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Hormone And Radiation For Prostate Cancer

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Hormonal Therapy On Its Own

Hormone Therapy & Advanced Therapies for Prostate Cancer, Celestia Higano, MD | 2021 Mid-Year Update

Doctors do not usually advise having hormonal therapy instead of a prostatectomy or radiotherapy. Hormonal therapy alone cannot cure early or locally-advanced prostate cancer.

Depending on your general health and preferences, you may decide to have hormonal therapy on its own. For example, if you:

Hormonal therapy can slow down or stop the cancer cells growing for many years. It can also improve any symptoms. Not having surgery or radiotherapy means you avoid the side effects of these treatments. But hormonal therapy also causes side effects. It is important to talk to your doctor or nurse before you decide.

The Future Of Hormone Therapy For Prostate Cancer

Some experts aren’t sure how much further we can improve hormone therapy for prostate cancer.

“I’m not saying that we’ve reached the end of what we can do with hormonal therapy,” Thrasher tells WebMD, “but there are only so many ways to shut down the hormonal effects. The cancer will still eventually escape.”

Brooks argues that, overall, prostate cancer is only moderately affected by hormones. “You can only do so much manipulating the levels of hormones,” says Brooks. “We have to find better ways to fight the basis of the cancer cells.”

Thrasher and Brooks have more hope that the next breakthroughs will come with different approaches, like chemotherapy or vaccines.

But Holden remains optimistic about the future of hormone therapy for prostate cancer.

“Cancer cells eventually figure out how to survive, how to overcome a specific hormone therapy,” he says. “But if we have enough types of drugs and can keep changing the hormone therapy, we might be able to keep the cancer cells in a state of confusion. We could change therapies before they have a chance to adapt.”

“It’s like an endless chess game,” he says. “You may not ever win, but you might be able to prolong the game indefinitely. I think that hormone therapy still has a lot of promise. We just need to develop better anti-androgens, and more varieties of them.”

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Radiation Added To Hormone Therapy Increases Survival For Men With Prostate Cancer

Oncology

For men with locally advanced prostate cancer, the addition of radiation treatment to antiandrogen hormone therapy reduces the risk of dying of prostate cancer by 50% compared to those who have antiandrogen hormone treatment alone, according to a randomized study presented September 22, 2008, during the plenary session of the American Society for Therapeutic Radiology and Oncologys 50th Annual Meeting in Boston.

For men with locally advanced prostate cancer, the addition of radiation treatment to antiandrogen hormone therapy reduces the risk of dying of prostate cancer by 50% compared to those who have antiandrogen hormone treatment alone, according to a randomized study presented September 22, 2008, during the plenary session of the American Society for Therapeutic Radiology and Oncologys 50th Annual Meeting in Boston.

Key Finding

This randomized trial is the first to show that men with locally advanced prostate cancer will survive substantially longer when radiation is added to their treatment plan, said Anders Widmark, md, lead author of the study and a professor in radiation oncology at Umea University in Umea, Sweden. I would encourage men with locally advanced prostate cancer to talk to their doctor to see if they would be a good candidate for radiation therapy in addition to hormone treatment.

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What Will I Learn By Reading This

You and your doctor may be talking about using hormone therapy to control your prostate cancer. It is important for you to learn about hormone therapy so that you will know what to expect and how best to take care of yourself before, during, and after treatment. You will learn:

It is important to think about how you will work these things into your everyday life if you and your doctor decide that hormone therapy is the best way for you to control your prostate cancer..

Heres What You Should Know About This Treatment Option

Frontiers

Men who get diagnosed with prostate cancer have several options to choose from for their next step. Many men with slow-growing, low-risk cancer follow active surveillance, a wait-and-see approach that monitors the cancer for changes.

But if the cancer shows higher risk or has already begun to spread, other treatments are recommended. There are two options: surgery to remove the prostate or radiation to destroy the cancer cells.

Studies comparing these two approaches demonstrate no advantage of one over the other with respect to cancer control. Your path will depend on factors like your current health, the specifics of your cancer, and personal preference. Yet for many men, radiation can be the better option.

“Its much more precise than the traditional radiation used for other kinds of cancer, and research also has found that long-term quality of life is often better, with fewer adverse health effects compared to surgery,” says Dr. Anthony DAmico, a radiation oncologist with Harvard-affiliated Dana-Farber Cancer Institute and Brigham and Womens Hospital.

There are two main ways to deliver radiation to the prostate: external beam radiation and brachytherapy.

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Hormone Therapy Helps Some Prostate Cancer Survivors Live Longer

A study published in the New England Journal of Medicine in January 2017 indicates that men whose prostates are removed to treat prostate cancer are likely to survive longer if they take drugs to block the male hormone testosterone in addition to undergoing radiation therapy.

Unfortunately, its not that simple.

What Have I Learned By Reading This

You learned about:

If you have any questions, please talk to your doctor or healthcare team. It is important that you understand what is going on with your treatment. This knowledge will help you take better care of yourself and feel more in control so that you can get the most from your treatment..

