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- Critical Care Pharmacy Specialist, University of Colorado Hospital
- Clinical Assistant Professor, Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado
http://www.ucdenver.edu/academics/colleges/pharmacy/Departments/ClinicalPharmacy/DOCPFaculty/Q-Z/Pages/Paul-Reynolds,-PharmD.aspx
Cognitive distrac- itive and negative mood on sexual arousal in sexually func- tion in female sexual arousal. The effects of anxiety and arousal and accuracy of its self-estimation in sexually func- distraction on sexual arousal in a nonclinical sample of het- tional males. Cognitive aspects of sexual func- determinants of women’s sexual response to erotica. Differences in automatic thoughts response: the impact of co-occurring positive and negative emotions on subjective and physiological sexual responses to presented during sexual activity between sexually functional and dysfunctional men and women. Biopsychosocial determinants of men’s sexual activity: differences between homosexual and hetero- sexual desire—testing an integrative model. Effects of appraisal of sexual stimuli on sexual arousal in women with and without super- testing a cognitive-emotional model. Cognitive and emotional determinants characterizing women with persistent genital approach regarding psychological, medical, and relationship dimensions. Linking external stress and cognitive processes approach based on Beck’s cognitive theory. Shock threat and sexual arousal: the role of selective attention, thought con- 170. J Sex Marital function assessment in postmenopausal women with the 14- Ther 2001;27:273-277. Mezones-Holguin E, Cordova-Marcelo W, Lau-Chu-Fon F, obsessive-compulsive disorder and social anxiety disorder. Association between sexual function and depression in J Nerv Ment Dis 2007;195:254-257. Fam Syst Health sexually functional and dysfunctional women: physiological 2010;28:48-68. Preliminary evidence diabetes mellitus: partner relationship as the most important that acute and chronic daily psychological stress affect predictor. The recurrent pain and sexual sequelae of provoked on female sexual function in women. Philadelphia: sexual function in women with systemic sclerosis: a cross- University of Pennsylvania; 1967. Mediators of sexual female sexual dysfunction in the general population: exploring functioning and marital quality in chronically depressed adults factors associated with low sexual function and sexual with and without a history of childhood sexual abuse. J Sex Med dysfunction in female patients with panic disorder alone or 2008;5:458-468. Kontrolluberzeugungen und Angst bei heterosexuellen Mannern mit einer Erektionssorung 222. Int J Impot Res 2002; among male veterans returning from Iraq and Afghanistan: 14:S87. Sexual functioning in psychological characteristics of Belgian men with premature military personnel: preliminary estimates and predictors. Adv A case-control study of erectile dysfunction among men Alcohol Subst Abuse 1984;4:41-56. Erectile dysfunction: prevalence and relationship to depression, alcohol abuse and 227. J Sex Marital erectile dysfunction in three cities of China: a community- Ther 2006;32:183-187. Int J dysfunction and substance use among a community epide- Impot Res 2003;15:S16-S19. Smoking and risk of erectile erectile dysfunction in men with depressive symptoms: re- dysfunction: Systematic review of observational studies with sults of a placebo-controlled trial with sildena?l citrate. Comorbidity tion prior to ?rst drug use among former drug addicts and its of sexual problems and posttraumatic stress disorder in fe- possible causal meaning on drug addiction: preliminary re- male crime victims. Sexual satisfaction and of abstinence on sexual functioning in a Spanish male relationship happiness in midlife and older couples in ?ve drug-dependent sample: a multisite study. Drug addiction and sexual sexual dysfunction in female rectal and anal cancer survivors: dysfunction. Sexual desire and