Tuesday, August 2, 2022

How Does Hormone Therapy Work For Prostate Cancer

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Therapies That Interfere With Androgen Function

Hormone Therapy Basics | Ask a Prostate Cancer Expert, Mark Scholz, MD

Taken daily as pills, antiandrogens bind to the androgen receptor proteins in the prostate cells, preventing the androgens from functioning. In addition to preventing a flare reaction, antiandrogens may be added to your treatment plan if an orchiectomy, LHRH agonist or LHRH antagonist is no longer working by itself. Commonly prescribed antiandrogens include flutamide and bicalutamide .

Enzalutamide is a newer type of antiandrogen that blocks the signal that the receptor normally sends to the cells control center to trigger growth and division. This antiandrogen may be used to treat castration-resistant prostate cancer.

How Much Hormone Therapy Costs

The cost of hormone therapy depends on:

  • the types of hormone therapy you receive
  • how long and how often you receive hormone therapy
  • the part of the country where you live

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for hormone therapy for their members. To learn more, talk with the business office where you go for treatment. You can also go to the National Cancer Institute database, Organizations that Offer Support Services and search “financial assistance.” Or call toll-free 1-800-4-CANCER to ask for help.

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

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Hormonal Therapy On Its Own For Early And Locally Advanced Prostate Cancer

If your doctors are using the watchful waiting approach and the cancer starts to grow, you may have hormonal therapy on its own.

Some people with early prostate cancer decide to have hormonal therapy on its own instead of with surgery or radiotherapy. Some people with locally advanced cancer decide to have hormonal therapy on its own instead of radiotherapy. Unlike these treatments, hormonal therapy on its own will not get rid of all the cancer cells. Doctors do not usually advise this. But it may be suitable if you:

  • are not well enough to have surgery or radiotherapy
  • do not want these treatments.

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

How Does Radiation Therapy Work For Prostate Cancer

Why does hormone therapy worsen some prostate cancers?

Radiation therapy works by use of high doses of radiation to kill or slow down its growth rate. In prostate cancer treatment it is used to kill the cancerous cells or slow the growth rate. It also kills the nearby healthy cells as it kills the cancerous cells. Where curing the cancer is impossible,

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Can Hormone Therapy Cure My Prostate Cancer

No, hormone therapy cannot cure your prostate cancer. The goal of hormone therapy is to stop or slow the growth of the prostate cancer cells in your body. Hormone therapy can shrink prostate cancer tumors and may stop or limit the spread of your prostate cancer. Hormone therapy is used to control your prostate cancer.

Side Effects Of Hormone Therapy

As the primary male hormone, testosterone plays an important role in establishing and maintaining the typical male characteristics along with a variety of other processes in the body.

The potential effects of testosterone loss include the following:

  • Hot flashes

  • Osteoporosis, which can lead to bone fractures

  • Fatigue

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Gnrh Antagonists For Advanced Prostate Cancer

These drugs block messages from the brain to the testicles telling them to make testosterone. They work more quickly than LHRH agonists and do not cause tumour flare.

At the moment degarelix is the only GnRH antagonist available. You have it as an injection under the skin of your tummy once a month. It may be used for advanced prostate cancer that has spread to the spine . As well as hormonal side effects, it commonly causes skin reactions.

Treating Advanced Prostate Cancer

Hormone Therapy & Radiation for Prostate Cancer | We Answer Your Youtube Questions #6 | The PCRI

If the cancer has reached an advanced stage, it’s no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.

Treatment options include:

  • hormone treatment
  • chemotherapy

If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.

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Hormone Therapy Side Effects

Because ADT shuts down androgen production and the AR effect on gene expression, male characteristics are affected. Men on ADT may experience loss of sexual desire and function, breast tenderness and enlargement, loss of muscle tone, loss of bone density, shrinking of penis and testicles, hot flashes, mood swings, depression, weight gain, fatigue, and mental fogginess. Some studies have linked ADT with other systemic problems such as cardiovascular disease, high blood pressure, and diabetes, but the jury is still out on these.

There is no doubt that under a doctors supervision, ADT extends life and reduces the severity of PCa metastasis. Some protocols have fewer sexual side effects than others. Talk with your doctor if you have questions or concerns about hormone therapy for prostate cancer.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

Hoang DT, Iczkowski KA, Kilari D, See W, Nevalainen MT. Androgen receptor-dependent and -independent mechanisms driving prostate cancer progression: Opportunities for therapeutic targeting from multiple angles. Oncotarget. 2017 Jan 10 8: 37243745.

