This section discusses a variety of additional treatments including antiangiogenesis agents, bisphosphonates, spot radiation, radiopharmaceuticals and investigational agents that were not discussed in previous sections.
Angiogenesis is the growth of new blood vessels. This is a normal biologic process that occurs in both healthy and disease states. Angiogenesis is necessary for cancerous tumors to keep growing and spreading. Thalidomide, bevacizumab (Avastin®), lenalidomide (Revlimid®) are examples of drugs that inhibit angiogenesis.
Bisphosphonates come in oral and intravenous forms. They can be used to treat osteoporosis and/or metastatic cancer in the bones. The intravenous agents, Zometa® and Aredia®, are primarily for cancer, though they are also potent anti-osteoporosis agents. In addition to bisphosphonates, Denosumab® targets a protein known as the RANK ligand. This protein regulates the activity of osteoclasts (cells that break down bone). Denosumab has been shown to be more effective than Zometa at delaying bone complications.
Individual tumors can be targeted with either external radiation or with bone-seeking radiopharmaceuticals. Radiopharmaceuticals represent a theoretically attractive approach because they target relatively stable bone stromal elements, yet they have the potential capacity to inhibit the growth of both metastatic CRPC cells and the cancerous stem cells that give rise to continued cancer growth, despite the administration of conventional hormonal chemotherapy. Further, it may be possible to alter stromal elements via radiation in a manner that inhibits growth-promoting tumor-stromal interactions; older clinical studies indicate that radiated bone may be a less hospitable environment for development of metastatic disease.
Finally, participation in clinical trials can allow you to gain access to new research treatments before they are widely available.
- Bisphosphonates for Osteoporosis or Bone Metastasis • Mark Scholz, MD 2010
- Denosumab More Effective Than Zometa at Delaying Bone Complications
- Bone -Targeted Therapy for Advanced Prostate Cancer • Oliver Sartor, MD 2009
- Newer Concepts in the Treatment of Hormone-Refractory Prostate Cancer with Bone Metastases • Oliver Sartor, MD 2005
- Video – Radiation for Metastases: Christopher Rose, MD – 2007 PCRI Conference
- Video – New Oral Agents – Charles Myers, MD – 2007 PCRI Conference
- PCRI Clinical Trials page
- Denosumab versus zoledronic acid for treatment of bone metastases in men with castration-resistant prostate cancer. Lancet. 2011 Mar 5;377(9768):813-22.Fizazi K, Carducci M, et al.
- Angiogenesis inhibitors in prostate cancer therapy. Discov Med. 2010 Dec;10(55):521-30. Yu EM, Jain M, et al.
- Angiogenesis inhibitors in the treatment of prostate cancer. J Hematol Oncol. 2010 Aug 2;3:26. Hwang C, Heath EI.