Research into treatments for prostate cancer

All treatments have to be fully researched before they can be adopted as standard treatment for everyone. This is so that

• We can be sure they work
• We can be sure they work better than the treatments that are available at the moment
• They are known to be safe

First of all, treatments are developed and tested in laboratories. For ethical and safety reasons, experimental treatments must be tested in the laboratory before they can be tried in patients. If a treatment described here is said to be at the laboratory stage of research, it is not ready for patients and is not available either within or outside the NHS.

Tests in patients are called clinical trials. The trials and research section has information about what trials are including information about the 4 phases of trials. If you are interested in taking part in a clinical trial, visit our searchable database of clinical trials and choose 'prostate' from the dropdown list. If there is a trial you are interested in, print it off and take it to your own specialist. If the trial is suitable for you, your doctor will need to make the referral to the research team. The database has information about open trial, closed trials and trial results.

All the new approaches covered here are the subject of ongoing research. Until studies are completed and new effective treatments are found, these treatments cannot be used as standard therapy for cancer of the prostate.

It can be difficult for doctors to decide on the best treatment for prostate cancer that is completely inside the prostate (localised cancer). Options for treatment include surgery, radiotherapy or careful monitoring with check ups (active monitoring). Research studies are comparing these three treatments, and aiming to find out which works best, and how many men with prostate cancer might never need treatment. 

The ProSTART trial is trying to find out if it is best for men with prostate cancer contained within the prostate gland to have treatment straight away or to have active surveillance. 

There is a trial looking at HIFU treatment for the largest area of early prostate cancer to see if it can delay it from spreading. HIFU is high frequency ultrasound treatment. The researchers hope that this would reduce the need for other treatments that can cause more severe side effects. 

The Mapped trial is looking at whether a drug called dutasteride can control prostate cancer in men who are having active surveillance.

Researchers also want to find out what men think about the treatments for early prostate cancer. The SABRE 1 trial is looking at giving men a DVD or video to help them decide which treatment to have. And it wants to find out if a study comparing radical prostatectomy with brachytherapy to the prostate can be done. 

There is detailed information about these trials on the CancerHelp UK clinical trials database. Pick 'prostate' from the dropdown menu of cancer types.

Research into surgery for prostate cancer is looking at 

• Different types of surgery
• Scans during planning for surgery

Different types of surgery

A trial called LopeRA is comparing three operations for prostate cancer. It is comparing open surgery, keyhole (laparoscopic) surgery and robot assisted surgery for prostate cancer that has not spread. Doctors usually remove localised prostate cancer with surgery. There are several ways to do this, and no one is quite sure yet which one is best.

Open surgery is when the surgeon makes a cut in the abdomen, or between the testicles and back passage, to remove the prostate. Laparoscopic surgery is when the surgeon makes several smaller cuts and puts surgical instruments and a camera through these small holes. The surgeon uses these to look inside, find and remove the prostate.

Robot assisted surgery is similar to laparoscopic surgery. But the surgeon controls the instruments and camera using a machine (robot). It is sometimes called da Vinci surgery. Some of the aims of the trial include how long you stay in hospital, the side effects, and to see if the cancer comes back after surgery.

Scans during planning for surgery

If you have prostate cancer that is completely inside the prostate (localised prostate cancer), you may have surgery to remove the whole prostate (a radical prostatectomy). To help plan your surgery, your surgeon looks at scans taken when the cancer was diagnosed. The scans include an ultrasound of your prostate through your back passage (transrectal ultrasound), and an MRI scan. These scans are helpful but cannot always clearly show the difference between healthy and cancerous tissue. 

The DMAPS pilot study is looking at a type of MRI scan called diffusion weighted MRI (DWI MRI) to see if it can show up areas of cancer more clearly. This would help the surgeon to more accurately remove the cancer.

Radiotherapy is already an effective treatment for prostate cancer. Research continues to try to improve cure rates and reduce side effects. There is research into the following areas.

