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How Many Hormone Injections For Prostate Cancer

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How Long Does Hormone Therapy Work To Stop Cancer Progression

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

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.

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.

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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How The Study Was Performed

During the study, scientists randomized 1,071 men with intermediate- or high-risk localized prostate cancer into four groups. One group received radiation and six months of an anti-testosterone drug called leuporelin, and the second group received radiation plus 18 months of leuporelin therapy. Two other groups were treated with the same regimens of either radiation plus six or 18 months of leuporelin therapy, along with another drug called zoledronic acid, which helps to limit skeletal pain and related complications should cancer spread to the bones. Study enrollment occurred between 2003 and 2007 at 23 treatment centers across New Zealand and Australia.

Hormone Therapies For Prostate Cancer Treatment

Prostate Cancer

Male hormones cause prostate cancer cells to grow. Androgens support a healthy prostate gland however, they can also promote the growth of cancerous prostate cells.

When using hormone therapy for prostate cancer, the treatment can block the production or use of androgens in one of the following ways:

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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:

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:

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

If you have early stage prostate cancer, you and your doctor may decide on a course of hormone therapy prior to the start of your main prostate cancer treatment. This is called neoadjuvant or pre-therapy. This type of hormone therapy is used to help shrink your prostate cancer tumor. This helps make your main treatment more effective. This is very common with men who get radiation therapy.

Adjuvant hormone therapy

Adjuvant therapy is given to you at the same time you have your main prostate cancer treatment.

Salvage hormone therapy

The Suitability Of Patients Over Age 70 For Hormonal Therapy

It is agreed by all that hormonal therapy is indicated for an increasing percentage of patients with increasing age, but the only entirely uncontroversial indication for it is symptomatic, metastatic prostate cancer . Irritative and obstructive urinary symptoms can also be treated hormonally .

The patients chronological age is less important than his biological age and life expectancy. In one study, the tumor-specific survival rates of patients with local prostate cancer were no different at age 60 and at age 80 if the patients were given hormonal treatment only in case of progression of their prostate cancer. In this age group, it was the Gleason scorea tumor-associated, rather than patient-associated, factorthat shortened metastasis-free 10-year survival: The figure for highly differentiated prostate cancer was 81%, while that for poorly differentiated prostate cancer was 26% .

The case studies mentioned above yielded survival figures based on the patients chronological age. One may suspect, however, that the treating physicians were also influenced by their patients comorbidities when choosing the therapy to be given to each. In a population-based study in the Netherlands, only 8% of the patients under age 69 had two or more comorbidities, as compared to 27% of patients aged 80 .

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How Effective Is Hormone Therapy For Prostate Cancer

In the initial years of diagnosis, hormone therapy for prostate cancer can help patients with their symptoms and add years to their lives.

For men who need hormone therapy, such as men whose prostate-specific antigen levels are rising after surgery or radiation or men with advanced prostate cancer who dont yet have symptoms, its not always clear when the best time is to start hormone treatment:

  • Some doctors think that hormone therapy works better if its started as soon as possible, even if the patient feels well and is not exhibiting any symptoms. Studies have shown that hormone treatment may slow down the disease and perhaps even help men live longer.
  • Some doctors, however, don’t agree with this approach. Because of the side effects and the risk of the cancer becoming resistant to therapy sooner, some doctors feel that treatment should not be started until cancer symptoms appear.

Table : Boosting The Effectiveness Of Radiation Therapy

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

A randomized controlled study involving 206 men with early-stage prostate cancer evaluated whether adding six months of hormone therapy to external-beam radiation treatment would boost both overall survival and disease-free survival . The results are given below. The same research group found, in an earlier study, that the addition of hormone therapy was of most benefit to men who were considered at moderate or high risk, based on their clinical profile.

Five-year follow-up 82% Source: Journal of the American Medical Association, 2004 292:8217. PMID: 15315996.

Combined with radiation therapy. A number of studies have shown that men with early-stage prostate cancer are more likely to be cured when hormone therapy is given in conjunction with radiation therapy . Even when the disease is regionally advanced, meaning that it has progressed to tissues immediately surrounding the prostate gland, neoadjuvant hormone therapy reduces risk of progression and relapse .

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How Is Prostate Cancer Diagnosed

Prostate cancer may be suspected based on your symptoms or the results of a screening test.

Screening is when your doctor looks for cancer before you have any symptoms. This can help find cancer at an early stage when it may be easier to treat. Two of the most frequently used screening tests used today include the digital rectal exam and the prostate-specific antigen test.

  • A digital rectal exam is an exam of the rectum where the doctor inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or enlargement in the prostate gland.
  • A prostate-specific antigen is a blood test that measures levels of PSA in your blood. However, PSA is reasonably nonspecific and high levels may be associated with prostate cancer, prostatitis , or an enlarged prostate gland. Very high levels of PSA .

There is controversy over whether screening tests should be used at all. The USPSTF recommends men aged 55 to 69 have a discussion with their doctor about the pros and cons of PSA screening to determine if it is an appropriate preventive test for them. For men aged 70 and older, the USPSTF does not recommend PSA screening.

The American Cancer Society, recommends early-detection screening starting at age 40 or 45 if men are at high risk or age 50 in men at average risk.

