If you've just learned that you have prostate cancer, it's natural to feel concerned. But remember, you are not alone—in 2004, about 230,000 men in the United States found out they have prostate cancer.1 That's 33% of all cases of cancer diagnosed each year in men in the United States.2
In order to begin to understand this disease, it is important to begin with some background information.
Prostate cancer is cancer of the prostate gland. The prostate is a gland in the male reproductive system and is found at the base of the bladder. The prostate is about the size of a walnut, and is responsible for producing semen, which transports sperm during male orgasm.
Cancer develops when cells in a part of the body grow out of control. Unlike normal cells that have a life cycle of growth, division, and death, cancer cells live for a long time and breed other cancer cells. Most cancers form as a tumor in one body part or organ and can travel to other parts of the body where they may continue to grow and replace normal cells. This process is called metastasis.
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Being aware of the risk factors and getting checked regularly can assist with early diagnosis and better control of the disease. The chance that a man will get prostate cancer increases with age. The disease is rare in men younger than 40 while more than 70% of new prostate cancers are diagnosed in men over the age of 65.2 Race can also be a factor—African American men are at greater risk for prostate cancer than any other group in the Untied States.3 Men with a family history of prostate cancer are also at greater risk for the disease.4 In particular, you should be aware of whether any immediate male family member, such as a father or brother, was ever diagnosed with prostate cancer.4 Speak with your doctor about other factors that may increase the risk for prostate cancer.
In its early stages, most men will not notice any symptoms of their prostate cancer. If the cancer advances and spreads just beyond the prostate, some men experience difficulty urinating or impotence—which can also be symptoms of diseases other than prostate cancer. If the cancer becomes advanced and moves to other organs, some men experience pain in the pelvis, lower back, or upper thighs. Some men also experience bone pain, fatigue or weight loss.4-6
Once you have been diagnosed with prostate cancer, your healthcare team will recommend a plan of treatment that meets your individual needs. Doctors consider several key factors when choosing the treatment that is right for you:5,6
- Your age and overall health
- If your prostate cancer has just been discovered or if it was previously diagnosed and has now recurred
- The stage of your cancer—based on how much cancer you have and whether it exists only in the prostate or if it exists beyond the prostate as well
- Stage I - very early cancer that is still microscopic and confined to the prostate
- Stage II - the cancer is still small and confined to the prostate, but can be felt
- Stage III - the cancer has spread to local areas around the prostate
- Stage IV - the cancer has spread beyond the prostate to bones, lymph nodes, lungs, or other organs
- The grade of your cancer is an important indication of how well you may respond to therapy in the long run (because it estimates how aggressive your cancer is)
- The Gleason grading system measures cancer grade. To use it, the doctor will take a sample of your prostate cancer cells and, after a complex series of calculations, a Gleason score between 2 (nonaggressive cancer) and 10 (very aggressive cancer) will be assigned5
- Your level of PSA (prostate-specific antigen). PSA is a substance produced by your prostate gland. A small amount of PSA naturally enters your bloodstream. Fluctuation in PSA level may be an indication of a prostate infection, inflammation, or possibly cancer. A simple blood test is used to determine your PSA level5
VANTAS is indicated in the palliative treatment of advanced prostate cancer.
VANTAS is contraindicated in patients with hypersensitivity to GnRH, GnRH agonist analogs, or any components in VANTAS. VANTAS is contraindicated in women and pediatric patients and was not studied in women or children. VANTAS, like other LHRH agonists, causes a transient increase in serum concentration of testosterone during the first week of treatment. Patients may experience worsening of symptoms or onset of new symptoms including bone pain, neuropathy, hematuria, or ureteral or bladder outlet obstruction. Cases of ureteral obstruction and spinal cord compression, which may contribute to paralysis with or without fatal complications, have been reported with LHRH agonists. If spinal cord compression or renal impairment develops, standard treatment of these complications should be instituted.
The most common systemic side effects were hot flashes (65.5%), asthenia (9.9%), implant site reaction (5.8%), testicular atrophy (5.3%), and renal impairment (4.7%). Five of the 8 patients had only a single occurrence of mild renal impairment (defined as creatinine clearance  30 and < 60 mL/min), which returned to a normal range by the next visit. The most common local side effects were bruising (7.2%), and pain/soreness/tenderness (3.6%).
Once serum testosterone concentrations at or below castrate level ( 50 ng/dL) were achieved, a total of 4 patients (3%) demonstrated breakthrough during the study. In one patient, a serum testosterone level of 63.1 ng/dL was reported at week 44; this patient's serum testosterone level returned to 8.1 ng/dL at the next reading. In another patient, a serum testosterone level of 3,340 ng/dL was reported at week 40. This aberrant value was possibly related to lab error. In two patients, serum testosterone rose above castrate level and the implant could neither be palpated nor visualized with ultrasound.
Response to VANTAS should be monitored by measuring serum concentrations of testosterone and PSA periodically, especially if the anticipated clinical or biochemical response to treatment has not been achieved.
References:
1. What are the key statistics about prostate cancer? American Cancer Society Web site. Available at: http://www.cancer.org. Accessed August 30, 2004.
2. Data on file. Indevus Pharmaceuticals, Inc.
3. McDavid K, Lee J, Fulton JP, et al. Prostate cancer incidence and mortality rates and trends in the United States and Canada. Public Health Rep. 2004;119:174-186.
4. Hernandez J, Thompson IM. Diagnosis and treatment of prostate cancer. Med Clin N Am. 2004;88:267-279.
5. Prostate cancer: overview. Mayo Clinic Web site. Available at: http://www.mayoclinic.com. Accessed July 15, 2004.
6. National Cancer Institute, U.S. National Institutes of Health Web site. Prostate Cancer (PDQ®): Treatment. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/prostate/patient. Accessed July 15, 2004.
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