• Changing the external radiotherapy dose
• Conformal radiotherapy
• Intensity modulated radiotherapy (IMRT)
• Radiotherapy after surgery
• Stereotactic radiotherapy
• Finding out about radiotherapy side effects
• Internal radiotherapy for bone metastases
• Finding out how radiotherapy affects the immune system

Changing the external radiotherapy dose

Researchers are looking at different ways of giving the total dose of radiotherapy for men with prostate cancer. The CHHIP trial has found that giving a higher dose of radiotherapy per session (fraction), but fewer fractions, is as safe as standard radiotherapy and does not cause more side effects. The next phase of this trial aims to find out whether the higher doses in fewer fractions is better at curing the cancer than the standard treatment.

The PIVOTAL trial is comparing 2 different ways of giving radiotherapy for prostate cancer that may have spread to the lymph glands in the pelvis. The pelvis is the area surrounded by your hip bones. The trial aims to confirm whether is safe to give high doses of radiotherapy to the prostate and the lymph glands in the pelvis. It also wants to find out more about the side effects of having radiotherapy to the prostate only and having radiotherapy to the prostate gland and pelvis.

Conformal radiotherapy

Conformal radiotherapy uses a computer to shape the radiotherapy beams to a more exact shape of your prostate. The idea is to cut down on the amount of healthy body tissue that receives radiation. The National Institute for Health and Clinical Excellence (NICE) has issued guidance for the treatment of prostate cancer. The guidelines say that conformal radiotherapy is the best way to give radiotherapy for prostate cancer and should be available to patients.

This type of radiotherapy can lower the number of men who have long term side effects of straining and bleeding from the back passage (proctitis) after radiotherapy treatment. Although doctors know that conformal radiotherapy can reduce side effects, we don't know yet whether it could be better at controlling prostate cancer or stopping it from coming back. So trials are looking at this.

Intensity modulated radiotherapy (IMRT)

Studies are taking place in the UK of a type of conformal radiotherapy called intensity modulated radiotherapy (IMRT). Like conformal radiotherapy, IMRT shapes the radiation beams to closely fit the area where the cancer is. But it also changes the dose of radiotherapy depending on the thickness of the body tissue. IMRT can also create an indented (concave) area within the radiotherapy field to avoid structures that would be damaged by the radiotherapy. Researchers want to find out how IMRT compares to standard radiotherapy.

Radiotherapy after surgery

At the moment, many men who have removal of the prostate gland (radical prostatectomy) for early prostate cancer will not have any further treatment unless their PSA level rises. The RADICALS trial is looking into whether it would be better to give all men radiotherapy after radical prostatectomy, whatever their PSA level. It is also investigating whether having hormone therapy as well works better than radiotherapy on its own for this stage of prostate cancer, and if so, how long you should take it for.

Stereotactic radiotherapy

Stereotactic radiotherapy gives radiotherapy in fewer sessions, using smaller radiation fields and higher doses than conventional external beam radiotherapy techniques. The PACE trial is comparing stereotactic radiotherapy with either conventional radiotherapy or surgery. It is for men with prostate cancer that has not grown outside the prostate gland (localised prostate cancer).

Finding out about radiotherapy side effects

A study called PRECIOUS is looking into how doctors and nurses collect information about the side effects of radiotherapy for prostate cancer. Researchers have developed a questionnaire which people answer on a computer. They want to test the questionnaire to find out how good it is at helping doctors understand and treat the side effects.

Radiation kills cells by damaging the DNA inside them. Having radiotherapy kills cancer cells, but also damages nearby healthy cells close to the area being treated. A study is looking at DNA and tissue damage in men having radiotherapy for prostate cancer. The researchers will look for signs of cell damage and repair in blood samples from men having different types of radiotherapy for prostate cancer. The men taking part will also fill out questionnaires about any side effects. Doctors hope that this research will tell them more about how radiation damages DNA during treatment and give them better ways of predicting side effects. This might help them to improve treatment in the future. 

Radionuclide radiotherapy for bone metastases

In Belfast, there was a small trial of internal radiotherapy for men whose prostate cancer had spread to the bones, and was no longer responding to hormone treatment. The 14 men that took part in this phase 1 trial had docetaxel chemotherapy, steroids, and rhenium-186. Rhenium-186 is a radioactive substance which doctors think will target the cancer cells in the bone, and stop them growing. The researchers found that they could safely use this combination of treatment. They hope to do larger trials of chemotherapy and this type of internal radiotherapy in the future.

