Thursday, June 20, 2024

Chemo And Hormone Therapy For Prostate Cancer

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How Might I Feel During Hormone Therapy

Hormone therapy and chemotherapy – prostate cancer

Nearly all men being treated for prostate cancer say that they feel emotionally upset at different times during their hormone therapy. It’s not unusual to feel anxious, depressed, afraid, angry, frustrated, alone, or helpless. Hormone therapy may affect your emotions because it lowers the amount of testosterone in your body.

Some men find it helps to learn about their disease and treatment because it makes them less afraid of their treatment. Find out as much as you want to know. Do not be afraid to ask questions. Your emotional health is as important as your physical health.

Talking with an understanding friend, relative, minister or another patient may be helpful. Your doctors office may be able to give you a list of local prostate cancer support groups. There will be men in the support groups who have had hormone therapy. You may also contact the American Cancer Society at 1-800-227-2345 or the National Cancer Institutes Cancer Information Line at 1-800-422-6237 to find out about cancer resources in your local community.

Many people don’t understand prostate cancer or its treatment. They may stay away from you because they’re not sure what to say or how to help. Try to be open when you talk to other people about your illness, treatment, needs, and feelings. People will often be willing to lend their support. If you get tired easily, limit your activities and do only the things that mean the most to you.

Will Side Effects Limit What I Can Do

What you are able to do will depend on which side effects you have and how bad they are. Many men are able to work, cook meals, and enjoy their usual daily activities when they have hormone therapy for their prostate cancer. Other men find that they need more rest than before they started hormone therapy so they cant do as much. You should try to keep doing the things you enjoy as long as you don’t get too tired.

What Types Of Hormone Therapy Are Used For Prostate Cancer

Hormone therapy for prostate cancer can block the production or use of androgens . Currently available treatments can do so in several ways:

  • reducing androgen production by the testicles
  • blocking the action of androgens throughout the body
  • block androgen production throughout the body

Androgen production in men. Drawing shows that testosterone production is regulated by luteinizing hormone and luteinizing hormone-releasing hormone . The hypothalamus releases LHRH, which stimulates the release of LH from the pituitary gland. LH acts on specific cells in the testes to produce the majority of testosterone in the body. Most of the remaining androgens are produced by the adrenal glands. Androgens are taken up by prostate cells, where they either bind to the androgen receptor directly or are converted to dihydrotestosterone , which has a greater binding affinity for the androgen receptor than testosterone.

Treatments that reduce androgen production by the testicles are the most commonly used hormone therapies for prostate cancer and the first type of hormone therapy that most men with prostate cancer receive. This form of hormone therapy includes:

Treatments that block the action of androgens in the body are typically used when ADT stops working. Such treatments include:

Treatments that block the production of androgens throughout the body include:

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Chemo Drugs Used To Treat Prostate Cancer

For prostate cancer, chemo drugs are typically used one at a time. Some of the chemo drugs used to treat prostate cancer include:

In most cases, the first chemo drug given is docetaxel, combined with the steroid drug prednisone. If this does not work , cabazitaxel is often the next chemo drug tried .

Docetaxel and cabazitaxel have been shown to help men live longer, on average, than older chemo drugs. They may slow the cancers growth and also reduce symptoms, resulting in a better quality of life. Still, chemo is very unlikely to cure prostate cancer.

Other chemo drugs being studied for use in prostate cancer include carboplatin, oxaliplatin, and cisplatin.

Types Of Chemotherapy Drugs

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The most common chemotherapy drug for prostate cancer is docetaxel , which is usually given with prednisone, a steroid medicine. After starting docetaxel, many men experience the improvements in disease-related symptoms, including pain, fatigue and loss of energy.

If docetaxel does not work or stops working, cabazitaxel may be used.

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Hormone Therapy Plus Chemotherapy May Boost Survival In Men With Advanced Prostate Cancer

A team of Harvard-affiliated investigators made headlines recently when they reported that treating men with advanced prostate cancer using a two-drug combination significantly increased survival. One expert called the results potentially transformative.

When prostate cancer spreads beyond the prostate gland, the standard treatment is androgen-deprivation therapy . This treatment cuts off the bodys production of testosterone. Prostate cancer cells need testosterone to grow. ADT works for a time, but eventually cancer cells become resistant to it and begin to grow and spread again. At that point, doctors typically add a chemotherapy drug called docetaxel to ADT.

After scientists first reported in 2005 that docetaxel improved survival in men with advanced prostate cancer, some experts wondered if such men might live even longer if they got ADT and docetaxel at the same time.

Dr. Christopher Sweeney and his colleagues at the Dana-Farber Cancer Institutes Lank Center for Genitourinary Oncology recruited 790 men with advanced prostate cancer and randomly divided them into two groups. One group was given ADT and six cycles of docetaxel over 18 weeks, then ADT alone. The other group was initially treated only with ADT, and then started on docetaxel if their cancer began to get worse.

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Drugs That Stop The Body From Making Androgens

Androgens can be produced in other areas of the body, such as the adrenal glands. Some prostate cancer cells can also make androgens. Three drugs help to stop the body from making androgens from tissue other than the testicles.