relationship bisexual women’s perceptions and experiences of chronic functioning: the effects of marital satisfaction and power. The impact of individual and rela- tionship intimacy among women with provoked vestibulo- tionship factors on sexual dysfunction among males and fe- dynia and their partners: associations with sexual males. Intimacy and quality of life among sexually long-term ovarian germ cell tumor survivors: a Gynecologic dysfunctional men and women. Let’s talk about sexu- sexual dysfunctions: some concomitant conditions and life ality and relationships. Demographic and psychologi- of couples’ communication in female orgasmic disorder. J Sex cal factors related to sexual desire among heterosexual Marital Ther 2006;32:81-95. Can J functions in women with male partners complaining of Hum Sex 1997;6:277-283. Role of sexual self-disclosure in the dysfunction improve female partner’s sexual functions? The mediating role of sexual and partner-related factors in rapid ejaculation: differences be- nonsexual communication between relationship and sexual tween dysfunctional and functional men. An audit of patients attending a sexual problems in Britain: Findings from the third National Survey of Sexual clinic. Health Qual it over with sexual motivation, desire, and satisfaction in Life Outcomes 2008;6:33. The interpersonal exchange model of sexual to the male partners’ erectile function? Sexual satisfaction in long-term het- quality of sexual life in female partners of men with erectile erosexual relationships: the interpersonal exchange model of dysfunction treated with sildena?l citrate: ?ndings of the In- sexual satisfaction. Age as a moderator of the association between sexual desire and sexual distress in women. Behav Res Ther 2010; agreement and impact of the erection hardness score on 48:106-115. J Sex Med 2012; perceived partner responses predict pain and sexual satis- 9:2652-2663. Sexual function and differentially associated with pain and sexual satisfaction in satisfaction in heterosexual couples when men are adminis- women with provoked vestibulodynia. New York: Guilford Press; citrate (Viagra) is effective and well tolerated for treating 2014. J Sex Med 2009; Psychosexual functioning of partners of men with presumed 6:2244-2254. Sexual function, relationship adjustment, for assessment of sexually related personal distress in and the relational impact of pain in male partners of women women. A systematic developmental life stage on qualityof life in survivors of prostate review of sexual dysfunction measures for gay men: How cancer and their partners. Gender differences in desire discrepancy as a predictor of sexual and relationship satisfaction in a 300. Exploring the effects of behavioral treatments for vestibulodynia: two-and-one-half sexual desire discrepancy among married couples. Erectile dysfunction and depression: screening trial comparing group cognitive-behavioral therapy and a and treatment. A meta- exposure for women with lifelong vaginismus: a randomized analysis of comparative studies. Psycho- partner responses and depression in women with vulvody- logical and interpersonal dimensions of sexual function and nia: a dyadic daily experience study. Combination therapy for sexual dysfunction: in men and women with sexual dysfunctions—a systematic Integrating sex therapy and pharmacotherapy. In: Balon R, review of controlled clinical trials: part 1—the ef?cacy of Segraves R, eds. In: Leiblum S, in women: a literature review of etiology and current treat- Rosen R, eds. Integrating Viagra into cognitive-behavioral and its relation to female orgasmic response and simulta- couples sex therapy. J Sex Educ Ther 1998; directed masturbation: a comparative study on female 23:229-231. The effectiveness of psy- behavior sex therapy for psychogenic erectile dysfunction: a chological interventions for the treatment of erectile pilot study. J Person and Soc vs sildena?l plus brief couple sex therapy on erectile Psychol 2014;106:843-866.
