Provenge is the first FDA-approved immunotherapy for prostate cancer. But … is it right for you?

Author: Dr. John Maggioncalda

The goal of every Urologist is to diagnose and treat prostate cancer early. The earlier the detection, the greater the chance a treatment will lead to long-term survival. Sadly, some patients progress even after their treatment and still others are diagnosed with advanced disease from the very beginning of our interaction with them. The next step for these patients is to ensure their testosterone level is very low. This is usually accomplished by using an agent, or a combination of agents, such as Lupron, Zometa, Eligard, or Casodex. These medicines will block the body’s production of testosterone and its attachment to receptors in cells preventing the growth of prostate cancer. Unfortunately, they work for a variable amount of time, in some cases only 2-4 years. What next?  Recently, a new immunotherapy called Provenge has been approved for patients with metastatic prostate cancer with rising PSA levels despite low, castrate levels of testosterone. 

Provenge is the first FDA approved form of immunotherapy for the treatment of metastatic prostate cancer.  Patients must have a rising PSA, despite castrate levels of testosterone, and some demonstrable form of metastatic disease by CT/MRI, ultrasound or bone scan.  Potential patients must also be healthy enough to receive Provenge with at least a 6-month life expectancy and no or limited pain from their metastases. 

Provenge is not a form of chemotherapy; it is considered immunotherapy.  The treatment uses the body’s own cancer fighting cells and energizes them to attack prostate cancer cells.  Once approved for treatment a patient will have blood drawn and the immune cells separated from the red cells.  These immune cells are then stimulated so that they will begin attacking the prostate cancer cells.  The immune cells are reintroduced into the body after stimulation and the process is repeated two more times.  These three treatments are all that is required and the total treatment takes 4-5 weeks.  The side effects of Provenge can include bruising from the needle sticks, fatigue, backache, and low-grade fevers. 

Once a patient receives Provenge the progress of their disease will continue to be monitored by their Urologist or Oncologist.  There is often no direct reduction in a patient’s PSA level after treatment but, studies have shown an improvement in overall survival compared to subjects that did not receive the treatment.  Patients are still able to receive other forms of chemotherapy once Provenge is administered. 

If you are a patient with metastatic, castrate-resistant prostate cancer, I encourage you to talk with your Oncologist or Urologist about Provenge to see if it is an option for you.  Remember, not every patient may be a good candidate for Provenge.

Spending too much time in the men's room?

Author: Dr. Murphy

You're probably heard the ads on TV —  Trouble going?  Always in the bathroom?  Take this medication and stop being bothered by your aging prostate!

Prostate enlargement, called "Benign Prostatic Hyperplasia," or BPH for short, affects a lot of us — up to a third of all men will be bothered by it at some point. As the prostate enlarges, it pinches off the flow of urine from the bladder. Slowing of the stream, difficulty starting, and poor bladder emptying are the most common signs. A strong urge to go right away, even leaking before making it to the bathroom can happen, as well as getting up more often at night. We're not really sure why some men get it and others don't. It isn't caused by the things we eat or drink, or anything we do — you could say it's just part of aging, like arthritis or getting cataracts.

Fortunately there are ways to treat it. Some men feel that herbal remedies such as saw palmetto help them (although medical studies that compared saw palmetto to a sugar pill do not seem to show much benefit).  There are a couple of different types of prescription meds that work well:  

• Flomax, now available as the generic drug Tamsulosin, is the most commonly used medication for BPH. It relaxes the muscle fibers where the bladder empties through the prostate to open up the urinary flow. This medication starts working in just a week or two.
• Avodart, and a similar generic called Finasteride, shrink the prostate to improve the urinary stream, although it can take a few months to notice any improvement.  

Side effects of both of these meds are usually temporary and aren't too bothersome.

For some men, medications don't help enough. They might need a procedure to open up the urinary channel. These treatments are done under a sedative or fully asleep so there isn't any pain:

• Microwave Hyperthermia heats the prostate tissue up, and over the next few weeks it shrinks to open the channel.
• Another type of treatment removes the enlarged prostate tissue through a scope in the urethral channel. Some people call this a "Roto-Rooter."  In one technique, a laser uses a beam of energy to vaporize the tissue. The other, called Transurethral Resection, or TURP, trims out the tissue. Most men are back to full activities within a week or two. 

So all those ads on TV do make a good point. Prostate enlargement can be really annoying, and there are lots of ways to treat it. Like they say, talk to your doctor and see what you can do to urinate normally again.