  • The results of any tests you have taken such as your Prostate-Specific Antigen test.
  • When you found out you had prostate cancer.
  • Information on the kinds of treatment you have had for your prostate cancer including:
  • The places and dates where you had your treatment.
  • What type of treatment you had. And,
  • Any medicines you took before, during, and after your prostate cancer treatment.
  • Contact information for all your doctors and the other members of your health care team who helped with your prostate cancer treatment and followup care.
  • Any side effects or problems you had during and after your prostate cancer treatment.
  • Any supportive care you got during your treatment. Supportive care is treatment given to keep, control, or make your side effects better and to make your life better. For example, pain medicine, emotional support, and nutritional supplements.
    • What hormone therapy is

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    Radiation Therapy For Prostate Cancer

    Radiation therapy is an effective treatment that kills prostate cancer cells by using high energy rays or particles. The radiation can be delivered in several ways, including brachytherapy and external beam radiation that projects the energy through the skin. Radiation therapy for prostate cancer is best delivered by experienced radiation oncologists who work in high volume centers of excellence.

    Radiation therapy can:

    • Treat both early stage cancers of the prostate gland and more advanced cancers that may have spread beyond the prostate
    • Be used alone or with other treatments such as hormone deprivation
    • Treat recurrent prostate cancer following surgery
    • Treat men with limited spreading prostate cancer to reduce the tumors size and improve survival and quality of life
    • Slow cancer growth, reduce fracture risk
    • Be used as a palliative treatment to address pain from advanced cancer

    External Beam Radiation Therapy

    Gleason 4+4=8 & Hormone Therapy | Ask a Prostate Cancer Expert, Mark Scholz, MD

    This is the most common type of radiation therapy, and it is painless. Before treatment, your radiation team will use computerized tomography scans and magnetic resonance imaging scans to map out the location of the prostate and tumor cells.

    During each treatment session, X-ray beams are focused on the targeted cancer areas. Oncologists can change the intensity of doses and radiation beams to better deliver high doses of radiation to tumor cells while delivering lower doses to surrounding healthy tissues.

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    How Are Hormone Therapy Medicines Used

    Hormone therapy medicines may be used alone, with another type of hormone therapy, or with another type of prostate cancer treatment.

    Monotherapy

    Monotherapy is when only one type of hormone therapy medicine is used to lower the amount of testosterone in your body. Monotherapy can be effective in shrinking a prostate cancer tumor, slowing the spread of your prostate cancer, and relieving pain caused by your prostate cancer. Monotherapy may be used with neoadjuvant therapy or adjuvant therapy. Please read When is Hormone Therapy Used for Prostate Cancer? to learn more about neoadjuvant and adjuvant therapy.

    Combination therapy

    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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    Will I Need To See My Doctor During And After Hormone Therapy

    Yes, you will need regular medical checkups while getting hormone therapy. During these checkups your doctor will look at your medical history and give you a physical exam. Your checkup may include blood tests and imaging tests. For example:

    Imaging studies are ways used by doctors to take pictures of the inside of your body, such as x-rays or a CT Scan . These check-ups are important because:

    Are There Any Surgical Techniques That Have Been Developed To Improve Erectile Function Outcomes

    Risk of death higher for some prostate cancer patients who use hormone ...

    At this time, there are several different surgical approaches to carry out the surgery, including retropubic or perineal approaches as well as laparoscopic procedures with freehand or robotic instrumentation. Much debate but no consensus exists about the advantages and disadvantages of the different approaches. Further study is needed before obtaining meaningful determinations of the success with different new approaches.

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    What Is Hormone Herapy

    To help you understand what hormone therapy is and how it may affect your prostate cancer, it is good for you to understand what hormones are and how they work in your body. Hormones control or manage your bodys activities. Hormones are made by glands in your body and are carried by your blood to all areas in your body. Glands are groups of cells in your body that make and release materials needed by your body.

    Testosterone is the main male hormone in your body. It makes you grow hair on your face and body and have a mans body shape and controls your desire for sex. Testosterone also controls your prostate gland. Your testicles make most of the testosterone in your body. A small amount of testosterone is also made by your adrenal glands. Your adrenal glands are located on top of each kidney. Your adrenal glands also make other hormones.

    Prostate cancer is hormone sensitive or hormone dependent. This means that the testosterone in your body helps your prostate cancer to grow. The goal of hormone therapy is to lower the amount of testosterone in your body to stop or slow the growth of your prostate cancer. You can lower the amount of testosterone in your body by taking medicines or having surgery.

    Stereotactic Body Radiation Therapy Or Stereotactic Ablative Radiation Therapy

    Guided by advanced imaging techniques, SBRT delivers large doses of radiation over a short period of time to a precise area. SBRT is commonly referred to by the names of the machines used to deliver the radiation. SBRT can offer some patients with localized prostate cancer the convenience of fewer treatments while maintaining treatment effectiveness and safety. SBRT may also be used to treat metastases for some patients to reduce tumor mass and potentially enhance survival.