Early results from the ALSYMPCA trial found that the radioactive injection Radium 223 (Alpharadin) can help some men with advanced prostate cancer to live a few months longer than current internal radiotherapy treatments. Alpharadin also seemed to cause very few side effects. The trial looked at this treatment for men with prostate cancer that had spread to the bone and where hormone therapy is no longer working.

Finding out how radiotherapy affects the immune system

The Prostate Radiotherapy Pneumovax Study (PRP) is a small study looking at how radiotherapy affects the immune system of men with early prostate cancer. Men with prostate cancer on this study have already started hormone therapy. Researchers take blood tests from some men before they have radiotherapy and from some men before, during and after radiotherapy. 

All the men on the PRP trial have vaccinations against a particular type of pneumonia at different stages of their treatment. Blood tests aim to show how the immune system responds to the vaccine before or after radiotherapy. The researchers hope that the results from this study will help them to develop a cancer vaccine to treat prostate cancer. 

You can find more information about prostate cancer radiotherapy trials on the clinical trials database. Pick 'prostate' from the dropdown menu of cancer types.

Cancer of the prostate depends on the male hormone testosterone for its growth. If the amount of testosterone in the body is lowered, it is possible to slow down or shrink the tumour. Sometimes the cancer symptoms disappear completely. There is information here about

• New hormone therapies
• Timing of hormone therapy
• Hormone therapy in combination with other treatments

New hormone therapies

Doctors are continuously looking for new hormone therapies to treat prostate cancer. Many of the current hormone drugs cause a rise in testosterone when they are first taken. So prostate cancer symptoms tend to get worse before they improve. A drug called abarelix does not seem to do this.

Research so far shows that abarelix works more quickly on prostate cancer and does not seem to cause an initial rise in testosterone levels. Similar drugs are also being tested, including ganirelix and cetrorelix.

The AFFIRM trial is testing a new hormone therapy drug called MDV3100 (enzalutamide) for prostate cancer that is getting worse despite hormone therapy and chemotherapy. Enzalutamide blocks the receptors that testosterone uses to get into prostate cancer cells. It is a type of hormone therapy called an androgen receptor antagonist. This trial aims to see if enzalutamide helps men with prostate cancer to live longer.

In 2003 a small pilot study looked at hormone replacement therapy (HRT) patches to treat men with advanced prostate cancer. The researchers reported that all the men in the study who were treated with HRT patches felt that they had an improvement in their quality of life. But this was only one small study. Larger, randomised, controlled clinical trials are needed before we know more about the side effects men get when treated with hormone patches. The PATCH trial is comparing oestrogen patches with standard hormone treatment to see if they work as well. 

A hormone therapy called abiraterone is used to treat advanced prostate cancer. Abiraterone acetate stops an enzyme in your body called CYP17 from working. If CYP17 can't work, your body cannot make testosterone. 

A phase 3 trial called COU-AA-301 recruited 1,195 men with prostate cancer that  had continued to grow despite other treatment, including chemotherapy. The results so far show that men who had abiraterone with prednisolone (a steroid) lived over 4 months longer on average than the men who had the placebo with prednisolone.  Another phase 3 trial called COU-AA-302 aims to find out how well the combination of abiraterone and prednisolone works for men with advanced prostate cancer who have had hormone therapy, but not chemotherapy. This trial has finished recruiting patients, but the results are not known yet.

The STAMPEDE trial is looking at treatment with abiraterone combined with other treatments for prostate cancer. The trial is for men whose prostate cancer has spread outside the prostate gland. The aim of the trial is to see which treatment is best for prostate cancer that has spread outside the prostate gland.

Hormone therapy timing

Some clinical trials are looking into the timing of hormone therapy. 

A 10 year European trial found that 3 years of hormone therapy after radiotherapy reduced the chance of the cancer coming back. The trial was for men who had stage T1 or T2 prostate cancer that was grade 3, or they had stage T3 or T4 of any grade.

Some trials have shown that intermittent hormone therapy gives reduced side effects compared to continuous hormone therapy for men with advanced prostate cancer. One trial has shown that it may not control the cancer for as long though. Intermittent therapy means having hormone therapy for 6 months, then having a break for a while and then having it for another 6 months. One UK trial is looking at intermittent hormone therapy for advanced prostate cancer. It wants to check whether giving hormone therapy for 7 months and then stopping can control the cancer as well as continuous therapy. The trial is no longer recruiting patients and we are waiting for the results. 