The mean 36 number of erections per week (grades 3–4) was also shown to be numerically greater in two 93,96 trials. For example, the mean number of erections per week in one trial among participants 96 who received 10 mg, 25 mg, and 50 mg sildenafil was 2. In one trial, participants received either a fixed dose (50 mg every night) or a 161 flexible dose (50 or 100 mg, as needed) of sildenafil for 12 months; in the other trial participants were randomly assigned to receive 100 mg/d of sildenafil either 1 hour before/during 157 a meal or 30–60 minutes before sexual activity. In the first trial, the effect of a fixed dose of sildenafil given every night was maintained to a greater extent compared with that achieved with a flexible dosage of sildenafil. In the other trial, the time between sildenafil administration and intercourse attempt (0–0. This review included nine 104-106,112,150,158,162,169,173 trials in which the efficacy and harm of mono- versus combination therapy of sildenafil were compared. The incidence of any 162 104-106,112, 150,158,162,169,173 adverse events were reported in only one of the nine trials. This study reported a higher proportion of participants with one or more adverse events in the combination arm (cabergoline and sildenafil) compared with the sildenafil monotherapy arm (12. In two trials no serious adverse events were reported during the trial 112,173 104-106,150,158, 162,169 period. There were no withdrawals due to adverse events in three of these trials in any of the compared 81,105,112 162,173 treatment groups, and two trials reported higher rates of withdrawals in sildenafil combination therapy than in sildenafil monotherapy. This review included five trials in which the 106,124,132,155,173 efficacy and harms for sildenafil and other active treatment were compared. Among these five trials, the incidence of any adverse event was reported in only one, in which more participants were found to have experienced one or more adverse event in the 40 mg phentolamine treatment group as compared with the flexible-dose (25 124 mg to 100 mg) sildenafil treatment group (41. More patients in the phentolamine group than in the sildenafil group experienced respiratory (17. The most frequent adverse events that 124 occurred during the trial were headache and rhinitis. These events were flushing, chest pain, shortness of breath with tachycardia in one participant, and cerebrovascular event and worsening of existing pterygium in the other two participants. One participant in the sildenafil treatment 124 group experienced a rupture of the Achilles tendon. The rates of withdrawals due to adverse events in participants treated 124 173 with sildenafil in two trials were <1. The corresponding rates for 124 173 participants treated with phentolamine and alfuzosin were 3. Quantitative Synthesis - Meta-analysis of Trials Monotherapy (any dose: 10, 25, 50, 100 mg) versus placebo. Thus, the use of sildenafil was associated with statistically significant improvements with respect to penetration and erectile maintenance frequency (Figures 4–5). This meta-analysis included 80,82,83,86-88,90,95,97,125, 17 trials including two trials reported in Young et al. Sensitivity analysis was performed with respect to the duration of sildenafil treatment. The 80,83,87,97,125,126,137,138,142,151,156 duration of sildenafil treatment in 11 trials lasted 12 weeks. The 90 82 duration of treatment in the remaining trials was 6 weeks, (studies a and b) 8 weeks, 16 95 86,88 weeks, and 26 weeks. The meta-analysis restricted to trials with 12-week treatment did not 2 appreciably affect the magnitude of the effect estimate and the degree of I test for heterogeneity, which decreased from 51. This meta-analysis was based on 16 80,82,83,86-88,95-97,122,125,126,137,142,151,166 trials. This meta-analysis is based on 16 80,82,83,86-88,95-97,122,125,126,137,142,151,166 trials. This meta-analysis is based on 20 80,82,83,86-88,90,95,97,122,125,126,135,137,138,142,151,156,171 trials. Twenty-eight trials of clinically homogenous groups compared the efficacy/safety of 78,79,81,84,91,93,94,98, sildenafil to that of placebo in patients with distinct, specific clinical conditions. The trials were conducted in participants diagnosed 81,93,94,98,101 79,91,115,167 102,109 with diabetes, depression, congestive chronic heart failure, 