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.
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.
What Are The Advantages And Disadvantages Of Hormone Therapy
What may be important to one person might be less important to someone else. So speak to your doctor or nurse about your own situation.
- Its an effective way to control prostate cancer, even if it has spread to other parts of your body.
- It can be used alongside other treatments to make them more effective.
- It can help to reduce some of the symptoms of advanced prostate cancer, such as urinary symptoms and bone pain.
- It can cause side effects that might have a big impact on your daily life.
- It cant cure your cancer when its used by itself, but it can help to keep the cancer under control, sometimes for many years.
Hormone Therapy For The Treatment Of Prostate Cancer Patients
Hormone therapy, also known as androgen deprivation therapy or;androgen suppression therapy, is one of the treatment options for patients with prostate cancer. The goal is to reduce levels of male hormones, called;androgens, in the body, or to stop them from affecting prostate cancer cells, explains the American Cancer Society.;It is particularly indicated in patients whose cancer has spread too far to be cured by;surgery;or;radiation, or when patients cant undergo these treatments for some reason, in patients whose cancer is resistant to or returns after previous;treatments, as well as in combination or before radiation therapy to increase the probabilities of success.
The main androgens are testosterone and dihydrotestosterone . Most of the bodys androgens come from the testicles, but the adrenal glands also make a small amount. Androgens stimulate prostate cancer cells to grow. 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.
There are different approaches included in the class of hormone therapy such as;orchiectomy ,;luteinizing hormone-releasing hormone analogs,;Degarelix;,;Abiraterone;, which are used to decrease the androgen levels.;Anti-androgens like; flutamide , bicalutamide , nilutamide , Enzalutamide;,;Estrogens , and;Ketoconazole are used to block the function of androgens.
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Advancing Prostate Cancer Treatment
The duration for which a man is exposed to ADT and, more specifically, to castrate or very low T levels is an important consideration for ongoing health and quality of life after primary treatment for prostate cancer.
The findings from our study indicate that before initiating ADT, clinicians should assess baseline TT levels and patients individual risk factors, and discuss with them the possibility that their levels may remain impaired for a longer time than expected.
At MSK, we plan to develop a nomogram that will incorporate weighted clinical risk factors to better predict the likelihood of the return to normal as well as above castrate and baseline levels of TT for men who take ADT for prostate cancer.
Our multidisciplinary team of prostate cancer experts collaborates to develop individualized treatment plans for each patient. We are committed to helping patients achieve their best possible cancer outcomes and minimizing the negative effects of cancer treatment on their quality of life. We are currently conducting more than 40 clinical trials, testing new drugs and drug combinations, surgical and radiation therapy techniques, diagnostic advances, and strategies for preserving the quality of life for men undergoing treatment.
Is Stage 4 Prostate Cancer A Death Sentence
Its bad news, but it isnt likely to be a death sentence . Thanks to widespread screening, nearly 90 percent of prostate cancers are detected before they spread beyond the gland. At this point, the disease is highly curable, meaning that after five years men who have undergone treatment remain cancer -free.
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What Should I Tell My Doctor During My Checkups
During each visit, you should tell your doctor about any:
- Symptoms that you have
- Pain that bothers you
- Problems that keep you from doing your daily activities, such as fatigue , hot flashes, pain, problems with your bladder, bowel, or ability to have sex, trouble sleeping, and weight gain or loss
- Medicines, vitamins, or herbs or over-the-counter products you are taking and any other treatments you may use
- Emotional worries you may have, such as anxiety or depression
It is important for you to look out for changes in your health and to tell your doctor or health care team so that they can help you.
Planning Before You Start Hormone Therapy
- What type of hormone therapy will you use?
- If you are taking medicine for your hormone therapy, what kind of medicine are you taking and how often do you need to take it? Write down the medicine, the dose, and when you need to take it.
- If you are having an orchiectomy where do you need to go, when will you have your surgery? Write down the place and your appointment time.