Two medicines, ketoconazole and aminoglutethimide , treat other diseases but are sometimes used to treat prostate cancer. The third, abiraterone treats advanced prostate cancer that has spread to other places in the body.

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Systemic Radiation Treatments For Prostate Cancer

Another type of systemic therapy is called radiotherapeutics . It uses very small amounts of radioactive materials. MSK medical oncologists and nuclear medicine doctors work as a team to deliver this treatment to our patients.

A drug called radium-223 is used to treat advanced prostate cancer with bone metastases . Radium-223 delivers a very strong form of radiation to bone metastases. This drug has few side effects, and can help you live longer.

Guide To Managing Side Effects Of Chemotherapy

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Follow these simple rules to manage your side effects:

  • Pay attention. Be aware of all expected and unexpected reactions to the drugs.

  • Be proactive. Make a list of your medications. Talk with your health care providers about what signs to look for and when to call them.

  • Relax and get well. Chemotherapy drugs are powerful and can take a toll on the body. Focus on getting well by finding ways to alleviate stress. These may include listening to music, doing yoga or stretching exercises, taking walks or watching TV.

  • Keep a journal. Write down any physical and emotional changes you experience while taking the medications. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your health care team to manage your side effects.

  • Consult your doctor. Talk with your health care providers about any side effects you experience. There are several drugs designed to help ward off or treat different side effects.

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Laparoscopic Or Robotic Prostatectomy

A laparoscopic or robotic prostatectomy are minimally-invasive procedures that typically have a shorter recovery time. For a laparoscopic procedure, the surgeon makes several small incisions in the abdomen and inserts special long instrumentsone of which has a small camera on the end so the surgeon can see inside your bodyto remove the prostate.

Robotic prostatectomy involves the use of robotic instruments to remove the prostate. The surgeon uses a control panel to direct the robotic instruments to perform the surgery and remove the prostate gland.

Hormone Therapy For Prostate Cancer

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Hormone therapy is also called androgen suppression therapy. The goal of this treatment is to reduce levels of male hormones, called androgens, in the body, or to stop them from fueling prostate cancer cell growth.

Androgens stimulate prostate cancer cells to grow. The main androgens in the body are testosterone and dihydrotestosterone . Most androgens are made by the testicles, but the adrenal glands as well as the prostate cancer cells themselves, can also make androgens.

Lowering androgen levels or stopping them from getting into prostate cancer cells often makes prostate cancers shrink or grow more slowly for a time. But hormone therapy alone does not cure prostate cancer.

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Hormonal Therapy And Chemotherapy In Metastatic Disease

It has been recently demonstrated that the use of chemotherapy can improve outcomes in patients with metastatic hormone naive prostate cancer. It appears that some patients initiating hormonal therapy may actually be better candidates for cytotoxic therapy at this stage of disease than when their disease becomes castration resistant .

It has been controversial as to whether or not early chemotherapy in hormone naive patients would be beneficial. There have been arguments for and against this approach. In favor is the idea that attacking de novo testosterone independent clones early should allow ADT to keep prostate cancer in remission longer. In addition, there is the possibility that some patients at the time of progression may be too frail to receive chemotherapy.

Alternatively, ADT may take cells out of cycle and make them less responsive to cytotoxics. The fact that some patients respond for long periods to ADT and never need chemotherapy is the other argument against early chemotherapy.

Since the early 80s several studies tried to clarify these differing viewpoints, investigating the addition of chemotherapy with hormonal therapy in patients with metastatic prostate cancer .

None of the trials reported positive results, concluding that androgen suppression remains the preferred first line treatment in metastatic prostate cancer and that there was no cytotoxic regimen with consistent activity against hormone-sensitive prostate cancer.

How Prostate Cancer Staging And Risk Stratification Affect Treatment Options

Prostrate Cancer Hormone Therapy

Your treatment choices are determined by several factors, including your cancers stage, aggressiveness and assigned risk stratification . Your age and current general health condition may also affect your choices.

Prostate cancer staging

Prostate cancer staging determines whether the cancer is confined to the prostate gland or whether theres evidence of metastasis, meaning its spread to other areas of the body.

Tools and methods to determine staging may include the prostate-specific antigen test, the digital rectal examination , the Gleason score and the American Joint Committee on Cancer TNM system, which provides information on the tumor, lymph node involvement and metastasis of a cancer. Imaging tests, such as a PET/CT scan, may also help determine your cancers stage.

The four stages of prostate cancer are subdivided into more precise categories, but we generally refer to three groups that indicate how far the cancer has spread:

Localized, meaning theres no indication that the cancer has spread beyond the prostate

Regional, meaning theres evidence of cancer cells in nearby lymph nodes or tissue

Distant, meaning theres evidence the cancer has spread to other organs or body parts farther from the prostate

Almost 90 percent of prostate cancers are diagnosed at the localized or regional stage. The five-year relative survival rate for men diagnosed with prostate cancer at these stages is nearly 100 percent.