The Intercontinental trial compared intermittent hormone therapy with continuous hormone therapy for prostate cancer that had continued to grow after radiotherapy. The trial team found no difference in the amount of time men lived when they compared the 2 treatment groups. But for many of the men having intermittent hormone therapy the side effects were reduced and they had a slightly better quality of life than the men who had continuous hormone therapy.

There is another trial looking at combining intermittent hormone therapy with radiotherapy for men with locally advanced prostate cancer.

In 2011, the 10 year TROG trial in New Zealand and Australia reported that hormone therapy should be given for at least 6 months alongside radiotherapy for locally advanced prostate cancer. But the researchers suggested that giving the hormone therapy treatment for longer than 6 months did not give any additional benefit. We need more studies to confirm this.

The GREAT study is looking at giving the hormone therapy drug triptorelin every 6 months instead of every 3 months to treat prostate cancer. Doctors want to see how well 6 monthly triptorelin works and if men prefer having treatment every 6 months instead of every 3 months.

Hormone therapy in combination with other treatments

The EDVART trial is looking at whether the hormone therapy Decapeptyl (triptorelin) can shrink the prostate gland before radiotherapy for early prostate cancer. Shrinking the prostate gland before treatment can help the radiotherapy to work better. The study aims to find out if Decapeptyl works as well as Goserilin (Zoladex) at reducing the size of the prostate gland. It also aims to learn more about the side effects of Decapeptyl.

Hormone treatment often works well for cancer that has spread outside the prostate gland. But doctors think that using it with other treatments could work better. The STAMPEDE trial is studying the combination of hormone therapy with chemotherapy, bisphosphonates or celecoxib for men who have prostate cancer that has grown outside the prostate gland. It is also for men whose prostate cancer has started to grow again after treatment with radiotherapy or surgery.

The RADICALS trial is looking at whether giving hormone therapy with radiotherapy helps to stop the cancer coming back, in men who have had surgery for early prostate cancer.

You can find more information about hormone therapy trials for prostate cancer on the Cancer Research UK Clinical trials database. Pick 'prostate' from the dropdown menu of cancer types.

In the past, chemotherapy drugs were not widely used to treat prostate cancer because they didn't seem to work very well. But over the past few years clinical trials have found that mitoxantrone and docetaxel (Taxotere) can work well for prostate cancer that has spread and stopped responding to hormone therapy. Research includes the following areas.

• Combining chemotherapy with other treatments
• Melphalan and stem cell rescue
• Cabazitaxel

Combining chemotherapy with other treatments

The Trapeze trial is looking at combined treatments for prostate cancer that has spread to the bones. It is comparing different combinations of treatment including docetaxel (Taxotere) chemotherapy, the bisphosphonate zoledronic acid (Zometa) and strontium 89 radiotherapy. 

Melphalan and stem cell rescue

A small trial is testing melphalan chemotherapy for prostate cancer that is no longer responding to hormone therapy. Melphalan can cause a severe drop in your blood cell counts, which limits the dose you can have. If you join this trial, you have growth factor injections to make you produce more stem cells. The stem cells are collected from your blood for a few days before you have the melphalan. After the melphalan you have your stem cells given back to you to help your blood counts to recover more quickly. Doctors hope that in this way they can give higher doses of melphalan. They also want to see if your cancer will become sensitive to hormone treatment again afterwards. 

Cabazitaxel

A newer drug that researchers are looking at is cabazitaxel (Jevtana). The international TROPIC trial compared cabazitaxel with mitoxantrone for men who had advanced prostate cancer that had continued to grow, despite hormone therapy and chemotherapy with docetaxel. Men in the trial had prednisolone and either mitoxantrone or cabazitaxel. The results showed that the men who had cabazitaxel lived an average of 3 months longer than the men who had mitoxantrone. The men who had cabazitaxel were more likely to get infections because their white blood cell count was low. More trials are looking at combining cabazitaxel with other types of chemotherapy.

Doctors continue to study different combinations of chemotherapy drugs, different doses, or different sequences in which drugs are given. The aim of this type of research is to find more effective ways of treating prostate cancer with chemotherapy. There is detailed information about chemotherapy trials for prostate cancer on our clinical trials database.

