Good Prostate Cancer Care
Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.
You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.
You should also be told about any clinical trials you may be eligible for.
If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.
How Long Does Hormone Therapy Work To Stop Cancer Progression
On average, hormone therapy can stop cancer progression for 1-2 years before the prostate cancer becomes resistant. Hormone therapy can stop working over time as the prostate cancer begins to grow again .
When this occurs, doctors may offer other therapies. Since they cant predict how long hormone therapy will work, they may perform regular blood tests to check PSA and testosterone levels. If PSA levels start to increase and testosterone levels are low, these may be signs that the cancer has started to grow again.
Orchiectomy Surgical Removal Of The Testicles
Once a common treatment, orchiectomy is rarely used now, thanks to the development of advanced ADT drugs. The procedure removes the testicles the source of most testosterone production. The scrotal sac is left intact, and patients can have testicular prostheses implanted for cosmetic purposes. Orchiectomy is effective in drastically reducing levels of testosterone, but it has several downsides. Removal of the testicles is permanent and irreversible. Loss of the testicles makes it challenging to have intermittent hormone therapy, an advantageous treatment. And there is a psychological effect: Many patients feel distress related to the idea of lost masculinity if they undergo this procedure.
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Drugs That Lower Androgen Levels
The most common treatment is to take drugs that lower the amount of androgens made by the testicles. They are called luteinizing hormone-releasing hormone analogs and anti-androgens . These drugs lower androgen levels just as well as surgery does. This type of treatment is sometimes called “chemical castration.”
Men who receive androgen deprivation therapy should have follow-up exams with the doctor prescribing the drugs:
- Within 3 to 6 months after starting therapy
- At least once a year, to monitor blood pressure and perform blood sugar and cholesterol tests
- To get PSA blood tests to monitor how well the therapy is working
LH-RH analogs are given as a shot anywhere from once a month to every 6 months. These drugs include:
- Leuprolide
- Goserelin
- Triptorelin
LH-RH antagonists are another class of treatments, including degarelix and relugolix . They reduce androgen levels more quickly and have fewer side effects. LH-RH antagonists are used in men with advanced cancer.
Some doctors recommend stopping and restarting treatment . This approach appears to help reduce hormone therapy side effects. However, it is not clear if intermittent therapy works as well as continuous therapy. Some studies indicate that continuous therapy is more effective or that intermittent therapy should only be used for select types of prostate cancer.
A New Treatment Standard
Still, some men have difficulty tolerating ADT, and not all of them should get it, particularly if theyre older and more likely to die of something other than prostate cancer. Id reserve ADT for younger men with a long life expectancy ahead of them who were diagnosed initially with high-grade or late-stage disease, Thompson said.
This important study confirms that combined therapy is superior to radiation alone and should be viewed as the standard treatment for PSA relapse, said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org. High dose bicalutamide has been associated with cardiovascular side effects, but ongoing and future research is clarifying how best to use ADT in this particular setting.
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How To Reduce The Side Effects Of Hormone Therapy For Prostate Cancer
Following hormone therapy, you may become anxious about your sexual functions. Discuss your feelings with your partner and healthcare team.
Lower levels of testosterone will have a negative on your bone density and muscle mass.
Lifestyle changes such as supplementation, exercise, and diet can help you manage this side effect.
You may consider taking calcium and vitamin D supplements. There is a negative relationship between smoking and bone density. Thus, stop smoking after hormone therapy.
Natural ways to help you manage the symptoms of hormone therapy include:
- A healthy diet and appropriate fluid intake to help you maintain a healthy body and mental state.
- Regular exercise help build muscle and bone strength as well as reduce obesity.
- Regular sleeping to help deal with potential fatigue and mental health problems.
How Testosterone Helps Prostate Cancer Grow
Testosterone travels through the bloodstream and eventually reaches prostate cancer cells, where it helps the cancer grow. Up to a point, the more testosterone the cancer cells have, the more the cancer can grow and eventually spread to other parts of the body. Hormone therapy is designed to prevent testosterone from fueling the growth of these cancer cells.