Prostate cancer risk assessment

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Theranostics A New Frontier In Prostate Cancer Treatment

This promising approach using new pharmaceuticals to target cancer cells and deliver radiation directly to the cell is a rapidly growing field called Theranostics. Roswell Park is at the forefront of this work and has offered Theranostic treatments to patients for years for the treatment of certain neuroendocrine and adrenal tumors. In addition to Pluvicto, a number of other radiopharmaceuticals to target other prostate-specific proteins are in development.

Are There Side Effects With Hormone Therapy

Yes, there are side effects or unwanted changes in your body caused by hormone therapy. Side effects are different from person to person, and may be different from one treatment to the next. Some people have no or very mild side effects. The good news is that there are ways to deal with most of the side effects. The side effects that you have depend on:

The side effects you have from hormone therapy may be acute or chronic. Acute side effects are sometimes called “early side effects.” These types of side effects happen soon after the treatment begins and usually go away after you finish your hormone therapy. Other side effects are called chronic side effects or “late side effects.” These side effects may happen several months after you start hormone therapy.

In order to reduce your chance of having side effects, your doctor may give you intermittent hormone therapy. If you are on intermittent hormone therapy, your doctor and health care team will carefully watch your PSA level. As it begins to go up, you are given hormone therapy medicine to lower your PSA. Another way for you to get intermittent hormone therapy is to take a medicine for a set period of time and then stop for a set period of time. For example, you may take a medicine for six months, stop for six months, and then start again for six months.

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Questions To Ask Your Doctor Radiographer Or Nurse

  • Which type of radiotherapy is suitable for me and why?
  • Will I have any other treatments while Im having radiotherapy?
  • How long will the pain relief last? What other treatments are available to help with my pain?
  • Will I get any side effects and if so, how can I manage them?
  • Are there any safety guidelines I should follow during and after treatment?
  • Who should I contact if I have any questions at any point during my treatment? How do I contact them?
  • Will having this treatment mean I cant have other types of treatment later on for example, chemotherapy?

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Hormonal Therapy For Endometrial Cancer

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Cancer of the uterus or its lining, the endometrium, may respond to hormone therapy with progestins. Other types of hormone therapy for endometrial cancer include:

  • Aromatase inhibitors

When and why theyre used: Hormone therapy is typically reserved for advanced uterine or endometrial cancer, or for cancer that has returned after treatment. Its often combined with chemotherapy.

Risks: Side effects are similar to those seen with hormone treatment for other types of cancer.

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Mental And Emotional Health

A cancer diagnosis and cancer treatment may affect how you feel mentally and emotionally. Hormone therapy can cause:

  • A drop in mental sharpness

If you have any of these side effects, your doctor may recommend medication, counseling, or both.

Research shows that hormone therapy for prostate cancer may lead to problems with short-term memory, language, thinking, and concentration. But these problems are usually mild. Researchers are still studying the effect of hormone therapy on the brain.

When you stop taking hormone therapy, emotional and mental side effects usually disappear. But if youâve taken the drugs for many years, they may not fully go away.

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Hormonal Treatments In Crpc

Abiraterone is a potent and specific steroidogenic inhibitor that irreversibly inhibits the enzyme CYP17A1, the most important enzyme that catalyzes two essential steroidogenic reactions, the 17-hydroxylase and 17,20-lyase responsible for converting pregnenolone to 17-OH-pregnenolone and subsequently 17-OH-pregnenolone to DHEA and androstenedione .

Abiraterone at 1,000 mg daily with prednisone 5 mg twice daily has demonstrated an overall survival benefit in patients with metastatic CRPC who have progressed before and after docetaxel treatment.

The phase III COU-AA-301 trial evaluated abiraterone and prednisone vs. placebo and prednisone in 1,195 patients with metastatic CRPC pretreated with docetaxel and up to two lines of chemotherapy. Abiraterone was the first novel hormonal therapy to demonstrate a significant improvement in overall survival, with a 26% reduction in the risk of death , and significant improvements in radiographic progression-free survival, time to PSA progression and PSA responses .

Enzalutamide is a novel AR inhibitor that binds to the AR with eight times more affinity than bicalutamide. This hormonal agent possesses three mechanisms of action in blocking the AR. It blocks testosterone binding to the AR, impairs nuclear translocation of the AR and inhibits association of the AR with DNA . This drug is administered without corticosteroids and has shown an improvement in overall survival in both the pre and post chemotherapy settings.

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When Is Brachytherapy Alone The Right Choice

For some patients with disease that is confined to the prostate and not too aggressive , brachytherapy alone is a good option. It is also convenient for the patient as it is done in an outpatient setting and most people can get back to work within a few days.

But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would be preferred. At MSK, our philosophy is that when the disease is caught very early, it is very appropriate to do active surveillance and hold off on treatment.

This philosophy applies to patients with a low PSA level, or nonaggressive disease as reflected by a Gleason score of 6 with evidence of cancer in only a few of the biopsy samples and no evidence from the MRI of a significant amount of disease. There are also very select patients with Gleason 7 disease who may be candidates for active surveillance.

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