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Cost Of Hormone Therapy For Prostate Cancer

Are There Side Effects With Hormone Therapy

What is the Best Hormone Therapy for Prostate Cancer?

Yes, there are side effects or unwanted changes in your body caused by hormone therapy. Side effects are different from person to person, and may be different from one treatment to the next. Some people have no or very mild side effects. The good news is that there are ways to deal with most of the side effects. The side effects that you have depend on:

  • The type of hormone therapy you are taking, and
  • Your general health

The side effects you have from hormone therapy may be acute or chronic. Acute side effects are sometimes called “early side effects.” These types of side effects happen soon after the treatment begins and usually go away after you finish your hormone therapy. Other side effects are called chronic side effects or “late side effects.” These side effects may happen several months after you start hormone therapy.

In order to reduce your chance of having side effects, your doctor may give you intermittent hormone therapy. If you are on intermittent hormone therapy, your doctor and health care team will carefully watch your PSA level. As it begins to go up, you are given hormone therapy medicine to lower your PSA. Another way for you to get intermittent hormone therapy is to take a medicine for a set period of time and then stop for a set period of time. For example, you may take a medicine for six months, stop for six months, and then start again for six months.

The Future Of 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.

Overview Of Potential Out

You may need to pay:

Deductible. This is how much you have to spend for health services before your insurance company pays for your medical bills.

Copay or coinsurance. These are payments you make every time you get a medical service after you reach your deductible.

Premium. This is the amount you pay for your health insurance each month.

Out-of-network costs. Youâll need to pay these fees if you go to a health care professional who doesnât take your insurance.

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How Are Hormone Therapy Medicines Used

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

How Is Hormone Therapy Used To Treat Hormone

What

Hormone therapy may be used in several ways to treat hormone-sensitive prostate cancer, including:

Early-stage prostate cancer with an intermediate or high risk of recurrence. Men with early-stage prostate cancer that has an intermediate or high risk of recurrence often receive hormone therapy before, during, and/or after radiation therapy, or after prostatectomy . Factors that are used to determine the risk of prostate cancer recurrence include the grade of the tumor , the extent to which the tumor has spread into surrounding tissue, and whether tumor cells are found in nearby lymph nodes during surgery.

The use of hormone therapy before prostatectomy has not been shown to be of benefit and is not a standard treatment. More intensive androgen blockade prior to prostatectomy is being studied in clinical trials.

Relapsed/recurrent prostate cancer. Hormone therapy used alone is the standard treatment for men who have a prostate cancer recurrence as documented by CT, MRI, or bone scan after treatment with radiation therapy or prostatectomy.

Hormone therapy is sometimes recommended for men who have a “biochemical” recurrencea rise in prostate-specific antigen level following primary local treatment with surgery or radiationespecially if the PSA level doubles in fewer than 3 months.

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What Side Effects May I Have After I Start Hormone Therapy

The side effects that you may have after you start hormone therapy include: erectile dysfunction or impotence , lower sexual desire , hot flashes, fatigue , weight gain, breast enlargement, osteoporosis, anemia, memory loss, and cardiovascular problems. The following side effects can happen as soon as you start your treatment.

Erection problems

Difficulty getting or keeping an erection is a common side effect of hormone therapy for prostate cancer. This is also called impotence. Hormone therapy lowers the amount of testosterone in your body or stops your body from making testosterone.

Lower sex drive

Hot flashes and sweating

Breast tenderness or growth

Some men may find that their chest becomes sore and that their breasts get a little bit swollen. This is called gynecomastia . There are medicines and treatments that you doctor or health care team can give you to help with this side effect.

Fatigue

The drop in your testosterone level may make you feel very tired. You may feel tired all the time or you may get tired more easily when you do your daily activities. This is known as fatigue or tiredness. There are things you can do to help deal with this treatment side effect.

Tumor flare pain

The following side effects may happen if you take hormone treatment for a long period of time. These are:

Weight gain

Memory problems

Anemia

Bone thinning

There are several ways you can help to lower your osteoporosis risk

Cardiovascular problems

Types Of Hormone Therapy For Prostate Cancer

The overwhelming majority of patients get androgen deprivation by way of medical therapy, explains Moshe Ornstein, MD, a genitourinary medical oncologist at Cleveland Clinic Cancer Center.

Doctors use several types of medication to lower testosterone levels, but these therapies do so only temporarily. When you stop taking them, testosterone levels begin to rise again.

Here are some of the most commonly used hormone therapies.