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What To Expect During Hormone Therapy
As you go through hormone deprivation therapy, youâll have follow-up visits with your cancer doctor. Theyâll ask about side effects and check your PSA levels.
Doctors donât know how long hormone therapy works to keep prostate cancer in check. So, while you take it, your doctor will regularly draw blood to check your PSA levels. Undetectable or low PSA levels usually mean that the treatment is working. If your PSA levels go up, itâs a sign that the cancer has started growing again. If this happens, your cancer is considered castrate-resistant, and hormone deprivation therapy is no longer an effective treatment.
Youâll also get other blood tests to see if the cancer is affecting other parts of your body like your liver, kidneys, or bones. Scans will show how well your cancer is responding to hormone therapy.
To lessen the side effects of hormone therapy drugs, researchers suggest that you take them for just a set amount of time or until your PSA drops to a low level. If the cancer comes back or gets worse, you may need to start treatment again.
When Does Hormone Therapy Fail For Prostate Cancer
Cancer cells are smart. When faced with a continuous stressor such as chemotherapy or hormone therapy, they eventually evolve and learn evasive maneuvers. When prostate cancer cells grow resistant or become insensitive to hormone therapy, the cancer is referred to as hormone refractory.
Hormone therapy may work to treat prostate cancer for many years. However, its only a temporary fix because eventually, the cancer becomes resistant. The risk of resistance goes up if the cancer has taken hold for a long time or if it has relapsed.
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Epidemiological Data From Germany
More than 58 000 men are given the diagnosis of prostate cancer in Germany each year . This figure corresponds to 25.4% of the new cancer diagnoses in men prostate cancer is thus the most common form of cancer in men. The mean age at diagnosis is 69 years. The annual incidence is 720 per 100 000 per year in the 70-to-74-year-old age group and peaks at approximately 750 per 100 000 per year in men aged 75 to 79. The relative 5-year survival rate of patients with prostate cancer is currently 87% . These epidemiological figures reveal the importance of an appropriate choice of initial therapy.
Hormonal Therapy Or Watchful Waiting In Men Over Age 70
The expression “watchful waiting” has come into common use to designate delayed hormonal therapy of patients with prostate cancer. Palliative hormonal therapy is started only if the patient develops tumor symptoms such as bone pain or renal failure secondary to ureteric obstruction. Watchful waiting is not the same thing as active surveillance, a management strategy in which no treatment is given as long as the carcinoma seems to be relatively inactive and the patients life expectancy is 15 years or more . The Gleason score is the most commonly used grading system for prostate cancer it is used, for example, in the European guideline of 2008. The two most common histological patterns seen in the biopsy specimen are added together to yield a Gleason score from 2 to 10.
The Gleason score was the dependent variable in the uncontrolled Connecticut observational study, in which only 7% of patients with a Gleason score of 4 or below died of tumor-related causes. The figure rose to 45% with a Gleason score of 7 and to 66% with a Gleason score of 8 or above. Age did not influence the tumor-specific lethality, but nearly half of the patients required hormonal treatment because of progression. Extensive comorbidity, as quantified with the Charlson comorbidity index , raised the overall but not the tumor-specific lethality 2) .
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Evidence About Hormone Therapy And Prostatectomy
Gleave ME, La Bianca S, Goldenberg SL. Neoadjuvant Hormonal Therapy Prior to Radical Prostatectomy: Promises and Pitfalls. Prostate Cancer and Prostatic Diseases 2000 3:13644. PMID: 12497089.
Hurtado-Coll A, Goldenberg SL, Klotz L, Gleave ME. Preoperative Neoadjuvant Androgen Withdrawal Therapy in Prostate Cancer: The Canadian Experience. Urology 2002 60:4551. PMID: 12231047.
Kumar S, Shelley M, Harrison C, et al. Neo-adjuvant and Adjuvant Hormone Therapy for Localized and Locally Advanced Prostate Cancer. Cochrane Database of Systematic Reviews 2006 CD006019. PMID: 17054269.