In some cases, a prostate biopsy or imaging test like an ultrasound or magnetic resonance imaging may also be used to rule out cancer.

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Questions To Ask Your Doctor Or Nurse

  • What is the aim of treatment?
  • What type of hormone therapy are you recommending for me and why?
  • How often will I have my injections or implants?
  • How will my treatment be monitored?
  • How long will it be before we know if the hormone therapy is working?
  • What are the possible side effects, and how long will they last?
  • What will happen if I decide to stop my treatment?
  • Are there any clinical trials that I could take part in?

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Side Effects Of Hormone Therapy

Most side effects experienced by patients receiving HT are caused by low testosterone. The three most reported side effects are fatigue, hot flashes and sexual changes, including decreased libido and reduced erectile function.

Many of these side effects develop over time. Patients treated for eight months or less time are less likely to experience many of them, although some, such as hot flashes and sexual side effects, usually manifest within the first four to six weeks. Most of these side effects are reversible, diminishing or disappearing when the therapy is stopped and testosterone levels recover.

Not all patients experience all side effects, and there is much variability in their severity.

Here are the side effects patients most often report, along with suggestions for minimizing them:

Prostap Injection Side Effects

Prostrate Cancer Hormone Therapy

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that may be associated with leuprorelin. Just because a side effect is stated here doesn’t mean that all people having Prostap injections will experience that or any side effect.

Common side effects in men and women

Read the leaflet that comes with the medicine or talk to your doctor, nurse or pharmacist if you want any more information about the possible side effects of Prostap injections. If you think you have experienced a side effect, did you know you can report this using the yellow card website?

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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.

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.

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Hormone Therapy With Radiation

Hormone therapy is often given together with radiation therapy for localized disease .

Hormone therapy usually consists of a shot that lowers your testosterone, given every 1 to 6 months, depending on the formulation. Sometimes, it is prescribed as a daily pill that blocks testosterone from reaching the cancer cells. Clinical trials show a benefit in patients who receive hormonal treatment in combination with external beam radiation. Hormone therapy has been shown to improve cure rates of prostate cancer for men receiving radiation therapy and is part of the standard of care for men with certain types of intermediate-risk prostate cancer and nearly all high-risk prostate cancer. It is often given for intermediate-risk cancer for 4 to 6 months , and for 2 to 3 years in men with high-risk localized prostate cancer, although some doctors may recommend as little as 18 months of hormone therapy.

Hormone therapy should not be given to men with low-risk prostate cancer and is not a standalone treatment for localized prostate cancer in any risk category.

Want more information about a prostate cancer diagnosis and treatment options? Download or order a print copy of the Prostate Cancer Patient Guide.

How Are Hormone Therapy Medicines Used

Reducing Side Effects of Hormone Therapy for Prostate Cancer | Prostate Cancer Staging Guide

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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Treating Prostate Cancer With Combined Hormonal

Androgens, the family of male sex hormones that includes testosterone, function as a fuel for growth in normal development. However, in some men they can also drive the progression of prostate cancer. Hormonal therapy treats prostate cancer by dramatically reducing levels of testosterone and other androgens.

Hormonal therapy is sometimes given in conjunction with external beam radiation to boost the effectiveness of treatment. Hormonal therapy may also be used to shrink the size of large prostate glands before brachytherapy takes place, to enable proper placement of the radioactive seeds.

Combination hormonal/radiation therapy is now a standard option for men with cancer that has extended beyond the prostate or whose cancer is considered high-risk based on other clinical findings, with studies showing that it reduces the risk of dying from prostate cancer and other causes more than with either treatment given alone..

Combination therapy can also be considered for men with localized prostate cancer in the intermediate-risk category. Whether men with low-risk prostate cancer would benefit from a hormonal therapyradiation combination is uncertain.

Image: sturti/Getty Images

Hormone Therapies For Breast Cancer Treatment

Several treatment options are available for treating hormone-sensitive breast cancers. Some drugs block the effects of estrogen on the cancer cells in the breast, while others prevent estrogen production altogether.

Common hormone therapy drugs include Tamoxifen , Arimidex® , and Femara® , along with Faslodex® for recurrent breast cancer.

Breast cancer in males may also be treated with tamoxifen. Tamoxifen is currently being studied as hormone therapy for the treatment of other types of cancer.

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Hormone Therapy Can Cause Side Effects

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:

When To Consider Hormone Therapy

Androgen Deprivation Therapy for Prostate Cancer

Hormone therapy is a treatment option for men with prostate cancer in any of the following situations:

  • when cancer has metastasized beyond the prostate
  • when cancer is confined to the prostate, but hormone therapy is used to boost the effectiveness of radiation therapy or to shrink the size of a tumor before brachytherapy
  • when PSA begins to rise sometime after initial treatment with surgery or radiation therapy, indicating the cancer may have recurred.

Not all doctors agree on when to use hormone therapy, or how to administer it. Indeed, this is an area that requires a physician to exercise as much art as science in clinical practice. You should also be aware that side effects can be daunting, although most men tolerate treatment reasonably well .

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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.

Therapies That Interfere With Androgen Function

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.

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