Ferring

Prostate cancer is cancer of the prostate gland.

Prostate cancer may progress through 4 different stages that indicate increasing severity of the condition. At diagnosis, a physician will determine the appropriate treatment approach based on the stage of development.

Locally advanced prostate cancer usually means that the cancer has spread from the prostate, where it began, to nearby tissues or other areas of the body through the lymph system or bloodstream. Unlike early prostate cancer, the tumor is no longer confined to the prostate.

Locally advanced prostate cancer may also be associated with a higher grade and more aggressive type of cancer. In advanced prostate cancer, a measurement called the Gleason system is used to determine the grade of the cancer cells. A Gleason score of 2 to 10 is used to describe how advanced the cancer has become. A lower Gleason score (2-4) usually indicates a less aggressive tumor, while a higher score (8-10) signifies a more aggressive tumor.

The symptoms of locally advanced prostate cancer are similar to those of early prostate cancer but may include other, more serious health issues. As with early prostate cancer, signs of locally advanced prostate cancer are:

• Difficulty urinating
• Trouble starting or stopping the fl ow of urine
• A frequent urge to urinate, especially at night
• A weak flow of urine
• Burning or pain during urination
• Pain during ejaculation
• Persistent bone pain in the back, hips, or pelvis

In addition to the digital rectal examination (DRE), the prostate-specifi c antigen (PSA) test, and the biopsy, other tests will be run if your doctor has found that cancer has spread outside the prostate:

• Ultrasound: a finger-sized probe placed into the rectum uses sound waves to create images of the prostate
• Bone scan: a small amount of radioactive material is injected into the bloodstream; if there are cancer cells in the bones, the radioactive material will gather in those areas
  • During this process, patients are asked to lie on a table, where their body is scanned to see if the radioactive material has collected in bone
• Magnetic resonance imaging (MRI): this procedure allows your doctor to see detailed images of the body
• Computerized tomography (CT or CAT) scan: using an x-ray machine connected to a computer, this diagnostic tool helps your doctor look at organs and tissue from different angles
  • In some cases, your doctor may use an injected or digestible dye to help organs become more visible

It's important to understand that every case of prostate cancer is different, and your doctor is the best person to determine the right path of treatment for your individual circumstances.

The following treatment options may be recommended:

Prostate cancer surgery

• Sometimes localized prostate cancer is treated using surgery. The following are common types of surgery:
  • Prostatectomy by incision: removes the prostate, surrounding tissue, and seminal vesicles (pouches above the prostate that store semen)
  • Laparoscopic prostatectomy: uses tiny instruments that do not require a large incision

Radiation Therapy

• One of 2 methods is used, depending on the type and severity of cancer:
  • External beam radiation therapy uses a machine outside the body to direct radiation toward the cancer
  • Radioactive seeds are placed directly into or near the cancer (brachytherapy)
• Proton therapy may be indicated in certain patients

Hormone therapy in locally advanced prostate cancer

• Also known as androgen deprivation therapy, the goal of hormone therapy is to reduce testosterone levels to low levels to block tumor growth
  • Low testosterone levels are important to treatment results
• There are 2 categories of drugs used as noninvasive hormone therapies
  • Luteinizing hormone-releasing hormone (LHRH) agonists make testosterone levels increase ("surge") at first, which may make the tumor grow
    • A second drug may be required to help protect you against potential effects of the surge
    • It takes about 1 month to reduce testosterone to medically acceptable levels
• GnRH antagonists block and reduce testosterone production without causing an initial rise in testosterone production
  • LHRH agonists and gonadotropin-releasing hormone (GnRH) antagonists work in different ways to block production of testosterone
  • FIRMAGON^® (degarelix for injection) is the only available GnRH antagonist in the US for the treatment of locally advanced prostate cancer
  • FIRMAGON helps block testosterone production
    • Reduces testosterone levels within 1-3 days
    • Reduces PSA levels
    • Does not create an initial temporary rise in testosterone production
    • Does not need additional antiandrogen treatments to help protect against rise in testosterone
    • Is given as an injection once a month

Hormone therapy in locally advanced prostate cancer

Chemotherapy

• Powerful drugs are used to halt cancer cell growth by killing existing cells or preventing them from multiplying
• Chemotherapy may be injected into the bloodstream or muscle or taken by mouth