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    Addition Of Hormone Therapy To Radiotherapy Benefits Men With Localized Prostate Cancer

    Disclosures: We were unable to process your request. Please try again later. If you continue to have this issue please contact .

    The addition of androgen deprivation therapy to radiotherapy improved survival outcomes among patients with localized prostate cancer, according to study results published in TheLancet Oncology.

    Additionally, prolonging the adjuvant component of ADT provided significant benefit regardless of radiotherapy dose among those with intermediate-risk and high-risk disease, researchers noted.

    Lancet Oncol

    Rationale

    Prostate cancer is an extremely common cancer worldwide that has been studied in multiple randomized trials. Yet, to date there has been no prior effort to pool data from multiple global trials to quantify the benefits we see from common treatment intensification strategies,Amar U. Kishan, MD, associate professor and vice-chair of clinical and translational research, and chief of the genitourinary oncology service for the department of radiation oncology at David Geffen School of Medicine at UCLA and UCLA Jonsson Comprehensive Cancer Center, told Healio.

    These benefits include the addition of ADT to radiotherapy, prolonging the duration of ADT that follows radiotherapy , and extending the duration of ADT that may precede radiotherapy , Kishan added.

    Methodology

    Metastasis-free survival served as the studys primary outcome. Median follow-up was 11.4 years.

    Key findings

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    What Side Effects May I Have After I Start Hormone Therapy

    Intermittent Hormone Therapy for Prostate Cancer 101 | Ask a Prostate Expert, Mark Scholz, MD

    The side effects that you may have after you start hormone therapy include: erectile dysfunction or impotence , lower sexual desire , hot flashes, fatigue , weight gain, breast enlargement, osteoporosis, anemia, memory loss, and cardiovascular problems. The following side effects can happen as soon as you start your treatment.

    Erection problems

    Difficulty getting or keeping an erection is a common side effect of hormone therapy for prostate cancer. This is also called impotence. Hormone therapy lowers the amount of testosterone in your body or stops your body from making testosterone.

    Lower sex drive

    Hot flashes and sweating

    Breast tenderness or growth

    Some men may find that their chest becomes sore and that their breasts get a little bit swollen. This is called gynecomastia . There are medicines and treatments that you doctor or health care team can give you to help with this side effect.

    Fatigue

    The drop in your testosterone level may make you feel very tired. You may feel tired all the time or you may get tired more easily when you do your daily activities. This is known as fatigue or tiredness. There are things you can do to help deal with this treatment side effect.

    Tumor flare pain

    The following side effects may happen if you take hormone treatment for a long period of time. These are:

    Weight gain

    Memory problems

    Anemia

    Bone thinning

    There are several ways you can help to lower your osteoporosis risk

    Cardiovascular problems

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    How Long Do You Take Hormonal Therapy For

    For early prostate cancer this depends on the prostate cancer risk group. If the cancer is:

    • intermediate-risk you may have hormonal therapy for a few months after radiotherapy
    • high-risk you may be advised to have hormonal therapy for up to 2 to 3 years after radiotherapy.

    For locally advanced prostate cancer you usually have hormonal therapy for 2 to 3 years after radiotherapy.

    Checking Your Hormone Therapy Is Working

    You have regular blood tests to check the level of a protein called prostate specific antigen . PSA is a protein made by both normal and cancerous prostate cells. It is in the blood in small amounts in all men, unless you have had the prostate gland completely removed.

    While the hormone therapy is working, the level of PSA should stay stable or may go down. But if prostate cancer starts to grow and develop, the level of PSA may go up. This is hormone resistant prostate cancer or castrate resistant prostate cancer. Then your doctor may need to change your treatment. They will discuss this with you

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    Treatment To Lower Testicular Androgen Levels

    Androgen deprivation therapy, also called ADT, uses surgery or medicines to lower the levels of androgens made by the testicles.

    Orchiectomy

    Even though this is a type of surgery, its main effect is as a form of hormone therapy. In this operation, the surgeon removes the testicles, where most of the androgens are made. This causes most prostate cancers to stop growing or shrink for a time.

    This is done as an outpatient procedure. It is probably the least expensive and simplest form of hormone therapy. But unlike some of the other treatments, it is permanent, and many men have trouble accepting the removal of their testicles. Because of this, they may choose treatment with drugs that lower hormone levels instead.

    Some men having this surgery are concerned about how it will look afterward. If wanted, artificial testicles that look much like normal ones can be inserted into the scrotum.

    LHRH agonists

    Luteinizing hormone-releasing hormone agonists are drugs that lower the amount of testosterone made by the testicles. Treatment with these drugs is sometimes called medical castration because they lower androgen levels just as well as orchiectomy.

    With these drugs, the testicles stay in place, but they will shrink over time, and they may even become too small to feel.

    • Leuprolide mesylate

    LHRH antagonists

    Possible side effects

    Many side effects of hormone therapy can be prevented or treated. For example:

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