After Primary Chemotherapy

What is PSA Flare?

It is important to note that there can be an initial transient surge in serum PSA during the first six to eight weeks of treatment followed by disease stabilization and decrease in PSA. This occurs with docetaxel so a decision to discontinue treatment should be not be made until 2-3 months have elapsed unless very significant side-effects occur.

Are there other options for castrate-resistant prostate cancer?

• Abiraterone acetate – On April 28, 2011, FDA approved abiraterone acetate (Zytiga® Tablets) for use in combination with prednisone for the treatment of patients with metastatic castration-resistant prostate cancer who have received prior chemotherapy containing docetaxel. Zytiga® is a novel, targeted, oral androgen biosynthesis inhibitor that prevents cancer cells from producing their own testosterone.
• Cabizitaxel – On June 17, 2010, FDA approved cabazitaxel (Jevtana® Injection) for use in combination with prednisone for treatment of patients with metastatic castration-resistant prostate cancer previously treated with a docetaxel-containing regimen. Cabazitaxel is a chemotherapy that is similar to but distinct from docetaxel. Toxicities for cabazitaxel include low white blood cell counts, “febrile neutropenia” and diarrhea. Approximately 5% of the worldwide treated patients died from side effects attributable to the drug however in North America the death rate was less than 1% of the treated patients. Infections and kidney failure were responsible for the majority of the deaths.
  See: New FDA Approval for Cabazitaxel (Jevtana®)
• Docetaxel combinations – If prostate cancer progresses when treated with docetaxel, combinations with other pharmaceuticals may provide a renewed response. Some possible drugs include:  Thalidomide, Carboplatin, Capecitabine, Estramustine, Revlimid®, Avastin®
• Mitoxantrone – is approved for prostate cancer and has been shown in clinical trials to provide palliative relief for prostate cancer pain but has not demonstrated a survival advantage.
• Other chemotherapies – There are a number of other chemotherapy drugs that are approved for a variety of cancer and can be used off-label for prostate cancer. Since each prostate cancer case is different, many patients can obtain at least temporary control with one or more of these as a single treatment or in combination. This may be especially true for prostate cancer variants that demonstrate neuroendocrine characteristics. Several that have shown some benefit include: carboplatin, cyclophosphamide, doxorubicin, epirubicin, estramustine, etoposide, paclitaxel, vinblastine, vinorelbine.
• For more information – see: New Therapies In Clinical Trial for After Docetaxel Fails

Page updated 8/1/11