Bone pain and damage can be a problem in advanced prostate cancer that has spread to the bones. The growth of the cancer cells starts to break down the bone tissue. Bone secondaries could lead to pain or fractures. In the spine they can also cause pressure on your spinal cord. Bisphosphonates can help to control bone pain. Some trials have looked at how well bisphosphonates work to stop or slow down the damage caused to bone by bone secondaries. Trials are also comparing different types of bisphosphonate to see which works best. 

At present, the National Institute for Health and Clinical Excellence (NICE) recommends that bisphosphonates should not be used to prevent or reduce bone damage, from secondary cancers or osteoporosis, in men with prostate cancer. Their guidance says that bisphosphonates should only be used to control pain from bone secondaries in prostate cancer, and only if other treatments, such as painkillers or radiotherapy, are not working.

The RIB trial was a Cancer Research UK supported trial. It compared treatment with the bisphosphonate ibandronate to radiotherapy to see which is best at controlling pain from bone secondaries. In 2012 the trial team reported that there was little difference between the 2 treatments. They found that a single dose of ibandronate can be a useful treatment for pain caused by prostate cancer that has spread to the bone.

The Trapeze trial is looking at the bisphosphonate drug zoledronic acid (Zometa) in combination with chemotherapy and the internal radiotherapy strontium 89. The researchers want to find out how well these treatments work together and what the side effects are.

You can find information about bisphosphonates for prostate cancer trials on our clinical trials database. Pick 'prostate' from the dropdown menu of cancer types.

Cryosurgery is also called cryotherapy. This is a way of getting rid of prostate cancer that is completely within the prostate. It uses freezing probes to kill cancerous tissue. 

The National Institute for Health and Clinical Excellence (NICE) issued guidelines in 2012 for treating prostate cancer. These say that cryosurgery for prostate cancer appears to be safe enough for prostate cancer that has just been diagnosed, or that has come back within the prostate after treatment. But we don't yet have enough evidence about the long term benefit or the effects on quality of life. There is detailed information on cryotherapy in the prostate cancer question and answer section.

The CROP trial is comparing hormone therapy alone to cryotherapy followed by hormone therapy for prostate cancer that has come back after radiotherapy treatment. Researchers want to find out if there are long term benefits to having cryotherapy and how it affects men's quality of life. This trial is funded by Cancer Research UK.

When high frequency sound waves are concentrated on body tissues, those tissues heat up and die. Doctors have used high frequency focused ultrasound (HIFU) for prostate cancer that has just been diagnosed, or for cancer that has come back in the prostate gland after earlier treatment. There is information about HIFU for prostate cancer in this section of the website. 

Treatments such as surgery or radiotherapy for early prostate cancer can cause side effects such as erection problems and incontinence for some men. Doctors hope that HIFU may cause less side effects than other treatments. One trial looked at HIFU for just the areas of the prostate that contain cancer (focal ablation). The researchers found that focal ablation did not cause bad side effects. 42 men took part in the trial. 1 in 5 men had some pain passing urine after the treatment but this only lasted a few days. None of the men in the trial said they had urinary incontinence a year after treatment. Of the 35 men who said they were able to get an erection before treatment, 31 said this was the same a year after treatment.

There are a couple of other trials using HIFU for early prostate cancer. One trial is looking at whether using HIFU to treat only the largest area of early prostate cancer can delay the spread of cancer. This could delay the need for other treatments for a while and so reduce the side effects. The INDEX trial is looking at using HIFU to treat only the areas of cancer in the prostate that are at risk of spreading. Treating less of the prostate should mean a lower risk of side effects.

One trial is using HIFU after radiotherapy for men with prostate cancer that has started to grow again after treatment. This trial is for men whose cancer is completely contained within the prostate.

You can find detailed information about HIFU trials for prostate cancer on our clinical trials database. Select 'prostate' from the dropdown menu of cancer types. Or type 'HIFU' into the free text search.

Biological therapies are cancer drugs developed from natural body substances or they change the way that some chemicals work in the body. These treatments include

• Monoclonal antibodies
• Cancer growth blockers
• Drugs that block the cancer's blood supply
• PARP-1 inhibitors
• Gene therapy
• Vaccine therapy

Monoclonal antibodies

Drugs called monoclonal antibodies (MABs) can recognise particular types of cancer cell and help the immune system to destroy them.