Luteinizing hormone-releasing hormone agonists and antagonists LHRH is one of the key hormones released by the body before testosterone is produced. LHRH agonists and antagonists lower testosterone levels by blocking the release of LHRH. Treatment with these drugs is sometimes called medical castration because they lower androgen levels as much as orchiectomy, or removal of the testicles, does.

LHRH agonists and antagonists include:

CYP17 inhibitors An LHRH agonist or antagonist can stop the testicles from making androgens, but other cells in the body still make small amounts of androgens. These small amounts of hormones can continue to stimulate cancer growth. A newer medication, Zytiga , blocks a key enzyme involved in androgen production called the CYP17 enzyme. Zytiga can be used to treat metastatic prostate cancer that has become resistant to traditional hormone therapies.

Traditional anti-androgens may be given along with LHRH agonists and antagonists. They include:

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Outlook For Men With Advanced Prostate Cancer

While it isnt possible to cure advanced prostate cancer, treatments can help keep it under control, often for several years. Treatments will also help manage any symptoms, such as pain.

Some men may not respond well to one treatment, but may respond better to another. And when your first treatment stops working, there are other treatments available to help keep the cancer under control for longer.

What Are Your Treatment Options

PSA & Hormone Therapy for Prostate Cancer | Ask A Prostate Expert, Mark Scholz, MD

When it comes to the treatment methods used for hormone replacement therapy for men, you have several treatment options. These treatment options include:

Intramuscular Injections

Testosterone is injected into the buttocks every few weeks, usually about once or twice a month. Intramuscular injections are ideal for patients who prefer a quicker absorption, or who have more severe symptoms that benefit from a quicker treatment.

Pellets

Pellets are generally a long-term treatment with a slow, consistent release of testosterone into the body. Testosterone pellets, which are about the same size as a grain of rice, are injected into the buttocks once about every three or four months. Pellets are a good option for patients who are searching for a steady treatment of multiple symptoms.

Topical Gels or Creams

Topical gels or creams are loaded with a certain percentage of testosterone and are applied daily to various parts of the body, such as the arms or the abdomen. Topical treatments might be good choices for men who have minor symptoms or who are using testosterone to target a specific issue.

Patches

Patches are another topical treatment in which a small patch of testosterone is applied to the body each day, typically in a rotating pattern to get the best results. Patches are ideal for patients who seek consistent levels of testosterone but who do not want injections.

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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 cancers 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 doesnt work forever. The problem is that not all cancer cells need hormones to grow. Over time, these cells that arent reliant on hormones will spread. If this happens, hormone therapy wont help anymore, and your doctor will need to shift to a different treatment approach.

How Fast Does Hormone Therapy Work

Hormone therapy can work rather quickly to lower testosterone levels in the body. Testosterone levels usually drop within 2 to 4 weeks while using leuprolide . This is a common hormone therapy medication.

Degarelix works even faster than leuprolide. This is another hormone therapy medication. In one study, it caused testosterone levels todrop by about 88% after 1 day. After 3 days, levels had dropped by 94%. After 28 days, levels dropped by 98%.

In other words, timing varies by medication. But, as a rule of thumb, testosterone levels drop to a desired amount often within a month.

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Blocking The Pituitary Gland Stimulation Of The Testicles To Produce Testosterone

The pituitary gland is a small gland located below the brain. It uses the gonadotrophin-releasing hormone to make the testicles to produce testosterone. GnRH antagonist to block the communication between the pituitary gland and the testes. Degarelix marketed under Firmagon is a GnRH antagonist used in the USA and Europe.

What Are Common Side Effects Of Hormone Therapy

Hormone Treatment For Prostate Cancer Side Effects

Hormone therapy can have many side effects. The longer you take hormone therapy, the greater your risk for side effects. This includes thinning bones , weight gain, and heart disease. Your healthcare provider may recommend taking calcium and vitamin D3 supplements. This can support bone health while on hormone therapy for prostate cancer.

Other side effects of hormone therapy can include:

  • Erectile dysfunction

  • Loss of muscle mass

  • Depression or mood swings

In general, hormone therapy may lower your desire for sex and can cause erectile dysfunction . Luckily, there are ways to manage this side effect. You can read more about medications for EDhere.

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Can Hormone Therapy Cure My Prostate Cancer

No, hormone therapy cannot cure your prostate cancer. The goal of hormone therapy is to stop or slow the growth of the prostate cancer cells in your body. Hormone therapy can shrink prostate cancer tumors and may stop or limit the spread of your prostate cancer. Hormone therapy is used to control your prostate cancer.