143,147 108,123 hypertension, or who were on dialysis. Separate meta-analyses for these efficacy outcomes are presented (see Figures 16–19). No meta-analysis for adverse events could be performed, due to a lack of 91 sufficient detail for the adverse events definitions provided in the trials. Note that one trial included younger patients (mean: 45, range 18–55 years) compared with the other trial (mean: 115 53, range 24–75 years). One of the trials used a crossover design; it reported pre- crossover results graphically, without presenting numeric measures of the variability. In the same trial, no participant had any adverse events; therefore, no meta-analysis for adverse events was performed. There were two trials that looked at patients with chronic renal failure on peritoneal dialysis. A meta-analysis for adverse events was also not feasible, since in one 108 of the trials only one event was observed. Meta-analysis was possible for sildenafil versus placebo trials involving hypertensive 143,147 patients using multiple antihypertensive drugs (i. Note that the respective rates in the sildenafil arms were quite similar (73 percent versus 71 percent). The two trials employed similar dosing regimens (from 50 mg to 25 mg or 100 mg) and duration of sildenafil treatment (6–8 143,147 weeks). Meta-analysis of trials comparing different doses of sildenafil (dose-response effect). The dose-response efficacy/harm effect of sildenafil given at a fixed dose (10 mg, 25 mg, 50 78,85,86,93,96,137 mg, and 100 mg) was assessed in six trials. Of these, two trials were conducted in 78 93 clinically distinct groups of participants (those with spina bifida and diabetes ) and therefore were not included in the meta-analysis. Therefore, the meta-analysis exploring the dose-response 86,96,137 effect of sildenafil was based on three trials. The following two pair-wise comparisons were made: 1) Sildenafil 25 mg versus sildenafil 50 mg 2) Sildenafil 50 mg versus sildenafil 100 mg the efficacy and harm outcomes examined in the meta-analysis (i. The latter result may have been due to the small sample of the meta-analysis (Figure 31). Assessment of Publication Bias Funnel plots were generated to assess the extent of asymmetry for each meta-analysis. The following list shows the reference identifications for these trials and corresponding publications (each row). Hellstrom 2002, Hellstrom 2003, Hellstrom 2005, and Donatucci 2004 Overview of Trials 181-184,190,190,192,192,197,197-199,199,203 184,190, the trials were conducted in North America, Europe, 191,193-201,203,204 182,190,203 180,182,184,189,203,203,205,206 South America, and Asia. The total and mean numbers of patients randomly assigned to an intervention or placebo across the 22 trials were 8,621 and 392, 193 respectively, while the number of randomly assigned patients in each trial ranged from 21 to 190 1020. Interventions the patients in all 22 included trials were randomly assigned to receive monotherapy of oral 180-183,189,190,192-195,198,205 vardenafil at either a fixed or a flexible dose. In 12 trials, vardenafil was 189,192,194 193 administered at a fixed dose ranging from 5 mg/d to 40 mg/d, whereas in the remaining 10 trials a flexible dose with upward and downward titration was used, depending on the observed response in terms of efficacy and tolerability (i. In 10 trials patients were randomly assigned to receive two or more different fixed doses of 181,183,190,195,198,205 vardenafil in each arm: 10 mg/d versus 20 mg/d, 5 mg/d versus 10 mg/d versus 189,192,194 193 20 mg/d, and 20 mg versus 40 mg. In the majority of included trials, the duration of treatment with vardenafil was about 12 181-184,189,194,211 198,206 weeks. In one trial patients 203 were instructed to take the dose 8 hours before sexual activity for up to one dose a day. The Jadad total 206 191,197 score for the individual trials ranged from one to five. The methods for generating the 183,191,192,197 sequence of random assignment were described for four studies and were judged to 206 be appropriate. For all trials except 189 for one the methods for treatment allocation concealment were judged to be “unclear. This section presents results derived from 21 placebo-controlled trials that compared the efficacy and harms profile of 180-184,189,191-201,203-206 190 vardenafil (any dose) to that of placebo.