A monoclonal antibody called ipilimumab is used to treat melanoma. Researchers want to see if it works for prostate cancer. There is a trial looking at ipilimumab after radiotherapy to the bones. The trial is for men who have already had docetaxel chemotherapy for prostate cancer that has spread to the bones and is not responding to treatment. It aims to see how well radiotherapy followed by ipilimumab works for prostate cancer that is not responding to other treatments. The researchers also want to learn more about the side effects of ipilimumab and find out how it affects quality of life.

There is another trial looking at ipilimumab for prostate cancer that has stopped responding to hormone therapy. The trial aims to find out if ipilimumab helps men in this situation to live longer and to learn more about the side effects.

Cancer growth blockers

Some biological therapy drugs block the growth of cancer cells. Some are called endothelin blockers or endothelin receptor agonists. They work by blocking growth receptors called endothelin receptors. Some early results from trials have shown that endothelin blockers may be able to slow down the growth of cancer in the bone and delay the symptoms of secondary bone cancer for men with advanced prostate cancer. 

Researchers have been studying several endothelin blockers, such as Atrasentan and YM598. But it will be some years before we know the full results.

Some drugs work by blocking tyrosine kinases. Tyrosine kinases are chemicals that trigger cell growth. Dasatinib is a type of tyrosine kinase blocker. In one trial researchers are adding dasatinib to docetaxel chemotherapy to see if it can control advanced prostate cancer that is no longer responding to hormone treatment.

Some drugs block a protein called clusterin. Researchers think that clusterin may help cancer cells to protect themselves from cancer drugs and stop the drugs working as well as they could. There is a trial looking at a clusterin blocker called custirsen (OGX-011). It is being used alongside chemotherapy for prostate cancer that has spread to other parts of the body and is not responding to hormone therapy. The trial is to find out whether adding custirsen to docetaxel chemotherapy and the steroid prednisolone improves this treatment.

Drugs that block the cancer's blood supply

Cancers need to grow their own blood vessels as they get bigger. Angiogenesis means the growth of new blood vessels. Drugs that stop cancers growing new blood vessels are called anti angiogenic drugs. For prostate cancer, those being tested include COX2 inhibitors and tasquinimod. 

COX2 inhibitors stop the cancer cell producing a growth factor called vascular endothelial growth factor (VEGF) that stimulates blood vessel production. COX2 inhibitors are a type of non steroidal anti inflammatory drug (NSAID). Researchers think a COX2 inhibitor called celecoxib (Celebrex) may be useful in the future for treating prostate cancer. If celecoxib can reduce the amount of VEGF in prostate cancer cells it will mean that the cancer won't be able to grow.

The STAMPEDE trial is looking at treatment with celecoxib combined with other treatments for prostate cancer that has spread outside the prostate gland. The aim of the trial is to see which treatment is best. Early results from this trial found that celecoxib with hormone therapy did not work any better than hormone therapy alone.      

A trial is looking at a drug called tasquinimod for prostate cancer that has spread to another part of the body (metastatic). The trial aims to find out how well tasquinimod works for prostate cancer that is no longer responding to hormone therapy.

PARP-1 inhibitors

PARP-1 inhibitors block a protein in cells called PARP. This protein is important for cells to repair their DNA. By blocking this protein, cancer cells can't repair themselves and they die.

Olaparib is a type of PARP-1 inhibitor. The TOPARP trial is looking to see if olaparib helps men with prostate cancer that has got worse despite treatment with hormone therapy and chemotherapy drugs called taxanes.   

Gene therapy

Gene therapy is one of the newer approaches to cancer treatment and is in the very early stages of clinical trials. Cancer cells have abnormal genes. If researchers can get copies of the normal genes inside the cells to replace the abnormal genes, they may be able to use this to treat the cancer. One gene that is often abnormal in cancer cells is the P53 gene. This gene usually tells cells that are old and damaged to self destruct. Scientists call this self destruction apoptosis. Some cancer cells don't self destruct because they have an abnormal p53 gene. This is one reason why they can go on growing and dividing even with damaged genes.

