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Prostate Cancer And Hormone Therapy

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Surgically Removing The Prostate Gland

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

A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.

Like any operation, this surgery carries some risks, such as urinary incontinence and erectile dysfunction.

In extremely rare cases, problems arising after surgery can be fatal.

It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.

Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.

You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation .

The Eastern Cooperative Oncology Group Trial

The ECOG trial randomized 98 patients with pathologically positive lymph nodes after radical prostatectomy with lymphadenectomy to immediate or delayed hormonal therapy with goserelin or orchiectomy.30 Survival in the delayed therapy and immediate therapy arms was 65% and 85%, respectively, at a median of over 7 years of follow-up. Patients receiving immediate therapy were 75% less likely to progress and die of prostate cancer.30

The appropriate time to initiate hormonal therapy for prostate cancer remains a matter of debate. Certainly, a patient with painful metastasis can expect symptomatic relief from castration. D1 patients after prostatectomy and patients with advanced disease undergoing external beam radiation therapy have solid evidence that hormonal therapy delays progression and extends survival.30,31 Treatment of M0 and locally advanced cancer becomes less clear however, the most recent findings of the MRC trial suggest that these patients will benefit from early initiation of androgen deprivation.29

What Are The Potential Complications

Prostate cancer and treatment can lead to problems with urination as well as erectile dysfunction.

If stage 2 prostate cancer spreads outside the prostate, it can reach nearby tissues, the lymph system, or bloodstream. From there, it can metastasize to distant sites. Later-stage prostate cancer is difficult to treat and can be life-threatening.

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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?
  • 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 To Reduce The Side Effects Of Hormone Therapy For Prostate Cancer

    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.

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    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 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.

    Intermittent Versus Continuous Hormone Therapy

    Most prostate cancers treated with hormone therapy become resistant to this treatment over a period of months or years. Some doctors believe that constant androgen suppression might not be needed, so they advise intermittent treatment. This can allow for a break from side effects like decreased energy, sexual problems, and hot flashes.

    In one form of intermittent hormone therapy, treatment is stopped once the PSA drops to a very low level. If the PSA level begins to rise, the drugs are started again. Another form of intermittent therapy uses hormone therapy for fixed periods of time for example, 6 months on followed by 6 months off.

    At this time, it isnt clear how this approach compares to continuous hormone therapy. Some studies have found that continuous therapy might help men live longer, but other studies have not found such a difference.

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    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.

    What Kinds Of Medical Information Should I Keep

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

    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.

    Remember, you have the right to copies of all your medical paperwork and the actual slides, x-rays and any other information about your health care and treatment. A good idea would be to create two copies of your medical information and keep them in folders. Keep one folder at home and take the other one with you to your doctors appointments. Whenever you see a new doctor, it is important for you to let them know about your prostate cancer and any treatment that you have had.

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    2022. 7. 27. ·New research indicates that hormone therapy for prostate cancer can increase the risk of death from cardiovascular disease. In a population study involving more than 13,000 patients, researchers discovered a clear link between hormone therapy for prostate cancer and an increased risk of death from cardiovascular disease in older men.

    2022. 7. 12. ·Additionally, hormone therapy may be combined with radiation therapy initially if theres a high risk of cancer recurrence. It can also be given before radiation therapy to shrink the cancer and make other treatments more effective. Other types of hormone therapy for prostate cancer include: Androgen deprivation therapy .

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    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 Stop The Body From Making Androgens

    Androgens can be produced in other areas of the body, such as the adrenal glands. Some prostate cancer cells can also make androgens. Three drugs help to stop the body from making androgens from tissue other than the testicles.

    Two medicines, ketoconazole and aminoglutethimide , treat other diseases but are sometimes used to treat prostate cancer. The third, abiraterone treats advanced prostate cancer that has spread to other places in the body.

    Quality Of Life And Combined Androgen Blockade

    Androgen Deprivation Therapy for Prostate Cancer

    INT 0105/SWOG 8894 has been the only study to also enroll patients in a quality-of-life protocol.23 Patients completed a comprehensive battery of QOL questions at assignment and then at 1, 3, and 6 months after initiating treatment. Most patients showed improvement, but those in the flutamide arm showed more statistically significant episodes of diarrhea and worse overall emotional functioning. Those receiving flutamide also more often discontinued the treatment and showed less overall improvement in most QOL dimensions, suggesting that the addition of flutamide might actually detract from the palliative benefits of bilateral orchiectomy.23

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    How Often And For How Long Will I Need Hormone Therapy

    How often you have hormone therapy will depend on the type of drug you are receiving and the type of cancer treated. Some medications need to be administered monthly, while others dont have to be administered quite as frequently.

    In regards to how long hormone therapy will last, this will vary based upon the type of cancer you have and how well you are responding to treatment. For some people, it could continue for a few months. However, it is normal to need to continue with hormone therapy for several years. A common example is women undergoing hormone therapy for breast cancer it is normal to continue with treatment for five to seven years.

    Read Also: How To Reduce Androgen Hormones In Females

    Staging Of Prostate Cancer

    Doctors will use the results of your prostate examination, biopsy and scans to identify the stage of your prostate cancer .

    The stage of the cancer will determine which types of treatments will be necessary.

    If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.

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    Hormone Therapy In Hormone

    Hormone-sensitive cancer depends on hormones to grow. For those with early-stage prostate cancer thats at increased risk of spreading, hormone therapy may be given before, during or after radiation therapy or after surgery. It may also be used in men who have localized cancer and are unable to have other treatments.

    For cancers that have recurred after radiation therapy or surgery, hormone therapy is the primary treatment. In patients with advanced prostate cancer, hormone therapy is usually combined with ADT and sometimes chemotherapy.

    The Future Of Hormone Therapy For Prostate Cancer

    Hormone Therapy for Prostate Cancer

    Some experts arent sure how much further we can improve hormone therapy for prostate cancer.

    Im not saying that weve 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.

    Its 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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    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.

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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.


    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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    What Is Prostate Cancer

    Prostate cancer is cancer that affects the prostate gland in men. Prostate cancer is the second-leading cause of cancer deaths for men in the US.

    Growth in the prostate can be of two types

  • Benign growths: These are noncancerous growths and are rarely a threat to life. For example, benign prostatic hyperplasia.
  • Malignant growths: These are cancerous growths that can sometimes be life-threatening.
  • Prostate cancer starts in the prostate gland and may spread to the nearby areas: lymph nodes, organs, or bones in other parts of the body.

    Types Of Hormone Therapy


    The table at the right provides an overview of three commonly used types of hormone therapy. These and others are discussed below. While hormone therapy is commonly used, side effects of the treatment are reported as well. They range from erectile dysfunction, hot flashes, weight gain and loss of bone density.

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    Medical Research Council Study

    Two recent studies provide convincing clinical evidence supporting the early treatment of advanced prostate cancer: the randomized trial reported by the Medical Research Council 29 and the Eastern Cooperative Oncology Group /SWOG Stage D1 study.30 The MRC study randomized 934 patients with locally advanced prostate cancer or asymptomatic metastasis to either immediate treatment or to the same treatment deferred until an indication occurred. This study showed that there was a more rapid local and distant disease progression in the deferred treatment group, as evidenced by an earlier onset of pain and an increased need for transurethral resection of the prostate. There was also a 2-fold increase in serious complications, such as pathologic fractures, spinal cord compression, and extraskeletal metastasis, in the deferred treatment group compared with those who received immediate treatment .29

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