How Often Should I Receive Lupron Depot

Lupron Depot is given as an intramuscular injection into the muscle in your upper arm, buttock or thigh. Lupron Depot is available as single dose kits that contain a prefilled injection syringe of:

  • 7.5 mg
  • 22.5 mg
  • 30 mg
  • 45 mg

Depot formulations continuously release medicine into your body over a certain period of time after injection. This means you may not need to get a shot every day, or even every month. Your healthcare provider will give you Lupron Depot injection, and together you can decide which treatment dose and schedule might work best for you.

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What Is Prostate Cancer Hormone Therapy And How Does It Work

Prostate cancer hormone therapy is used quite often when treating prostate cancer patients. This therapy does not involve the patient actually receiving hormones. Rather, doctors try to suppress the hormone testosterone. Dr. Richard Bevan-Thomas tells us that prostate cancer cells actually use testosterone for fuel in its early stages.

For hormone therapy, patients are routinely given a shot which tells their brain to stop signaling the testicles to make testosterone. These shots may be administered from one to six months. This therapy works well but does have side effects. For more, watch the video below:

Video Transcripts

Richard Bevan-Thomas, MD: Hormone therapy is a therapy which we use for prostate cancer quite often, but it is not actually giving a patient hormones. We also refer to it as what is called androgen deprivation therapy because what we do is we want to starve the prostate cancer cells of testosterone. We know that prostate cancer certainly in the early stages actually uses testosterone for fuel.

Confirming What Weve Practiced For Years

How Hormone Therapy Works: What You Need to Know
  • What was the grade of the cancer?
  • Was it at the edge of the removed prostate gland?
  • Was it in the attached seminal vesicles or extending beyond the capsule?
  • Was there cancer in any removed lymph nodes?
  • What is the trend of serum PSA since surgery?
  • How old is the patient, what are his other medical issues, and what are his goals?
  • We infrequently operate on men with a Gleason cancer aggressiveness score of 6 or lower given our robust surveillance program for such patients. Our focus has been on those with higher grade disease, where we have long added hormone therapy to radiation when disease recurs after surgery. The majority of patients on this study fit this profile, reassuring us we are concentrating on the right biology of patient.
  • When a mans PSA level is low, less than 0.5, we are more confident that radiation alone will prevent recurrence. Using early radiation and higher doses with modern techniques has improved outcomes, and thus the addition of hormones is more carefully measured in such patients. This study did not find survival benefit for patients with PSA levels of less than 0.7, supporting our emphasis on this strategy.
  • The study also confirms another of our standard practices: If a mans PSA is above 0.7, all patients do better with added hormone therapy.
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    How Might Hormone Therapy Make Me Feel

    Hormone therapy itself can affect your mood. You may find that you feel more emotional than usual or just different to how you felt before. Some men find that they cry a lot. You may also get mood swings, such as getting tearful and then angry. Just knowing that these feelings are caused by hormone therapy can help.

    Everyones different some men are surprised by the side effects and how upsetting they find them. Others have fewer symptoms or are not as worried by them.

    Some of the other side effects of hormone therapy are hard to come to terms with. Physical changes, such as putting on weight, or changes to your sex life, might make you feel very different about yourself. Some men say they feel less masculine because of their diagnosis and treatment.

    If youre starting hormone therapy very soon after being diagnosed with prostate cancer, you might still feel upset, shocked, frightened or angry about having cancer. These feelings are normal, and it’s okay to feel this way.

    Things in your day-to-day life can change because of the hormone therapy. Your relationships with your partner, family and friends might change. Or you might be too tired to do some of the things you used to do.

    Some men experience low moods, anxiety or depression. This could be directly caused by the hormone therapy itself, or because you’ve been diagnosed with prostate cancer. It could also be due to the impact that treatment is having on you and your family.

    What can help?

    Talking about it

    Complications Of Hormonal Therapy

    E. David Crawford, MD, Professor of Surgery and Radiation Oncology, Head of the Section of Urologic Oncology at the University of Colorado, and Chairman of the 16th International Prostate Cancer Update, provided an excellent overview of complications of hormonal therapy and their treatment. He began this discussion by outlining not only the benefits but also the complications of androgen deprivation, the latter including osteoporosis, hot flushes, gastrointestinal side effects, anemia, gynecomastia, sarcopenia, central nervous system effects, change in body weight, sexual dysfunction, loss of bone density, and increased risk of bone fracture and hot flushes .

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    Advising The Patient About Hormonal Therapy

    Finally, Mark Moyad, MD, Director of Complementary and Preventive Medicine, University of Michigan, Department of Urology and Oncology, delivered an excellent discussion of the 10 steps he takes in advising patients about initiation of androgen deprivation therapy. Step 1 is to introduce patients to the common and less common side effects of androgen deprivation therapy . Step 2 is to introduce the patient to moderate, practical, and realistic dietary and lifestyle changes that promote general health during the androgen deprivation therapy. Dr. Moyad stated that recommendations for cardiovascular well-being extrapolate well to provide benefit to patients receiving androgen deprivation therapy. Step 3 is to emphasize that when it comes to over-the-counter supplements and other alternative approaches, less is more. He emphasized that some of these agents might have adverse effects on surgery or radiation therapy and that patients should discontinue these agents at least 1 week before definitive treatment. Step 4 is to remind patients that there might be dyslipidemia associated with androgen deprivation therapy patients should be told, know your lipid levels as well as your PSA.