What Types Of Hormone Therapy Are Used For Prostate Cancer
- reducing;androgen production by the testicles
- blocking the action of androgens throughout;the body
- block androgen production throughout the body
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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Your Cancer Care Team
People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.
Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
- the type and size of the cancer
- what grade it is
- whether the cancer has spread to other parts of your body
Hormone Therapy: Immediate Versus Delayed
Medical Research Council Prostate Cancer Working Party Investigators Group. Immediate Versus Deferred Treatment for Advanced Prostatic Cancer. British Journal of Urology 1997;79:23546. PMID: 9052476.
Messing EM, Manola J, Sarosdy M, et al. Immediate Hormonal Therapy Compared with Observation after Radical Prostatectomy and Pelvic Lymphadenectomy in Men with Node-Positive Prostate Cancer. New England Journal of Medicine 1999;341:17818. PMID: 10588962.
Messing EM, Manola J, Yao J, et al. Immediate Versus Deferred Androgen Deprivation Treatment in Patients with Node-Positive Prostate Cancer after Radical Prostatectomy and Pelvic Lymphadenectomy. Lancet Oncology 2006;7:4729. PMID: 16750497.
Nair B, Wilt T, MacDonald R, Rutks I. Early Versus Deferred Androgen Suppression in the Treatment of Advanced Prostatic Cancer. Cochrane Database of Systematic Reviews 2002;CD003506. PMID: 11869665.
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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 .
When Is Hormone Therapy Used For Prostate Cancer
On its own, hormone therapy can be a good way to control the growth of your prostate cancer. It can also be used with another prostate cancer treatment to help it work better. You should keep in mind that the following things will affect when you have hormone therapy and if you have hormone therapy along with another type of prostate cancer treatment:
- The grade of your prostate cancer
- Your Gleason score
- The stage of your prostate cancer
- Your PSA level
- Your age
- Your general health
Your stage, grade, and Gleason score are determined by a pathologist. A pathologist is a specially trained physician who reviews biopsy results in order to find changes in your body caused by cancer. When you had your prostate biopsy, the pathologist looked at the tissue samples taken from your prostate gland and prepared your biopsy report. The report tells you and your doctor the following information:
- The grade tells you what your prostate cancer cells look like.
- The Gleason score. The Gleason score tells you what your prostate cancer cells look like compared to healthy cells and gives you an idea of how quickly your cancer is growing. Your Gleason score will range from 2 to 10.
- The stage tells how much prostate cancer you have and where your cancer is located.
This information is used to help your doctor chose the most effective type of hormone therapy for you. The types of hormone therapy include:
Neoadjuvant hormone therapy
Adjuvant hormone therapy
Salvage hormone therapy
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Forms Of Hormonal Manipulation And Hormonal Suppression
Hormone therapy, also described as ADT or androgen suppression therapy , allows for a decrease in serum testosterone in an effort to slow down the growth of CaP. Multiple medications and strategies have been used to induce castrate serum levels of testosterone or to interfere with its function. One of earliest methods described in the 1940s by Huggins and Hodges was bilateral orchiectomy . Surgical castration results in an effective reduction of circulating testosterone within a few hours, and still remains an underutilized method in the treatment of advanced CaP.
Several nonsurgical options exist in achieving hormonal suppression. Diethylstilbestrol , a semisynthetic estrogen compound, was one of the first nonsurgical options for the treatment of CaP. At one time a first-line hormonal therapy, its widespread use has been limited due to significant cardiovascular and thromboembolic toxicity. Cyproterone acetate is a steroidal, progestational antiandrogen that blocks the androgen-receptor interaction and reduces serum testosterone through a weak antigonadotropic action. CPA is also associated with a high rate of cardiovascular complications, and is not available in the United States.
How Does Hormone Therapy Work
Hormone therapy for prostate cancer works by either preventing the body from making these androgens or by blocking their effects. Either way, the hormone levels drop, and the cancer’s growth slows.
“Testosterone and other hormones are like fertilizer for cancer cells,” Holden tells WebMD. “If you take them away, the cancer goes into shock, and some of the cells die.”
