Raoul D. Concepcion, MD, and the panel continue the discussion about immunotherapy in advanced prostate cancer. Concepcion begins the discussion by asking how his colleagues present information about immunotherapy to their patients.

Daniel Saltzstein, MD, explains that the patients he’s seen are often cognizant of their PSA and are intrigued by the opportunity to receive immunotherapy. Saltzstein says that his patients understand the toxicity of chemotherapy and are more receptive to the idea of the leukapheresis process involved with sipuleucel-T (Provenge).

Bryan A. Mehlhaff, MD, continues the discussion and notes that he describes to his patients how the immune system is trained to attack the prostate cancer, rather than poison the body. Mehlhaff also explains to his patients the relatively minor side effects (fever, chills), survival advantage, and that immunotherapy is best done earlier rather than later.

Concepcion mentions that about 90% of prostate cancer patients develop bone metastases. He asks Saltzstein and Mehlhaff about any treatments specifically relating to bone metastases.

Saltzstein says that it is the job of the urologist to manage prostate cancer as well as the patient’s bone health and all metabolic consequences associated with treatment. In his practice, Saltzstein has incorporated Xgeva for patients with bone metastases. Saltzstein finds that Xgeva is easy to use because it is delivered monthly and subcutaneously. He does not give Zometa because it is given intravenously and requires monitoring of renal function. Saltzstein also explains that there is a 1.2 to 1.8% incidence of osteonecrosis of the jaw and he makes sure his patients see a dentist before the drug is administered.

Mehlhaff echoes Saltzstein’s points: the data on Xgeva is good and the administration is simple. Mehlhaff reinforces the idea that a patient’s calcium levels must be monitored, as he’s had to stop Xgeva because of a dental problem.

View Part I of the Discussion