Bechara et al reported a crossover study of alprosta-- dil versus trimix in a group of 32 men who had failed 6. These notably include men with sickle cell disease, Rates of pain for alprostadil was signiicantly higher multiple myeloma and leukemia. In a series multiple combinations of trimix ingredients versus al-- of 605 injections in 33 men using warfarin for prostadil in a 180 men with erectile dysfunction [15]. This rate of 9% of patients is fective and produce erections that are of equal fre-- comparable to the 14% (434/3143) of patients on quency and quality to those produced by alprostadil. How-- is advisable that the physician stress the need, in ever, duration of erections was longer than alprosta-- anticoagulated patients, to place pressure on the dil and a larger number of episodes of priapism (5% injection site for ive full, uninterrupted minutes of vs. Side Notable in this study, 995/1511 patients had in-ofice effect rates are noted in Table 12. To There have been several advances in the under-- date no suficiently effective product exists.. In this regard there are several issues worth mentioning: 1) High systemic levels are A large trial of topical alprostadil without a skin pen-- undesirable as they may result in an unacceptable etration enhancer was also published by Padma- level of adverse events. This study used 100, 200 and the corpora cavernosa in a timely fashion with the 300?g doses of alprostadil and achieved successful effective (highest) concentration. A criticism of this study is that its Topical penile therapy has a unique set of anatomic high initial function rates do not adequately represent and physiologic issues that are important to consider. There are several anatomic/fascial layers between the penile skin and the corpus cavernosa. Therefore, topical Since the introduction by Virag in the early 1980s of treatment trials have empathized exposure to the injection of papaverine into the corporal bodies for glans penis as it has direct venous communication the treatment of sexual dysfunction has become a to the corpora cavernosa [27,28]. It use as a a relatively impermeable tissue due to the stratum topical therapy has a much shorter experience and corneum. The horny cells at the stratum corneum one that has not moved beyond preliminary clinical are bonded with a very tight intercellular lipid matrix trials. Serum papaverine levels after topical adminis-- bilayer that makes the passage of drugs challenging tration have been measured in a single study with a [29]. To overcome this barrier investigators have high performance liquid chromatography assay [35]. Fortunately, the suggesting that absorption did occur, but not signii-- penis and scrotum are unique in that their stratum cantly over baseline values. The papaverine levels corneum is the most permeable of all anatomic in this study indicated that topical absorption is less locations tested. Relaxation of vascular of the excipients in topical formulations have been smooth muscle is the principle pharmacologic action reported [27,28,31,32]. Nitroglycerin produces, in a dose is to: 1) Disrupt the stratum corneum lipid bilayer, dependent manner, dilation of both arterial and 2) Interact with the membrane keratin, 3) Produce venous beds, dilatation of the post-capillary vessels a weak interaction with the drug molecule, and 4) including large veins and decreases in venous return. The available evi-- Contraindications to the use of topical nitroglycerin dence indicates that this agent enhances skin pen-- include those who have allergic reactions to organic etration by altering the luidity of lipids in the stratum nitrates. These are extremely rare, but they do corneum, without any interaction with the chemical occur. Intra-cavern-- safe in patients with erectile dysfunction after failing silde-- ous Alprostadil-A Comparative Study in 103 Patients With nail (Viagra). Multicenter, intestinal polypeptide and phentolamine mesylate adminis-- double-blind, placebo-controlled evaluation of the erectile tered by autoinjector in the treatment of patients with erec-- response to transurethral alprostadil in men with chronic tile dysfunction resistant to other intracavernosal agents. Dermal and transdermal with intracavernosal vasoactive intestinal polypeptide and drug delivery: new insights and perspectives. Prostate cancer represents the second most common As with all areas of sexual medicine, the literature has solid malignancy diagnosed in adult men in many areas of great strength and signiicant weaknesses, Western societies. These dysfunctions injury has on cavernous smooth muscle content and include reduction in libido, anejaculation, alterations function as well as potentially the tunica albuginea[6- in orgasm, penile size alterations and possibly 8]. Anejaculation the concept of penile rehabilitation, the use of has several implications: irstly, it may interfere with any intervention or combination of interventions subject’s self perception of his manhood and body (medications, devices