Gene therapy is in the very early research stages and we don't know if it will work yet. The GDEPT trial looked at gene therapy for early stage prostate cancer. It found the safe dose for this drug. Another trial used GDEPT for prostate cancer that had continued to grow. It found that GDEPT seemed to help to control the cancer in some men but we need larger trials to confirm how well it works.

Vaccine therapy

Cancer vaccines are designed to try to stimulate the body's own immune system to fight cancer. There are different ways to make vaccines. Some can be used by anyone with prostate cancer, while others are made specifically for each patient. The personalised vaccines are made by taking cells called dendritic cells out of a patient's blood and mixing them with their own prostate cancer cells. The idea is that the dendritic cells in the vaccine will stimulate other cells in the immune system to recognise and attack the prostate cancer cells in the body.

In the United States, the Food and Drug Administration agency (FDA) have approved a dendritic cell cancer vaccine called sipuleucel T (Provenge). Sipuleucel T is for the treatment of prostate cancer that has spread and standard hormone therapy treatments are not working. This drug has not been approved for use in Europe yet.

Other types of prostate cancer vaccines in trials have used viruses that are changed in the laboratory to contain prostate specific antigen (PSA). When the virus injection is given, the immune system reacts to the virus. It becomes sensitive to PSA and hopefully kills the prostate cancer cells that contain it.

If you are interested in finding out whether you can have vaccine treatment within a clinical trial, you could ask your specialist. This is still all early stage research – phase 1 and 2 trials. That means that the research is looking at the safety of these new types of treatment or testing whether they are likely to work against prostate cancer. You can find out about biological therapy trials for prostate cancer on our clinical trials database. Early phase trials tend to be quite short running – over weeks or months. So if you are interested in vaccine trials, it may be worth checking the clinical trials database from time to time to see if new trials have opened.

Researchers are looking at 2 new treatments for prostate cancer when hormone therapy is no longer working (hormone resistant prostate cancer – HRPC). Rosiglitazone is a drug normally used to treat diabetes. Fenofibrate treats high cholesterol. Researchers are studying these 2 drugs to see if they can keep the prostate cancer under control when hormone therapy is not working. These drugs do not have such severe side effects as the usual treatments for HRPC – steroids or chemotherapy.

Doctors think that some men with advanced prostate cancer may benefit more from the steroid dexamethasone than others. There is a trial looking at levels of a substance called interleukin 8 (IL8) in the body, and whether these levels affect how well dexamethasone works against prostate cancer. Or whether the dexamethasone affects the IL8 levels. This trial is no longer recruiting and we are waiting for the results.

The PREVAIL trial is looking at a new hormone therapy called MDV3100 to see if it helps men to live longer or slows down the growth of the cancer. It also wants to learn more about the side effects and what happens to MDV3100 in the body.

Researchers are continually looking for ways to prevent cancer cells becoming resistant to treatments. Cancer Research UK researchers in Newcastle are studying a protein called NF-kB. This protein helps prostate cancer cells become resistant to various types of therapy. NF-kB is activated by a protein called PARP-1. The team hopes that by designing drugs to block the activity of PARP-1 they may develop a new generation of treatments for cancer.

Researchers are trying to develop a very sensitive test for finding small numbers of prostate cancer cells in blood samples. This could be used as a test to pick up cancer spread at a very early stage. But doctors are still not sure whether having a few prostate cancer cells in the bloodstream means that you will actually develop a secondary cancer. It is not yet clear how this test could be used in deciding treatment options.

PC-SPES is a combination of eight herbs that is supposed to be active against prostate cancer. This agent has received a lot of media attention in the past couple of years. But recent research by the National Cancer Institute (NCI) of the USA found that PC-SPES was contaminated with synthetic drugs, including diethylstilbestrol (which is known to be active against prostate cancer) and warfarin, which is an anti-clotting medicine. Unknowingly taking extra doses of warfarin could be dangerous for people who are already taking it. The manufacturers withdrew PC-SPES and they have now gone out of business.

Another form of this herbal treatment, called PC-HOPE is now on sale. This is a cocktail of 10 herbs and is available on the web. We are not aware of any research that has tested whether this helps with prostate cancer or not. It looks as if both these herbal remedies contain plant oestrogens. So any effect they have is probably very similar to the hormone therapy that is routinely prescribed by prostate cancer specialists.

