Advanced Prostate Cancer Clinic

At AAU, we strive to provide the highest quality and most comprehensive care for our patients.

Our Advanced Prostate Cancer Clinic (APCC) was established to provide our patients the most up-to-date care using consensus guidelines established by the American Urological Association and the National Comprehensive Cancer Network.

These guidelines along with expert opinions optimize quality of life and enable patients to take advantage of the most novel, life-extending treatment options.

Treatment for advanced prostate cancer can be complex and daunting for any patient and his family. The algorithm is complex involving multifaceted modalities including hormonal therapies, immunotherapies, oral oncolytics, systemic chemotherapies, radiotherapies, and clinical trials. These medications can be used solely or in tandem, but the decision is made after careful treatment planning with the patient and his family. At AAU, we provide extensive patient education, counseling, and consideration of your personal treatment goals prior to starting any new treatment. This enables you and your loved ones to make specialized determinations about which treatments are best for you. Our APCC is directed by Dr. Zhu and NP Kati Watts. Please ask your physician about the program.

Common Questions

What is advanced prostate cancer?

Advanced prostate cancer is often defined when your cancer has spread outside of the prostate. This can be microscopic or it could be detected by imaging studies. Your physician will determine the stage of your prostate cancer by obtaining imaging studies such as a CT, Bone scan, or advanced PET scans. These studies are indicated when your PSA level increases after primary treatment.

What are my treatment options if my prostate cancer recurred after primary treatment (i.e. Surgery or Radiation)?

There are 2 types of recurrences. 1. Biochemical recurrence occurs when the PSA rises after treatment without any radiographic detection of cancer. 2. Radiographic identification of cancer on CT, Bone scan, or specialized prostate cancer scans. Treatment for prostate cancer recurrence will depend on the type of recurrence and location. Additional treatment options include salvage adjuvant radiation, cryoablation, and/or hormone therapy. Please ask your physician which one is best suited for you.

What is hormone treatment?

Prostate cancer thrives on testosterone which is naturally produced by your body. As a result, manipulation of your testosterone production pathway and its receptors on cells allow your physicians to control the disease and potentially promote regression of the disease. The target goal for hormone therapy is to lower your testosterone level to <50ng/dL.

What are the side effects of hormone treatment?

Most common side effects are: Hot flashes, fatigue, decreased libido, anemia, and bone weakness.

What is hormone sensitive prostate cancer?

Hormone sensitive prostate cancer means the prostate cancer cells responds to hormone deprivation treatments and the cells will stop growing and potentially regress while on hormone therapy.

What is castrate resistant prostate cancer or hormone resistant prostate cancer?

Castrate resistant prostate cancer is defined as progression of prostate cancer while on sufficient hormone therapy. This is determined by your physician with PSA and testosterone level testing. It is very important to identify castrate resistance due to additional treatment options that are currently available.

What are some of the available advanced prostate cancer treatment options?

Currently there are multiple medications that can be taken orally to treat advanced prostate cancer. These advanced oral medications include but are not limited to: Zytiga, Xtandi, Erleada, Nubeqa, Lynparza, and Rubraca. Additional therapies include immunotherapy agent (Provenge), radiotherapy agent (Xofgio), chemotherapy agents (Taxotere, Jevtana), and bone health agents (Xgeva, Prolia, Fosamax, Actonel, Boniva, and Zometa). All these medications require expert considerations and treatment planning.

Why do I need to talk to my physician about bone health?

During long-term hormone therapy treatment with deprivation of testosterone, your body will lose bone density and mass. As a result, it will over time increase your risk of fracture from a fall. Your physician will assess your bone density based on a specialized bone density x-ray called a DEXA scan. We at AAU will strive to reduce your risks and maintain your bone health during your prostate cancer treatment. Please ask us about our bone health clinic.