What Is Hormone Therapy For Cancer
Also referred to as hormonal or endocrine therapy, this cancer treatment is different from menopausal hormone replacement therapy , which refers to the prescription of supplemental hormones to help relieve the symptoms of menopause.
Certain cancers rely on hormones to grow. In these cases, hormone therapy may slow or stop their spread by blocking the bodys ability to produce these particular hormones or changing how hormone receptors behave in the body.
Breast and prostate cancers are the two types most commonly treated with hormone therapy. Most breast cancers have either estrogen or progesterone receptors, or both, which means they need these hormones to grow and spread. By contrast, prostate cancer needs testosterone and other male sex hormones, such as dihydrotestosterone , to grow and spread. Hormone therapy may help make these hormones less available to growing cancer cells.
Hormone therapy is available via pills, injection or surgery that removes hormone-producing organs, namely the ovaries in women and the testicles in men. Its typically recommended along with other cancer treatments.
If hormone therapy is part of your treatment plan, discuss potential risks or side effects with your care team so that you know what to expect and can take steps to reduce them. Let doctors know about all your other medications to avoid interactions.
What Is Hormonal Therapy For Prostate Cancer
Hormonal therapy for prostate cancer is a treatment to lower the levels of the hormone testosterone in the body. Prostate cancer needs testosterone to grow. Testosterone is mainly made by the testicles. Hormonal therapies reduce the amount of testosterone in the body, or stop it reaching the prostate cancer cells.
Testosterone is important for:
- muscle development and bone strength.
Hormonal therapies are drugs that can be given as injections or as tablets.
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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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While Youre Taking Hormonal Therapy
- Tell your doctor or nurse if youre taking any medications, including patches and creams, or if youve changed medications. Some medications may change the way hormonal therapy works. Tell your doctor if youre taking:
- Medications that require a prescription
- Medications that dont require a prescription
- Any herbal remedies, vitamins, or dietary supplements
Mental And Emotional Health
A cancer diagnosis and cancer treatment may affect how you feel mentally and emotionally. Hormone therapy can cause:
- A drop in mental sharpness
If you have any of these side effects, your doctor may recommend medication, counseling, or both.
Research shows that hormone therapy for prostate cancer may lead to problems with short-term memory, language, thinking, and concentration. But these problems are usually mild. Researchers are still studying the effect of hormone therapy on the brain.
When you stop taking hormone therapy, emotional and mental side effects usually disappear. But if youâve taken the drugs for many years, they may not fully go away.
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Study Shows Group Exercise And Nutrition Program Prevents Fat Gain And Strength Loss
- Ohio State University
- Men on hormone therapy for prostate cancer may benefit significantly from hitting the gym with fellow patients and choosing more veggies and fewer cheeseburgers, a new study suggests.
Men on hormone therapy for prostate cancer may benefit significantly from hitting the gym with fellow patients and choosing more veggies and fewer cheeseburgers, a new study suggests.
Androgen deprivation therapy is a powerful tool against prostate cancer, and more and more men are opting for the treatment as a growing array of hormone-based therapies become available.
But it comes with a cost. Suppressing male hormones, including testosterone, that fuel cancer growth also means that patients lose strength and muscle mass and gain fat. And that puts the men at risk for other health problems, including heart disease and diabetes.
But diet and moderate exercise proved to be valuable tools in fending off those side effects in the new research from The Ohio State University. The study appears in the journal Annals of Behavioral Medicine.
“We found that a comprehensive exercise and diet program in a group setting can make a difference for prostate cancer patients, and the difference was greater than I expected in a short period of time,” said lead author Brian Focht, a professor of human sciences at Ohio State.
The National Cancer Institute supported the study.
How Does Hormone Therapy Work Against Prostate Cancer
Early in their development, prostate cancers need androgens to grow. Hormone therapies, which are treatments that decrease androgen levels or block androgen action, can inhibit the growth of such prostate cancers, which are therefore called castration sensitive, androgen dependent, or androgen sensitive.
Most prostate cancers eventually stop responding to hormone therapy and become castration resistant. That is, they continue to grow even when androgen levels in the body are extremely low or undetectable. In the past, these tumors were also called hormone resistant, androgen independent, or hormone refractory however, these terms are rarely used now because the tumors are not truly independent of androgens for their growth. In fact, some newer hormone therapies have become available that can be used to treat tumors that have become castration resistant.
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Diabetes And Heart Disease
Hormonal therapy may increase your risk for diabetes and heart disease. Maintain a healthy lifestyle to help reduce this risk.
- Dont smoke or use tobacco products. If you currently smoke, the Tobacco Treatment Program can help you quit. Your healthcare team will refer you to this program for support, or you can call for more information.
- Maintain or achieve a healthy body weight. If youd like to meet with a clinical dietitian nutritionist, call .
- Follow a healthy diet. Your diet should be high in fiber, low in fat, and low in concentrated sweets. For more information, read Nutrition and Prostate Cancer: Making Healthy Diet Decisions.
- Exercise regularly. Examples include brisk walking, jogging, biking, aerobics, and yard work. We recommend you exercise 30 minutes every day in addition to your daily routine. Even if you cant exercise every day, whatever you can do will be helpful.
