Prostate Cancer Is Getting Easier to Treat — How Hormonal Compounding Plays a Big Role
In the last twenty-five years, prostate cancer has seen a great increase in disease awareness, no doubt due to a significant increase of new cases in the 1980s. Since then, prostate cancer research and translational treatment has resulted in a dramatic decrease of incidence and mortality1, with a recent shift from infusion-based therapies to oral strategies. Prostate cancer, in particular, has long been based on hormonal treatment. Recent research continues to move in that direction, with oral treatment and topical gels based on hormonal compounding offering new hope for patients. Compounding pharmacies must respond to this shift, as we are poised to be an even bigger part of the cure.
Hormonal Compounding and Newer Prostate Cancer Treatments
Standard therapy for prostate cancer currently ranges from active surveillance to surgery and radiation therapy, depending on the stage of the cancer. The more advanced the stage, the more invasive the treatment can get. Hormonal therapy is a mainstay of later-stage cancers, typically used if radiation therapy and surgery are no longer options.2 The key to these hormone therapies is to reduce the level of androgens, mainly testosterone and dihydrotestosterone (DHT); there are different categories of treatment, some more invasive than others.
- Surgical castration: Removal of testicles, which is where androgens are made, lowers hormone levels;
- Chemical castration: Injecting or implanting certain drugs also lowers testosterone by shrinking the testicles over time;
- Luteinizing hormone-releasing hormones (LHRH): LHRH, delivered via injection or orally, lowers testosterone levels but at the cost of an initial flare up of the cancer;
- Anti-androgen therapy: Anti-androgen therapy binds to androgen receptors, eliminating androgen activity, but is typically used alongside another therapy, such as surgical castration.
While hormonal treatment remains the first line treatment for these late-stage prostate cancers, some cancers become resistant to androgen deprivation therapy (ADT). New treatments, particularly those that shift from perfusion-based to oral medications, make compounding pharmacies essential for better patient outcome.3 These newer oral drugs, which act mostly through pharmacological means but which may also block androgen production, have been approved in the last five years and are available only through specialty pharmacies. New drugs fall into one of two categories:
- Abiraterone: A daily administered androgen biosynthesis inhibitor that suppresses androgen synthesis; and
- Enzalutamide: An oral therapy that competitively inhibits androgen receptors, thereby decreasing in cancer volume and proliferation.
Compounded testosterone gels applied topically can also keep testosterone levels in a more reasonable range.4 Hormonal compounding treatments can also be combined with nutritional supplements that have anti-inflammatory properties and contribute to prostate health. Key dietary supplements include:
- Omega-3 fatty acids;
- Vitamin D;
- Zinc; and
Since prostate cancer often occurs and persists in older men, who may already have any medical conditions to contend with, understanding potential side effects and contraindications of existing therapies is obviously key. Specialty pharmacies that offer these oral treatments can routinely keep up with new research of medication side effects and efficiency, and can easily pass on that information to their patients. In fact, common side effects with these new medications may not differ from those the patient is used to with the current medications he is already on, such as:
- Loss of libido;
- Erectile dysfunction (ED);
- Hot flashes.
Other side effects that are less understood can include5:
- Breast enlargement;
- Loss of muscle mass and strength;
- Loss of penile length and testicular volume;
- Loss of bone density;
- Worsening of hypertension, diabetes, and coronary artery disease;
- Loss of cognitive function.
Abiraterone and enzalutamide may not be the best treatment for everyone but the truth is that prostate tumors can stop responding to any given treatment. Patients need to consider all of their treatment options and to balance potential side effects against optimum treatment. Pharmacists can also keep aware of new treatments under development that may be a better fit for patient, such as:
- Cabozantinib: Currently in use for treating thyroid cancer and only available thru specialty pharmacies;
- Tasquinimod: An immune system modulator in a Phase III trial;
- Vaccines: Intended to prolong patient lifespan, select vaccines will become available through some specialty pharmacies. Adverse effect management will be an essential part of pharmacist duties.
A patient’s whole healthcare team must be involved in developing the best hormonal compounding for each patient—pharmacists are not only a big part of that development and dispensation, but are also in the best position to add to a larger database of side effects and treatment response patients report, This, in turn, can lead to further knowledge of the cancer and development of other therapies. Pharmacists are not only poised to offer patients new treatments based on pharmacological and hormonal compounding, but we add value to both patient and physician education, which can only help reduce prostate cancer incidence and mortality even further.
Research and development for new treatments in healthcare is ongoing. Pharmaceutica North America is committed to evaluating the latest in pharmaceutical news and to provide you with safe and high-quality compounding materials. Please contact us today to learn more about how we can help you provide the best care for your patients.
- “A Snapshot of Prostate Cancer,” November 5, 2014, http://www.cancer.gov/research/progress/snapshots/prostate ↩
- “Hormone (androgen deprivation) therapy for prostate cancer,” March 12, 2015, http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-treating-hormone-therapy ↩
- “Specialty pharmacy’s expanding role in prostate cancer management,” October 1, 2013, http://www.pharmacist.com/specialty-pharmacy%E2%80%99s-expanding-role-prostate-cancer-management ↩
- “Hormonal Influences in Prostate Cancer: An Update of a Complex Subject,” March/April 2010, http://www.ncbi.nlm.nih.gov/pubmed/23965417 ↩
- “Androgen Suppression: Monitoring and Minimizing Toxicity,” http://www.medscape.org/viewarticle/438957_5 ↩