Soloway MS, Sharifi R, Wajsman Z, et al. Randomized Prospective Study Comparing Radical Prostatectomy Alone Versus Radical Prostatectomy Preceded by Androgen Blockade in Clinical Stage B2 Prostate Cancer. The Lupron Depot Neoadjuvant Prostate Cancer Study. Journal of Urology 1995 154:4248. PMID: 7541859.
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Survival Rates For Prostate Cancer
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. These rates cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.
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Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.
What Is Hormone Therapy
Hormones occur naturally in your body. They control the growth and activity of normal cells. Testosterone is a male hormone mainly made by the testicles.
Prostate cancer usually depends on testosterone to grow. Hormone therapy blocks or lowers the amount of testosterone in the body.
Hormone therapy on its own doesn’t cure prostate cancer. But it can lower the risk of an early prostate cancer coming back when you have it with other treatments. Or it can shrink an advanced prostate cancer or slow its growth.
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Why Hormone Therapy Is Not Working
Hormone therapy can keep prostate cancer in check for several years. For the cancer cells to grow, they require testosterone and hormone therapy works by preventing its production or blocking it from reaching the prostate. This then causes the cancer cells to shrink, making sure it doesnt spread to other body parts.
With hormone therapy, you could go for years without requiring treatment but it is difficult for your oncologist to predict how long it would be effective. The cancer cells may become hormone-resistant and stop responding to hormone therapy. This causes prostate cancer cells to start growing again and may eventually spread.
Confirming What Weve Practiced For Years
- 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?
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How Can I Lower My Testosterone With Surgery
The majority of the testosterone in your body is made by your testicles. You can lower your testosterone with an operation called an orchiectomy. An orchiectomy is a simple and effective way to lower the amount of testosterone in your body. However, it is a permanent form of hormone therapy.
Your surgery
Before your orchiectomy, you will be given anesthesia. Anesthesia is a medicine given to you by an anesthesiologist so that you do not feel pain during your operation. An anesthesiologist is the doctor who gives you medicine to make you sleep during the surgery and who carefully watches you during the operation. Your doctor will make a small cut in your scrotum and remove your testicles. Most men who have an orchiectomy go home the same day of their surgery. Your penis and scrotum, the pouch of skin that holds your testicles, will not be damaged during this operation. It will take you about two weeks to heal from the surgery.
Some men are concerned about how their body will look after their testicles are removed. There are testicular prostheses , or artificial testicles, that can be placed in your scrotum to replace the testicles removed during your surgery. The prostheses make your scrotum look like it did before surgery. If youare concerned about how your body will look, speak with your doctor or health care team about artificial testicles.
After surgery
Hormone Therapy For Breast Cancer
If you have breast cancer, your doctor might prescribe medications that stop estrogen or progesterone from attaching to cancer cells. They include:
Fulvestrant . For the first month, you get fulvestrant as a shot every 2 weeks. Then you get a dose every month. It treats advanced breast cancer in women who are past menopause.
Tamoxifen. Your usually take it every day as a pill. Doctors most often prescribe it to women whove been treated for early-stage breast cancer, to lower the chances of cancer coming back. In this situation, you might take it for 5-10 years. You can use tamoxifen before or after menopause.
Toremifene . You take toremifene every day as a pill to treat metastatic breast cancer. Thats breast cancer that has spread to other parts of your body. You use it only if youve already gone through menopause.
If youâve gone through menopause, your doctor may prescribe aromatase inhibitors. These stop your body from making estrogen. They include:
Anastrozole . It reduces the risk that cancer will return after youve been treated for early-stage breast cancer. Your doctor can also use it to treat advanced breast cancer.
Exemestane . You also take this to lower the risk of cancer coming back after treatment for early-stage breast cancer. You sometimes get it after taking tamoxifen for 2-3 years. Your doctor may also use it to treat advanced breast cancer if tamoxifen stops working for you.
- Radiation aimed at your ovaries
- Surgery to take out your ovaries
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