or actions) whose goal is image. Then as ejaculation and orgasmic sensations broadly thought of as being aimed at restoring erectile are closely related at least in some men, anejaculation function to pre-treatment levels, is believed to be may be associated with reduced orgasmic quality, based on three inter-related concepts: (i) improving and inally, it renders men infertile. Prostate cancer is cavernosal oxygenation, (ii) promoting endothelial perceived as a disease of old men, to whom infertility protection and (iii) preventing cavernosal nerve is no longer an issue. Most diagnosis may actually increase the motivation for patients (55%) had orgasm-associated pain for less parenting[20]. Though advanced sperm extraction than a minute, a third reported pain for 1–5 minutes and fertilization techniques are available, the issue and pain lasting more than 5 minutes was reported of anejaculation and its implication on future fertility by 12%; only 2. No consensus exists assume this to be non-relevant and semen should as to the etiology of orgasmic pain, however it is be cryopreserved for men who may potentially postulated that bladder neck/pelvic loor spasm plays bmay desire future fatherhood[21]. Based on this assumption, a prospective, the application of assisted reproductive technologies non-placebo controlled study was conducted to to couples whose male partner cannot deliver assess the use of tamsulosin, an alpha-adrenergic sperm in an antegrade fashion. Alternatively use of an analgesic taken physiological and psychogenic elements contribute prior to sexual activity has been described may be a to the genesis of orgasm. Schover et al, in a study a few drops in 58% of the subjects but 16% reported of 1236 men treated for localized prostate cancer a loss of more than 1 ounce. Treatment the sample reported a problem with their orgasms was bladder emptying in 84% and condoms use in including 31% who no longer tried to reach orgasm, 11% [27]. At present, there is no effective treatment presence or absence of orgasm, orgasm quality to restore the nature of preoperative orgasm. Pain to sexual activity) or mechanically (using a rubber during orgasm occurred in 14% of the patients, constriction ring or condoms, if the leakage amount located in the penis (63%), abdomen (9%), rectum is small). In those respondents partner education before surgery and supportive who had dysorgasmia, pain was reported to occur care afterwards. Similar indings were obtained 93% and ‘waistband’ deformity in 24%; palpable in a study by Savoie et al with a decrease in the plaques were present in 31 (69%)[28]. Gontero as this condition, manifested as penile curvature et al have suggested that penile shortening has during erection, is evident only in men who achieve been shown to be independently associated with some degree of penile rigidity. Another explanation that patients are given signiicantly decreased elastic iber and smooth is that the intracavernosal injections they are muscle content as well as increased collagen using after surgery has caused the tunical ibrosis, content [10]. It is postulated that the chronic absence despite the fact that there is no data to support this of erectile activity leads to absence of cavernosal whatsoever[29]. After cavernosal nerve injury, this for the existence of penile plaques, as a part of their phenomenon results in a penile hypertonic state. The sexual dysfunctions that should prevalence of any condition is dependent on knowing be discussed include, erectile dysfunction, libido both the true number of cases and the number of reduction, changes in orgasm, anejaculation, men at risk. This was a unanimous committee following: inadequate assessments of pre-operative recommendation. The exact scale of the clinician should discuss with the patient that the problem is thus inadequately deined owing to radical prostatectomy is associated with a number signiicant limitations of data accrual, reporting and of sexual dysfunctions, some of which may be perhaps most importantly a lack of consensus of permanent. There are many reasons why these differences 1980’s, with the landmark report from Walsh and in reported outcomes exist, and as depicted in Table Donker describing the potential and demonstrating 1, can best be thought of as: intrinsic patient factors, the importance of nerve sparing in radical prostate surgical factors, and reporting biases. The challenges faced by many of the other post-operative complications such the clinician researcher in achieving the goal of as incontinence, erectile function is more dificult to preserving erectile function are signiicant. The deine and represents a moving target, as recovery proximity of the cavernous nerves to the prostatic from surgery generally shows improving function but capsule, anatomically arranged as a diffuse poorly with advancing age, a decrease in function would visualized nerve plexus adherent to the lateral normally be expected. Additionally, the cavernous nerves’ have undergone