There is information about PC-SPES and PC-HOPE in the questions and answers section.

Treatment for prostate cancer has side effects and doctors and researchers are looking for ways of reducing them.

• Hormone therapy side effects
• Radiotherapy side effects
• Research into erection problems after treatment

Hormone therapy side effects

The side effects of hormone therapy can include weight gain, tiredness and thinning of the bones. These can affect quality of life. We know from research that exercise and a change of eating habits may help lessen these side effects and so improve quality of life. One study is trying to find out more about whether a change of eating habits and exercise can help men having hormone therapy. 

Hormone therapy can cause bone thinning. A phase 3 trial in America has found that the drug toremifene can reduce the risk of fractures. The trial compared toremifene with a placebo and found that just over 2 out of 100 men taking the toremifene (2%) developed a fracture compared to 5 out of 100 in those taking the placebo (5%). The bone density of the men taking toremifene also increased. The researchers also found that the men taking toremifene were more likely to develop a blood clot, just over 2 out of 100 (2%) compared to 1 in 100 taking the placebo (1%).

The MANCAN study is looking at ways to help men manage hot flushes and night sweats following treatment for prostate cancer. The men taking part in this study are having hormone treatment and have at least 10 hot flushes or night sweats a week.

Radiotherapy side effects

One of the side effects of radiotherapy is that problems with passing urine can get worse. There is a trial looking at the drug Flomax. Flomax is normally used as a treatment when the prostate is enlarged but not cancerous. The doctors running this study want to find out if it helps to reduce cancer treatment side effects and improves quality of life. There is another trial looking at helping men manage urinary symptoms after radiotherapy by teaching them certain exercises.

Most side effects will get better a few months after treatment has finished. But for a small number of people the side effects may be long lasting. Many of the long term side effects of pelvic radiotherapy affect the bowel. These include frequent bowel movements, diarrhoea, pain, bleeding from the bowel and the forming of scar tissue in the bowel (radiation fibrosis). These symptoms may get worse over time. This may be due to bacteria in the bowel. Researchers think that encouraging healthy bacteria to grow may help to control symptoms. The PRESident study is looking to see if taking a carbohydrate called FOS (fructo oligosaccharide) during radiotherapy can help reduce these bowel problems. 

The HOT 2 trial is looking at whether using a high pressure oxygen treatment called hyperbaric oxygen (HBO) therapy can help to relieve the long term side effects of having radiotherapy to the pelvic region.  

Research into erection problems after treatment

One of the side effects of surgery for prostate cancer (prostatectomy) is that some men may still have problems getting erections. You may hear this called erectile dysfunction. This means you are not able to get an erect penis, or keep it erect enough for sexual activity. There is a trial using tadalafil in men who have nerve sparing prostate surgery. In this trial the researchers are comparing the effects of tadalafil with a dummy drug (placebo) soon after surgery to see if tadalafil can help men to maintain their erectile function.

There is more information about treatment side effect trials on our clinical trials database. Choose 'prostate' from the dropdown menu.

There is a study looking at symptoms caused by cancer coming back after treatment. After treatment for cancer of the breast, lung, prostate or bowel, you have follow up appointments with your specialist doctor. But after a few years, if you stay well, these appointments may stop. You are then asked to see your GP if you have any new symptoms, or are worried about anything.

Researchers looked back at the medical notes of people who went to their GP with symptoms some time after cancer treatment. They looked at people whose cancer had come back as well as people whose symptoms were caused by something else. The trial aims to find common symptoms of cancer recurrence to help doctors spot the signs that cancer may have come back. The trial has now closed. You can find details on our clinical trials database. Choose 'prostate' from the dropdown menu of cancer types to find prostate cancer trials.

In the trials and research section you can find information about clinical trials and you can look for trials on our clinical trials database. The database has information about the UK trials mentioned on this page. Pick 'prostate' from the dropdown list of cancer types.

Remember that all these new approaches are the subject of ongoing research. Until studies are completed that show these new treatments to be effective, they cannot be used as standard therapy for prostate cancer. If you are interested in taking part in a clinical trial, you need to ask your specialist if there are any studies that may be suitable for you.

UK Prostate Link can direct you to more information about research into prostate cancer.