1. “Fighting Cancer: It’s All We Do.” ™

2. Restoring Quality of Life And Managing Side Effects Ulka Vaishampayan M.D. Chair, GU Multidisciplinary team Associate Professor Of Medicine Detroit Medical Center Wayne State University/ Karmanos Cancer Institute, Detroit MI.

3. Metastatic Prostate Cancer Common site of spread- bones Incurable, likely terminal condition Morbidity significant as it can lead to bone pain,cord compression, fractures, urinary obstruction etc. Initial therapy with hormones which is effective, but temporary

4. Metastatic disease: hormone therapy Hormone therapy questions: When to start? Continuous vs intermittent Which kind: Lupron/Zoladex with casodex or casodex alone (50 mg daily) or high dose casodex 150 mg daily Should we stop treatment when it stops working? What are the risks?

5. Common Complications of Hormone Therapy –Fatigue –Metabolic syndrome- high blood sugar, high cholesterol –Increased risk of heart problems in people who have heart disease –Hot flashes –Impotence –Osteoporosis –Gynecomastia and breast tenderness –Mood swings –Liver toxicity –Diarrhea, nausea

6. Strategies to address side effects of hormone therapy Hormone therapy works by suppressing the male hormone/testosterone levels. Fighting the side effects: -Increased Awareness -Stay active - Healthy diet -Ask for medication therapy for hot flashes if bothersome. -Consider intermittent hormone therapy if feasible -Monitor cholesterol, blood sugars periodically.

7. Supportive Care in Advanced Prostate Cancer Bone strengthening therapy Radiation Pain control therapies Chemotherapy/novel agents

8. Zometa vs. Placebo in Hormone Refractory Metastatic Prostate Cancer Berruti et al, JNCI 2003

9. Bisphosphonates for Treatment of Bone Metastasis Frequency of skeletal complications due to bone metastasis Median time to first skeletal-related event compared with placebo 0 10 20 30 40 50 Zoledronic acid Placebo 0 20 60 80 100 40 0 50100150200250300350400450 321 days P=0.011 Not reached Days After Start of Therapy Patients Without Event (%) 33% 44%

10. Dietary factors Lycopene: A minimum of 2 servings (1 cup) per week of tomato sauce can reduce the risk of development and progression of prostate cancer. Cruciferous vegetables: at least five servings per week can decrease the risk of developing prostate cancer by 20%. Green Tea may have possible protective effects A large study showed that too much calcium (over 2000mg daily) can increase metastatic prostate cancer risk fivefold compared with those consuming <500 mg daily- Health Professionals Follow Up study

11. Dietary factors Vitamins within the recommended daily intake are recommended Overdosage of vitamins maybe potentially harmful Male smokers study in Finland showed that Vitamin E supplementation decreased the incidence of prostate cancer by 32% and the mortality related to prostate cancer by 41%. Beta carotene (Vit A) increased risk of lung cancer Finasteride/Proscar prevented prostate cancer and reduced the risk by 25% Selenium and Vit E trial completed and no benefit noted.

12. Systemic Therapy in Treatment of Prostate Cancer –Discuss use of systemic therapy in metastatic prostate cancer to a} Prolong life b}Palliation or symptom control –In locally advanced prostate cancer, the goal is to improve cure rate and keep long term toxicity to a minimum

13. Development of Hormonal Escape Prostate Cancer. London, England: Times Mirror International Publishers Ltd;1996:143. Deprive androgen Cell numbers Time Androgen-independent cells take over Responsive Dependent Independent

14. Metastatic Disease Therapy in hormone refractory disease Supportive care and palliation options: Currently approved –Chemotherapy –Bisphosphonate therapy –Radioisotope therapy

15. “Fighting Cancer: It’s All We Do.” ™