Results Of Treating Prostate Cancer With Radiation Therapy

American Cancer Society. Radiation therapy for prostate cancer. January 2013.

Radiation therapy is best used as an early treatment for a lower-grade cancer that is confined within the prostate gland. The survival rates are similar to the results of radical prostatectomy. Radiation therapy treatments can also be used along with hormone therapy as a first step in treating prostate cancer that has spread outside of the prostate gland to nearby tissues. External beam radiation therapy can be focused on the prostate gland therefore, reducing the radiation exposure to the surrounding healthy tissues. This may increase survival rates over other forms of prostate cancer treatments.

National Cancer Institute at the National Institutes of Health. September 2012

Clinical trials show that external-beam radiation therapy does not seem to improve the survival rate of prostate cancer, but it does help to stop the progression of the disease. One such trial showed an increased progression-free survival at 4 years for patients with a 15% estimated risk of lymph node involvement who received whole-pelvic radiation therapy as compared with prostate-only radiation therapy With this in mind, radiation therapy treatments should be delayed 4 to 6 weeks after a TURP procedure in order to reduce incidence of stricture.

Stevens, G Firth, I. Audit in radiation therapy: long-term survival and cost of treatment. National Institute of Health. Feb. 1997

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Diminution Of Muscular Strength

A mans muscular strength is reduced by 12% to 66% as the result of androgen deprivation. Moreover, muscle mass declines by 20% to 30% by age 70 . Because androgen deprivation reduces the amount of protein synthesis and the non-lipid body mass, obesity results. Thus, elderly patients should actively work against the loss of muscle by directed strength-training exercises .

Treatment To Lower Androgen Levels From The Adrenal Glands

Hormone Therapy for High-Risk Prostate Cancer | Prostate Cancer Staging Guide

LHRH agonists and antagonists can stop the testicles from making androgens, but cells in other parts of the body, such as the adrenal glands, and prostate cancer cells themselves, can still make male hormones, which can fuel cancer growth. Drugs are available that block the formation of androgens made by these cells.

Abiraterone blocks an enzyme called CYP17, which helps stop these cells from making androgens.

Abiraterone can be used in men with advanced prostate cancer that is either:

  • High risk
  • Castrate-resistant

This drug is taken as pills every day. It doesnt stop the testicles from making testosterone, so men who havent had an orchiectomy need to continue treatment with an LHRH agonist or antagonist. Because abiraterone also lowers the level of some other hormones in the body, prednisone needs to be taken during treatment as well to avoid certain side effects.

Ketoconazole , first used for treating fungal infections, also blocks production of androgens made in the adrenal glands, much like abiraterone. It’s most often used to treat men just diagnosed with advanced prostate cancer who have a lot of cancer in the body, as it offers a quick way to lower testosterone levels. It can also be tried if other forms of hormone therapy are no longer working.

Ketoconazole also can block the production of cortisol, an important steroid hormone in the body, so men treated with this drug often need to take a corticosteroid .

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What Can Hormone Replacement Therapy Treat

Not all men experience the effects of low testosterone in the same way. Some men have many minor symptoms, while others have a few main symptoms. Hormone replacement therapy used to treat low testosterone can address many issues, including:

  • Overactive bladder
  • Muscle loss and loss of strength
  • General sense of fatigue
  • Reduction in body and facial hair
  • Osteoporosis
  • Dry skin and rapid skin aging
  • Increase in body cholesterol
  • Anemia and a decrease in hemoglobin
  • Muscle and joint ache

What Is Hormone Herapy

To help you understand what hormone therapy is and how it may affect your prostate cancer, it is good for you to understand what hormones are and how they work in your body. Hormones control or manage your bodys activities. Hormones are made by glands in your body and are carried by your blood to all areas in your body. Glands are groups of cells in your body that make and release materials needed by your body.

Testosterone is the main male hormone in your body. It makes you grow hair on your face and body and have a mans body shape and controls your desire for sex. Testosterone also controls your prostate gland. Your testicles make most of the testosterone in your body. A small amount of testosterone is also made by your adrenal glands. Your adrenal glands are located on top of each kidney. Your adrenal glands also make other hormones.

Prostate cancer is hormone sensitive or hormone dependent. This means that the testosterone in your body helps your prostate cancer to grow. The goal of hormone therapy is to lower the amount of testosterone in your body to stop or slow the growth of your prostate cancer. You can lower the amount of testosterone in your body by taking medicines or having surgery.

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