In 85% to 90% of cases of advanced prostate cancer, hormone therapy can shrink the tumor.
However, hormone therapy for prostate cancer doesn’t work forever. The problem is that not all cancer cells need hormones to grow. Over time, these cells that aren’t reliant on hormones will spread. If this happens, hormone therapy won’t help anymore, and your doctor will need to shift to a different treatment approach.
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How To Return To An Active Sex Life After Prostate Cancer Treatment
No matter the cancer, treatments often cause side effects that affect patients quality of life. But with prostate cancer, the potential side effects can be particularly concerning to men who are trying to decide which approach is right for them. Surgery, radiation therapy and other treatments may impact a patients sex life, causing challenges like low sex drive, loss of penis length, dry orgasm or low sperm counts. Despite the angst these issues may cause, experts say most of these side effects can be managed and many men have a good chance of returning to a full sex life after prostate cancer treatment.
Unfortunately, sexual dysfunction is a possibility for nearly all treatment options for prostate cancer, including surgery, says Scott Shelfo, MD, FACS, Medical Director of Urology at our hospital near Atlanta.;The degree of dysfunction depends on many factors, including the patients overall health, co-existing medical problems, as well as the patients level of sexual function and ability before treatment.
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.
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Treating Advanced Prostate Cancer
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
If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.
Mental And Emotional Health
A cancer diagnosis and cancer treatment may affect how you feel mentally and emotionally. Hormone therapy can cause:
- Mood swings
National Cancer Institute: âSexual Health Issues in Men with Cancer,â âHormone Therapy for Prostate Cancer.â
American Cancer Society: âAnxiety, Fear, and Emotional Distress,â âHormone Therapy for Prostate Cancer,â âDepression.â
Mayo Clinic: âHormone therapy for prostate cancer,â âBone density test,â âProstate cancer.â
ZERO: âPSA Screening.â
National Kidney Foundation: âWhat You Should Know About Blood Lipids.â
Urology: âCognitive Effects of Androgen Deprivation Therapy in Men with Advanced Prostate Cancer.â
Prostate Cancer UK: âLiving with hormone therapy: A guide for men with prostate cancer.â
American Cancer Society.
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Neoadjuvant And Adjuvant Hormone Therapy For Early
Hormone therapy is sometimes given in conjunction with a definitive prostate cancer treatment, such as radiation therapy, in order to improve health outcomes. When hormone therapy is given in advance of a primary treatment, its known as neoadjuvant therapy; when its given during or after a primary treatment, its known as adjuvant therapy.
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 dont get too tired.
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What Kinds Of Medical Information Should I Keep
It is important for you to keep a copy of your prostate cancer treatment records. You may not always see the same doctor for your follow-up care, so having this information to share with another doctor can be very helpful. The following is a list of medical information you may want to keep.
- 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.
Who Gets Prostate Cancer And What Are The Symptoms
Approximately one in nine men will be diagnosed with prostate cancer during their lifetime, according to the American Cancer Society.1 The average age at diagnosis is around 66 years. Common symptoms of prostate cancer can include frequent urination, blood in the urine, sudden onset of erectile dysfunction and discomfort when sitting due to an enlarged prostate gland. Risk factors for prostate cancer include being 65 years or older, having a family history of prostate cancer and certain genetic factors.
This is a cancer that, for some, is slow-growing and doesnt need immediate treatment. It may lay dormant for years. For others, a combination of surgery, radiation, or hormone-blocking therapies may be necessary.
Treating Prostate Cancer with Hormone Therapy
Men with prostate cancer often receive hormone-blocking therapy as part of their treatment plan. Approximately 75 percent of men undergoing this treatment will experience hot flashes. Hot flashes are one of the most common side effects of hormonal therapy, which lowers testosterone and androgens.
Hot flashes and night sweats can be very disruptive to a persons quality of life; affecting sleep, sexual function, weight, and mood. Recently, the Oncology Nursing Society released new guidelines to help patients mitigate these issues.2
New Guidelines for Treatment For Hot Flashes Caused by Hormone Therapy
Life After Prostate Cancer
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