Understanding Treatment Options for Your Prostate Cancer

This article is for patients who have prostate cancer, their caregivers, and others who want to learn more about new medicines used to treat this disease. The goal of this patient education activity is to increase your knowledge about new hormone treatments for prostate cancer.

You will learn about:

• Different types of prostate cancer

• New hormone medicines, called antiandrogens, and how to take them

• Most common side effects of antiandrogens

• Serious side effects of antiandrogens that could happen

• Questions to ask your healthcare team about antiandrogens and their side effects

Prostate cancer forms in the cells of the prostate gland, which is an organ in men that forms a ring around the urethra (a tube that carries urine from the bladder to the outside of the body).

There are different types of prostate cancer, depending on whether:

1. It gets better from hormone treatments

                    a. If yes = castration-sensitive (CS)

                    b. If no = castration-resistant (CR)

2. It has spread to other body parts

                    a. If no = non-metastatic (nm or M0)

                    b. If yes = metastatic (m or M1) 

Prostate cancer that is sensitive to (gets better from) hormone treatments is called castration-sensitive prostate cancer (CSPC). In CSPC, the cells are still responding to castration, which is a form of hormone treatment that keeps the body from making testosterone (an androgen).

Prostate cancer that is not sensitive to hormone treatments is called castration-resistant prostate cancer (CRPC) because it no longer responds to hormone treatment and does not need normal levels of testosterone to grow.

Both CSPC and CRPC can be either non-metastatic (nm or M0) or metastatic (m or M1). Non-metastatic means the cancer cells stay within the prostate. Metastatic means the cancer cells escape the prostate and grow quickly, spreading to nearby tissues.

Androgens are a type of male hormone. They are produced by men and control male characteristics, such as having a lower voice tone and growth of facial hair.

The 2 major androgens involved in the growth of prostate cancer are testosterone and dihydrotestosterone (DHT), which is created from the metabolism of testosterone.

Antiandrogens are medicines that work against androgens by binding to the androgen receptor on cancer cells and keeping testosterone from binding and functioning. This can block the production of androgens by prostate cancer cells or prevent the androgens from stimulating the growth of prostate cancer cells.

There are 4 new antiandrogens:

• Abiraterone acetate

• Apalutamide

• Darolutamide

• Enzalutamide

If your doctor decides to treat you with one of these medicines, you will receive another medicine called a gonadotropin-releasing hormone (GnRH) analog, unless you have had a bilateral orchiectomy (surgical castration).

In addition, abiraterone acetate is always given with prednisone (a corticosteroid) to lessen the chance of side effects from happening.

Prostate Cancer Type	New Antiandrogen
nmCRPC	Apalutamide (ERLEADA®) Darolutamide (NUBEQA®) Enzalutamide (XTANDI®)
mCRPC	Abiraterone acetate (YONSA®) Abiraterone acetate (ZYTIGA®) Enzalutamide (XTANDI®)
mCSPC	Abiraterone acetate (ZYTIGA®): for patients with high-risk features (which means you have at least 2 out of 3 risk factors that your doctor will look at before starting treatment) Apalutamide (ERLEADA®) Enzalutamide (XTANDI®)

New Antiandrogen	How Is the Medicine Given?
Abiraterone acetate (YONSA®) Abiraterone acetate (ZYTIGA®)	500 mg (4-125 mg tablets); take tablets once daily with methylprednisolone 4 mg twice daily. Take with or without food and swallow whole 1000 mg (4-250 mg uncoated or 2-500 mg film-coated tablets); take tablets once daily with prednisone 5 mg once or twice daily (depending on the hormone sensitivity of your cancer). Take without food (at least 1 hour before or 2 hours after a meal or snack) and swallow whole
Apalutamide (ERLEADA®)	240 mg (4-60 mg tablets); take tablets once daily with or without food and swallow whole
Darolutamide (NUBEQA®)	600 mg (2-300 mg tablets); take tablets twice daily with food and swallow whole
Enzalutamide (XTANDI®)	160 mg (4-40 mg capsules); take capsules once daily with or without food and swallow whole

Antiandrogen	Most Common Side Effects
Abiraterone acetate	Feeling tired, joint pain, high blood pressure (hypertension), nausea, swelling in your legs or feet due to fluid buildup (edema), hot flashes, diarrhea, vomiting, headache, cough; infected nose, sinuses, or throat Lab test abnormalities: low blood potassium (hypokalemia), low red blood cells (anemia), high blood cholesterol and triglycerides, high blood sugar, certain other abnormal blood tests
Apalutamide	Feeling tired, joint pain, rash (tell your doctor), decreased appetite, falls, weight loss, high blood pressure, hot flashes, diarrhea, fracture
Darolutamide	Pain in extremities (arm, leg, hand, or foot), feeling more tired than usual, rash Lab test abnormalities: decreased white blood cells (neutropenia), changes in liver function tests
Enzalutamide	Weakness or feeling more tired than usual, back pain, hot flashes, constipation, joint pain, decreased appetite, diarrhea, high blood pressure

Antiandrogen	Serious Side Effects
Abiraterone acetate	High blood pressure, low blood potassium, fluid buildup, irregular heartbeats, adrenal problems, liver problems   There may be a greater chance of bone fracture and death (when ZYTIGA® plus prednisone is used together with a type of radiation called radium Ra 223 dichloride). However, there can be some improvements using this combination -- it won’t cause myelosuppression (a possible side effect of antiandrogens that causes lowered red blood cells, white blood cells, and platelets). Your doctor will decide if this is the best treatment for you
Apalutamide	Heart disease, fractures with falls, seizures
Darolutamide	Urine retention, pneumonia, hematuria
Enzalutamide	Posterior reversible encephalopathy syndrome (PRES), seizure, allergic reactions, heart disease, fractures with falls

 

Serious side effects are not as common, but can happen, so be sure to talk to your cancer care team if you have questions about them.

Your doctor can manage your side effects with medicines that reduce your symptoms, or by lowering the dose or stopping the medicine you are on for a while.

Not all the possible side effects are included here, so make sure to ask your doctor for a complete list. Talk to your care team about any side effects that bother you or that do not go away after taking medicines to reduce your symptoms.

• Why are you recommending an antiandrogen medicine for me?

• Are there any medicines I should not take at the same time?

• How will my side effects be monitored?

• How will my side effects be managed?

• What can I do to lessen my side effects?

• How frequent do my follow-up appointments need to be? 

Congratulations!

You have successfully completed the program: Understanding Treatment Options for Your Prostate Cancer

View Additional Materials

View Additional Materials on this topic that you may find useful:

NCCN Guidelines For Patients^®: Prostate Cancer

American Cancer Society^®: Treating Prostate Cancer