New treatments

Over the last few years, several new treatments for prostate cancer have been developed. This page has information about these new treatments and how they treat prostate cancer.

Abiraterone (Zytiga®): A new type of hormone therapy for men whose prostate cancer has spread to other parts of the body (advanced prostate cancer) and has stopped responding to other types of hormone therapy.

Enzalutamide (Xtandi®): A new type of hormone therapy for men with advanced prostate cancer that is no longer responding to hormone therapy.

Cabazitaxel (Jevtana®): A new type of chemotherapy for men with advanced prostate cancer that has stopped responding to hormone therapy and the chemotherapy drug docetaxel (Taxotere®).

Radium-223 (Xofigo®): A new treatment for men with prostate cancer that has stopped responding to hormone therapy, has spread to the bones and is causing symptoms.

Which treatment should I have first?

There are a few new treatments for prostate cancer, and we don’t yet know the best order to have them in. For example, we don’t know whether having one treatment first might affect how well another treatment works in the future. There are clinical trials looking at the best order to have new treatments in.

Some treatments are only available for men who have already had another treatment. For example, cabazitaxel chemotherapy is only available for men who have already had docetaxel chemotherapy.

Talk to your doctor or nurse to find out which treatments might be suitable for you.

What is cabazitaxel?

Cabazitaxel (Jevtana®) is a new type of chemotherapy. It can’t cure prostate cancer, but it may help men to live longer. It can also help control or delay symptoms.

  • Who can have cabazitaxel?  

    Cabazitaxel is suitable for men whose prostate cancer has spread to other parts of the body (advanced prostate cancer) and has stopped responding to hormone therapy and the chemotherapy drug docetaxel (Taxotere®).

    If you live in England or Wales, you should be able to have cabazitaxel if your doctor thinks it's suitable for you.

    If you live in Northern Ireland, you may not be able to get cabazitaxel. But the Northern Ireland Department of Health is currently deciding whether to make it available on Northern Ireland's Health and Social Care (HSC) service.

    If you live in Scotland, cabazitaxel is not available on the NHS. This is because the Scottish Medicines Consortium (SMC) has decided not to recommend it.

    Read our information about getting new treatments that are licensed but aren’t available on the NHS. For more information on cabazitaxel, speak to your doctor or nurse, or call our Specialist Nurses.

  • How does cabazitaxel treat prostate cancer?  

    Cabazitaxel is a chemotherapy treatment. Chemotherapy uses anti-cancer drugs to kill cancer cells.

    Cabazitaxel is given through a drip (an intravenous infusion). This usually involves passing the drug through a thin tube into a vein in your arm. It is given once every three weeks for up to ten treatments.

    In a clinical trial, men who were given cabazitaxel lived about two and a half months longer than men who were given a different type of chemotherapy.

  • What are the side effects of cabazitaxel?  

    Like all treatments, cabazitaxel can cause side effects. These will affect each man differently, and you might not get all the possible side effects. If you get any side effects, talk to your doctor or nurse. They can help find ways to manage them.

    Some of the common side effects include:

    • being more likely to get an infection
    • anaemia, which is a low level of red blood cells, and can cause fatigue and feeling short of breath
    • bruising more easily
    • diarrhoea (loose and watery bowel movements)
    • feeling or being sick (nausea or vomiting)
    • constipation (difficulty emptying your bowels).

What is radium-223?

Radium-223 (Xofigo®) is a new drug for men with prostate cancer that has spread to the bones and has stopped responding to hormone therapy.

Radium-223 delays bone symptoms of advanced cancer, such as bone fractures, and can reduce bone pain. It may also help men live longer. In a recent clinical trial, men who received radium-223 at the same time as their usual treatments lived about four months longer than men who took a placebo. A placebo is a dummy treatment, such as an injection of water or salt water.

  • Who can have radium-223?  

    Radium-223 is suitable for men with prostate cancer that has spread to the bones (advanced prostate cancer) and has stopped responding to hormone therapy.

    After chemotherapy

    In England, Wales, Northern Ireland and Scotland, you should be able to have radium-223 if you've already had hormone therapy and the chemotherapy drug docetaxel.

    Before chemotherapy

    Radium-223 may also be suitable for men who have stopped responding to hormone therapy but haven’t yet had chemotherapy.

    It is licensed for these men, but it isn’t widely available on the NHS in England or Wales, or through the HSC service in Northern Ireland. This is because the National Institute for Health and Care Excellence (NICE) hasn’t recommended it for these men. But if your doctor thinks it’s suitable for you, they may be able to apply for you to get it. Read more about getting new treatments.

    If you live in Scotland, radium-223 is available to you if you haven’t had chemotherapy.

    Ask your doctor or nurse whether radium-223 is suitable for you, or speak to our Specialist Nurses. You might also be able to get radium-223 through a clinical trial.

  • How does radium-223 treat prostate cancer?  

    Radium-223 is a radioactive substance that is injected into a vein. It collects in bones that have been damaged by prostate cancer. It kills the cancer cells in the bones, but doesn’t damage many surrounding healthy cells.

  • What does treatment involve?  

    Radium-223 is injected into a vein through a small tube inserted into your arm (a cannula). The injection only takes a few minutes. You will normally have an injection every 4 weeks, for up to 6 injections. You can usually go home straight after the treatment.

  • What are the side effects of radium-223?  

    Because radium-223 does not cause much damage to the surrounding healthy cells, it doesn’t usually cause severe side effects. If you do get side effects they may include:

    • feeling and being sick (nausea and vomiting)
    • diarrhoea (loose and watery bowel movements)
    • low levels of blood cells called platelets.

    For more information about radium-223 speak to your doctor or nurse, or call our Specialist Nurses.

References

Updated: June 2016

  • List of references  

    • Bahl A, Oudard S, Tombal B, Ozguroglu M, Hansen S, Kocak I, et al. Impact of cabazitaxel on 2-year survival and palliation of tumour-related pain in men with metastatic castration-resistant prostate cancer treated in the TROPIC trial. Ann Oncol. 2013 May 30;24(9):2402–8
    • Brasso K, Thomsen FB, Schrader AJ, Schmid SC, Lorente D, Retz M, et al. Enzalutamide antitumour activity against metastatic castration-resistant prostate cancer previously treated with docetaxel and abiraterone: a multicentre analysis. Eur Urol. 2014
    • De Bono JS, Oudard S, Ozguroglu M, Hansen S, Machiels J-P, Kocak I, et al. Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: a randomised open-label trial. The Lancet. 2010 Oct;376(9747):1147–54
    • National Institute for Health and Care Excellence. Cabazitaxel for hormone-relapsed metastatic prostate cancer treated with docetaxel. Technology appraisal guidance 513. April 2016
    • National Institute for Health and Care Excellence. Radium-223 dichloride for treating hormone-relapsed prostate cancer with bone metastases. Technology appraisal guidance 376. January 2016
    • NHS England. National Cancer Drugs Fund List Ver 6.0. November 2015
    • Northern Ireland Department of Health, Social Services and Public Safety. Endorsed Technology Appraisals 2015/2016. Accessed February 2016
    • Parker C, Nilsson S, Heinrich D, Helle SI, O’Sullivan JM, Fosså SD, et al. Alpha Emitter Radium-223 and Survival in Metastatic Prostate Cancer. N Engl J Med. 2013;369(3):213–23
    • Scottish Medicines Consortium. Cabazitaxel, 60mg concentrate and solvent for solution for infusion (Jevtana®). SMC No.735/11. June 2016
    • Scottish Medicines Consortium. Radium-223 dichloride 1000kBq/mL solution for injection (Xofigo®). SMC No.1077/15. September 2015