deinitive management of their small size, delicate nature and dependent location prostate cancer. As such measuring erectile function deep within the male pelvis make visualization and prospectively has a moving baseline [44, 45]. There therefore preservation dificult, even in the current is an important psychologic component for these era with improved lighting, optics, laparoscopic and men, as well as a subjective degree of assessment robotic instrumentation even among men with low and it is further complicated by the necessary partner volume disease [8, 37]. Prevalence can be volunteer data suggest that following an initial period deined as the number of all new and old cases of of reasonable erectile function, neuropraxia at about a disease or occurrences of an event in a particular 3 months may peak and a nadir level of response period of time. Prevalence is typically expressed as a can be experienced by many men who early in the ratio in which the number of events is the numerator post-operative course experienced some degree of and the population at risk is the denominator [38]. As one follows men out This contrasts with incidence that deines the rate of beyond 2 years, some modest degree of ongoing increase or decrease of a condition over a speciic improvement in erectile function has been reported. Ideal prevalence data should be obtained through large, multicenter, multinational In the current era of early prostate cancer prospective studies among large cohorts of men detection, many young and sexually active men are with variable but clearly established erectile function undergoing radical surgery and express concern pre-operatively. The ability to deine the effect of about preservation of erectile function following the various surgical approaches, such as laparoscopic/ procedure, a fact that is true for older men as well. Furthermore, there continue in sexual satisfaction of the patient and partner to be modiications to the nerve sparing technique would be ideal. Finally, such a study may allow in an attempt to minimize nerve compromise and for the identiication of an optimally effective post- improve post operative erectile function as reported operative protocol consisting of oral, injectable, by Chuang et al. The ability 18-36 months to return, even among men in whom to identify intra-operative techniques to localize the bilateral nerve sparing was performed with reported cavernous nerves or in some other manner minimize recovery rates varying from 16% to 86% [51].
They are used to put medicines, blood products, nutrients, or fluids right into your blood. Doctors give chemo in cycles, with each period of treatment followed by a rest period to give you time to recover from the effects of the drugs. For example, with some drugs, the chemo is given only on the first day of the cycle. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle. The length of treatment for advanced prostate cancer is based on how well it is working and what side effects you have. Possible side effects of chemotherapy Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. The side effects of chemo depend on the type and dose of drugs given and how long they are taken. Some common side effects can include: q 3 Hair loss 38 ____________________________________________________________________________________American Cancer Society cancer. Along with the risks above, some side effects are seen more often with certain chemo drugs. For example: q Docetaxel and cabazitaxel sometimes cause severe allergic reactions. These drugs can also damage 11 nerves (known as peripheral neuropathy ), which can cause numbness, tingling, or burning sensations in the hands or feet. In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to prevent the effects from getting worse. Unlike traditional vaccines, which boost the body’s immune system to help prevent infections, this vaccine boosts the immune system to help it attack prostate cancer cells. To make it, white blood cells (cells of the immune system) are removed from your blood over a few hours while you are hooked up to a special machine. This process is repeated 2 more times, 2 weeks apart, so that you get 3 doses of cells. The vaccine hasn’t been shown to stop prostate cancer from growing, but it seems to help men live several months longer. As with hormone therapy and chemotherapy, this type of treatment has not been shown to cure prostate cancer. Possible side effects of vaccine treatment 2 3 Common side effects from the vaccine can include fever , chills, fatigue , back and joint 4 5 pain , nausea , and headache. These most often start during the cell infusions and last no more than a couple of days. A few men may have more severe symptoms, including 6 problems breathing and high blood pressure, which usually get better after treatment. To do this, it uses “checkpoint” proteins on immune cells, which act like switches that need to be turned on (or off) to start an immune response. Cancer cells sometimes use these checkpoints