor of the formation of androgens and estrogens , more in the magazine under New medicines prostate cancer ). According to one study, so that survival time is extended by an average of 3.9 months in fewer side effects than chemotherapy (especially high blood pressure, fluid retention, change in the salt budget).
Patients in good general condition (called ECOG status 0-1) with progressive disease (a corticosteroid) will be informed after or during chemotherapy are about the possibility of treatment with cabazitaxel (a taxane drug from yew =) and prednisone. According to a study thus prolongs the survival time (on average by 2.4 months compared to treatment with mitoxantrone plus prednisone). The patient should be advised of potential side effects, especially on the increased rate of major changes in the blood that can lead to a treatment-related death.
Any other cytostatic therapy (docetaxel weekly or every three weeks, mitoxantrone or estramustine) may help relieve discomfort. An extension of the survival time is not established, and numerous side effects are possible. A repeat dose of docetaxel is mainly questioned if the patient has responded well to it in the first-line treatment or if a second-line treatment with abiraterone or cabazitaxel is not possible.
Decides the patient to a second-line treatment, should it be offered with progressive disease with complaints, the administration of corticosteroids. After studying this improves pain, loss of appetite, fatigue and quality of life and possibly delaying the progression of the disease.
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