    Hormone Therapy Can Cause Side Effects

    Hormone Therapy for Prostate Cancer

    Because hormone therapy blocks your bodys ability to produce hormones or interferes with how hormones behave, it can cause unwanted side effects. The side effects you have will depend on the type of hormone therapy you receive and how your body responds to it. People respond differently to the same treatment, so not everyone gets the same side effects. Some side effects also differ if you are a man or a woman.

    Some common side effects for men who receive hormone therapy for prostate cancer include:

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    What Is Intermittent Adt

    Researchers have investigated whether a technique called intermittent androgen deprivation can delay the development of hormone resistance. With intermittent androgen deprivation, hormone therapy is given in cycles with breaks between drug administrations, rather than continuously. An additional potential benefit of this approach is that the temporary break from the side effects of hormone therapy may improve a mans quality of life.

    Randomized clinical trials have shown similar overall survival with continuous ADT or intermittent ADT among men with metastatic or recurrent prostate cancer, with a reduction in some side effects for intermittent ADT .

    Hormonal Therapy For Aggressive Prostate Cancer: How Long Is Enough

    • By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

    Men weighing treatment options for intermediate- or high-risk cancer that is still localized to the prostate can face a tricky question. A standard approach in these cases is to give radiation to the prostate along with drugs that block testosterone, a hormone that makes the cancer cells grow faster. For how long should this hormone therapy last? Thats not entirely clear. The drugs have side effects, such as fatigue, impotence, and a loss of muscle mass. But radiation doesnt control prostate cancer effectively without them. Doctors therefore aim to give hormone therapy only for as long as it takes to help their patients, without causing any undue harm.

    Now, newly published results from a phase 3 clinical trial are providing some needed guidance.

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    Androgen Receptors In Prostate Cells

    Each cell in our body has an outer membrane that holds the cells contents. When circulating androgens come into contact with a prostate cell, they cross through the membrane into the cell where they bind with ARs. Once it is bound with an androgen, it is activated to enter the cells nucleus that contains your DNA. The bound AR now binds with DNA. DNA is like a musical score for a symphony the printed notes on paper dont produce music until a conductor directs instruments to play their notes when its their turn, bringing the music to life. When AR binds with DNA, it behaves similar to a conductor.

    Like a maestro directing violins, brass, reeds, etc. to play their notes, the AR bound to DNA can direct the expression of genes. Gene expression means switching on the instructions it contains, thereby influencing the behavior of that cell, e.g. to duplicate itself. Thus, both androgens and their ARs are essential for the growth and reproduction of prostate gland cells. To recap the steps:

    • Androgens circulate through the body and can freely enter cells such as prostate cells.
    • Like a key in a lock, testosterone or DHT bind to an AR.
    • The bound AR can now enter the cells nucleus where, in turn, it binds with DNA.
    • The bound AR then determines which genes can be expressed and which cant.
    • The cumulative effect of expressed genes determines the cells identity and behavior.

    Heres What The Results Showed

    Hormone Therapy â Does It Treat Prostate Cancer?

    After a median follow-up of just over 10 years, 9.7% of men who were treated with radiation and leuporelin for 18 months had died from prostate cancer, compared to 13.3% of the men treated with radiation and leuporelin for six months. Adding zoledronic acid made no difference in either case.

    The authors concluded that hormonal therapy is more effective at preventing prostate cancer death when its given for 18 months rather than six. And similar benefits were noted for other endpoints as well. For instance, prostate tumors were less likely to metastasize, or spread, among men in the longer duration treatment group, and it took longer for their cancers to become resistant to hormone therapy if it was reinitiated later.

    In earlier clinical research, scientists discovered that hormonal therapy given for three years protects against prostate cancer death more effectively than a six-month treatment regimen. But three years of hormone therapy isnt easily tolerated, and evidence so far shows that 10-year survival rates after either 18 months or three years of hormonal therapy are similar, the authors of the new study claim.

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    How Are Treatments Administered

    GnRH agonists are either injected or placed as small implants under the skin. Anti-androgens are taken as a pill once per day. Degarelix is given as an injection. A chemotherapy drug called docetaxel is sometimes used in combination with these hormone therapies.

    Zytiga is taken by mouth once per day in combination with a steroid called prednisone.

    Surgery to remove the testicles can be done as an outpatient procedure. You should be able to go home a few hours after an orchiectomy.

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