to keep the immune system from attacking them. But drugs that target these checkpoints hold a lot of promise as cancer treatments. The drugs are used for people whose cancer starts growing again after chemotherapy. It has shown promising results in some men with prostate cancer and continues to be studied. Side effects can include fatigue, cough, nausea, itching, skin rash, decreased appetite, constipation, joint pain, and diarrhea. Sometimes the immune system starts attacking other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, or other organs. It’s very important to report any new side effects to your health care team promptly. If serious side effects do occur, treatment may need to be stopped and you may get high doses of corticosteroids to suppress your immune system. More information about immunotherapy To learn more about how drugs that work on the immune system are used to treat 8 cancer, see Cancer Immunotherapy. To learn about some of the side effects listed here and how to manage them, see 9 Managing Cancer-related Side Effects. Integrated data from 2 randomized, double-blind, placebo-controlled, phase 3 trials of active cellular immunotherapy with sipuleucel-T in advanced prostate cancer. Last Medical Review: August 1, 2019 Last Revised: August 1, 2019 43 ____________________________________________________________________________________American Cancer Society cancer. Each type of targeted therapy works differently, but they all change the way a cancer cell grows, divides, repairs itself, or interacts with other cells. Rucaparib (Rubraca) can be used to treat advanced castration-resistant prostate cancer that has grown after taxane chemotherapy (such as docetaxel or cabazitaxel) or anti-androgens have been tried. Olaparib (Lynparza) can be used to treat advanced castration-resistant prostate cancer that has grown after the hormone therapy drugs, enzalutamide or abiraterone, have been tried. Rarely, some people treated with these drugs have developed a blood cancer, such 1 2 as myelodysplastic syndrome or acute myeloid leukemia. Some men taking olaparib 44 ____________________________________________________________________________________American Cancer Society cancer. More information about targeted therapy To learn more about how targeted drugs are used to treat cancer, see Targeted Cancer 3 Therapy. To learn about some of the side effects listed here and how to manage them, 4 see Managing Cancer-related Side Effects. Last Medical Review: June 10, 2020 Last Revised: June 10, 2020 45 ____________________________________________________________________________________American Cancer Society cancer. Bone metastasis can be painful and can cause other problems, such as fractures (breaks), spinal cord compression (an area of cancer is pressing on the spinal cord), or high blood calcium levels, which can be dangerous or even life threatening. If the cancer has grown outside the prostate, preventing or slowing the spread of the cancer to the bones is a major goal of treatment. If the cancer has already reached the bones, controlling or relieving pain and other complications is also a very important part of treatment. Treatments such as hormone therapy, chemotherapy, and vaccines may help with this, but other treatments specifically target bone metastasis and the problems it may cause. Bisphosphonates Bisphosphonatesare drugs that work by slowing down bone cells called osteoclasts. These cells normally break down the hard mineral structure of bones to help keep them healthy. Osteoclasts often become overactive when prostate cancer spreads to the bones, which can cause problems. Bisphosphonates can be used: q To help relieve pain and high calcium levels caused by cancer that has spread to the bones q To help slow the growth of cancer that has spread to the bones and help delay or prevent fractures q To help strengthen bones in men who are getting hormone therapy Zoledronic acid (Zometa) is a commonly used bisphosphonate for prostate cancer. Men given this drug are advised to take a supplement containing calcium and vitamin D to prevent problems with low calcium levels. Sometimes other bisphosphonates are used to treat prostate cancer that has spread to bone. Bisphosphonates can have side effects, including flu-like symptoms and bone or joint 46 ____________________________________________________________________________________American Cancer Society cancer. They can also cause kidney problems, so patients with poor kidney function might not be able to be treated with these medicines. This can lead to tooth loss and infections of the jaw bone that are hard to treat. Many times men are advised to have a dental checkup and have any tooth or jaw problems treated before they start taking a bisphosphonate. Denosumab Denosumab (Xgeva) is another drug that can help when prostate cancer spreads to bone. Like the bisphosphonates, denosumab also blocks osteoclasts, but it does so in a different way.
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