Intermittent Or Continuous Therapy
Once prescribed, hormone therapy used to continue for life, but scientists are now reevaluating that strategy and investigating whether hormone therapy can be taken intermittently, with so-called holidays from treatment. The thinking is that this may not only help restore quality of life as, for example, returning libido and sexual health but also delay the hormone resistance that eventually develops in men taking hormone therapy.
Clinical trials evaluating whether intermittent therapy is as effective or more effective than continuous therapy are now under way, so it is too early to say for sure.
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Will I Have Other Treatments In Addition To Hormone Therapy
Your RMCC oncologist may recommend using hormone therapy in combination with other cancer treatments, such as chemotherapy and radiation therapy. When used with other treatments, hormone therapy can:
- Make a tumor smaller before surgery or radiation therapy. This is called neoadjuvant therapy.
- Lower the risk that cancer will come back after the primary treatment. This is called adjuvant therapy.
- Destroy cancer cells that have returned or spread to other parts of your body.
Radiation Therapy Side Effects
Because the prostate is close to several vital structures, radiation therapy can disrupt normal urinary, bowel, and sexual functioning.Short-term ComplicationsYou may experience some temporary urinary symptoms, such as waking up in the night and needing to urinate, needing to urinate more often during …
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What Is Unique About Receiving Hormone Therapy At Rocky Mountain Cancer Centers
At Rocky Mountain Cancer Centers, your cancer care team will design a personalized cancer treatment plan that provides the ideal combination of therapies for the best possible outcome. Under our care, you will be monitored closely to determine if your hormone therapy is working. This involves regular PSA tests for prostate cancer treatment and regular checkups for breast cancer treatment.
Rest assured, you are in good hands with Rocky Mountain Cancer Centers. We believe in treating the whole person, not just the disease, which is why we will work hard to create the best cancer treatment plan for you.
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.
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Risk Of Heart Problems
Hormone therapy for prostate cancer might increase the risk of heart problems if you have certain medical conditions.
This may be because some of the side effects of hormone therapy, such as weight gain, can make heart disease worse.
Gynecomastia in Patients with Prostate Cancer: A Systematic Review
A Fagerlund and others
Treatment Of Osteoporosis in Men
UpToDate, Accessed August 2019
Cardiovascular effects of hormone therapy for prostate cancer
J Lester and D Mason,
Drug, Healthcare and Patient Safety, 2015. Volume 7
Cognitive Effects of Androgen Deprivation Therapy in Men With Advanced Prostate Cancer
B Gunlusoy and others
When Hormone Therapy Is Indicated
HT can be administered before, during or after a localized treatment, such as radical prostatectomy, radiation, high-intensity focused ultrasound or cryotherapy. When given before a localized treatment, it is called neoadjuvant therapy. When given after localized treatment without evidence of prostate cancer recurrence, it is called adjuvant therapy. When HT is prescribed after localized treatment for a prostate cancer recurrence, it is called salvage therapy. If a patient’s PSA starts rising after a radical prostatectomy, HT is typically given in combination with radiation therapy. Treatment recommendations are based on each patient’s specific circumstances.
Sometimes we give neoadjuvant HT while the patient is deciding on his primary treatment or to reduce the tumor’s size before starting primary treatment. Neoadjuvant HT will usually slow or stop cancer growth for a period of time.
Many radiation oncologists use HT along with radiation treatment in the belief that HT weakens cancer cells so that they’re more susceptible to destruction by the radiation. Clinical studies have suggested a synergy between radiation therapy and hormone therapy meaning they work better together. Clinical trials have shown improved outcomes for patients who receive combined therapy.
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Hormone Therapy Side Effects
Testosterone is the primary male hormone, and plays an important role in establishing and maintaining typical male characteristics, such as body hair growth, muscle mass, sexual desire, and erectile function, and contributes to a host of other normal physiologic processes in the body. The primary systemic
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.
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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.
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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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.
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.
Hormonal Therapy On Its Own
Doctors do not usually advise having hormonal therapy instead of a prostatectomy or radiotherapy. Hormonal therapy alone cannot cure early or locally-advanced prostate cancer.
Depending on your general health and preferences, you may decide to have hormonal therapy on its own. For example, if you:
- are not well enough to have a prostatectomy or radiotherapy
- do not want to have a prostatectomy or radiotherapy
- are monitoring prostate cancer, for example having watchful waiting and the cancer starts to grow.
Hormonal therapy can slow down or stop the cancer cells growing for many years. It can also improve any symptoms. Not having surgery or radiotherapy means you avoid the side effects of these treatments. But hormonal therapy also causes side effects. It is important to talk to your doctor or nurse before you decide.
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Secondary Treatment Following Relapse
Hormone therapy may also be used as a secondary or salvage treatment when PSA levels rise following initial prostate cancer treatment, indicating the cancer has returned. This situation is known as biochemical recurrence. The salient points to keep in mind are that hormone therapy is most often used as a salvage treatment when PSA doubling time is less than six months, indicating that the cancer is aggressive or may have already metastasized.
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:
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.
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