Low doses of dexamethasone may provide an effective treatment option with limited side effects for patients with hormone refractory prostate cancer, according to a recent article published in the journal Cancer.

Cancer of the prostate, a male sex gland located between the bladder and rectum, occurs commonly in older men. There are many treatment options available for patients with this disease, depending on the extent of spread of the cancer. Presently, controversy exists regarding the optimal treatment strategy for patients with this disease, resulting in many clinical trials currently underway that are aimed at determining the most effective treatment strategies for these patients. Treatment options may consist of surgery, delaying treatment until the cancer progresses, radiation therapy, hormone therapy, biologic therapy (utilizing the body’s immune system to fight cancer), and/or chemotherapy.

One test to determine the extent of prostate cancer is the measurement of prostate specific antigen (PSA) levels in the blood. Prostate specific antigens are proteins normally produced by the prostate. High levels of PSA in the blood indicate the presence of prostate cancer, with higher levels of PSA correlating to more advanced stages of prostate cancer.

Prostate cancer is stimulated to grow by naturally occurring male hormones called androgens. A type of treatment called hormone therapy is aimed at lowering the levels of androgens (particularly testosterone) available to the cancer, thereby eliminating its source for growth. Although anti-cancer responses are achieved following hormone therapy, most patients ultimately stop responding to this therapy and experience a return of their cancer. Hormone-refractory cancer refers to the phase of cancer in which anti-cancer responses are no longer achieved with hormone therapy.

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Dexamethasone is a type of steroid that is commonly used in the treatment of prostate cancer. It has been shown to produce anti-cancer effects when relatively high doses are administered. Side effects produced by high doses of dexamethasone may include, but are not limited to, anemia, weakness of the bone, increased risk for infection, skin fragility and/or muscle wasting. Since these side effects may produce serious complications affecting tolerability of further treatment and decrease the quality of life for these patients, scientists have recently conducted a clinical trial evaluating the effects of lower doses of dexamethasone in the treatment of hormone refractory prostate cancer.

In a recent clinical trial, researchers from Japan administered low doses of oral dexamethasone as a single agent in 23 patients with hormone refractory prostate cancer. All of the patients had late-stage cancer that had spread to distant sites in the body. Sixty two percent of these patients experienced a significant regression of their cancer with PSA levels reduced by at least 50%. Patients who experienced the greatest reductions in PSA levels achieved the longest survival times following treatment – approximately 2 years compared to approximately one year for patients with less PSA reduction. Of significant importance is that all side effects caused by dexamethasone were mild.

These results indicate that lower doses of dexamethasone produce anti-cancer responses while reducing side effects in the treatment of hormone refractory prostate cancer. These results are important in helping to define optimal treatment strategies for patients with this disease. Patients with hormone refractory prostate cancer may wish to speak with their physician about the risks and benefits of participating in a clinical trial further evaluating low-dose dexamethasone alone or in combination with other agents as treatment for this disease. Two sources of information about ongoing clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute (cancer.gov) and eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients. (Cancer, Vol 89, No 12, pp 2570-2600, 2000)

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