Table : Survival Benefits Of Early Treatment
An analysis of 98 men with prostate cancer that had spread to the lymph nodes, who were randomly assigned to receive immediate hormone therapy or to forgo it until the disease spread further to bones or lungs, found that early treatment saved lives.
Deaths from prostate cancer 21 Source: Lancet Oncology 2006 7:4729. PMID: 16750497.
Other studies have shown that starting hormone therapy early on increases survival times, delays cancer progression, and results in better quality of life. However, in a review of four studies involving 2,167 men with metastatic prostate cancer, the Cochrane Collaboration concluded that early hormone therapy had offered only a small overall survival advantage over deferred treatment, and cautioned that more research on the issue needs to be done.
Although debate on this issue continues, in most cases I advise my patients with metastatic disease to begin hormone treatment early on. This is particularly important for someone with spine metastases, because a bone fracture or extension of the cancer into the spinal cord area could lead to impaired mobility and even paralysis. Fortunately, this is a rare event.
Prognosis For Prostate Cancer
It is not possible for a doctor to predict the exact course of a disease, as it will depend on each persons individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of prostate cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.
Prostate cancer often grows slowly and even more aggressive types tend to grow more slowly than other types of cancer. If diagnosed early, prostate cancer has one of the highest five year survival rates.
Evidence About Hormone Therapy And Prostatectomy
Gleave ME, La Bianca S, Goldenberg SL. Neoadjuvant Hormonal Therapy Prior to Radical Prostatectomy: Promises and Pitfalls. Prostate Cancer and Prostatic Diseases 2000 3:13644. PMID: 12497089.
Hurtado-Coll A, Goldenberg SL, Klotz L, Gleave ME. Preoperative Neoadjuvant Androgen Withdrawal Therapy in Prostate Cancer: The Canadian Experience. Urology 2002 60:4551. PMID: 12231047.
Kumar S, Shelley M, Harrison C, et al. Neo-adjuvant and Adjuvant Hormone Therapy for Localized and Locally Advanced Prostate Cancer. Cochrane Database of Systematic Reviews 2006 CD006019. PMID: 17054269.
Soloway MS, Sharifi R, Wajsman Z, et al. Randomized Prospective Study Comparing Radical Prostatectomy Alone Versus Radical Prostatectomy Preceded by Androgen Blockade in Clinical Stage B2 Prostate Cancer. The Lupron Depot Neoadjuvant Prostate Cancer Study. Journal of Urology 1995 154:4248. PMID: 7541859.
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Recurrent Prostate Cancer Symptoms
Prostate cancer that returns after treatment is considered recurrent. When it returns to the area around the prostate, the disease is classified as a local recurrence. If the cancer is found in another part of the body, the recurrent cancer is considered metastatic. If the cancer metastasizes outside the prostate, it most likely develops in bones first. Metastatic prostate cancer most often spreads to the liver, bones and lungs.
After initial treatment for prostate cancer, PSA levels are expected to drop dramatically. The first sign of recurrent prostate cancer may be a rise in the PSA level. Other symptoms of recurrent cancer may depend on whether and where the cancer has spread. Symptoms include:
- Blood in the urine
- Difficulty breathing
Patients should discuss any symptoms with their doctor and ask about scheduling regular PSA tests after treatment.
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Eligard For Prostate Cancer
The Food and Drug Administration approves prescription drugs such as Eligard to treat certain conditions. Eligard may also be used off-label for other conditions. Off-label drug use means using a drug for a purpose other than what its been approved for by the FDA.
Eligard is approved for use as a palliative treatment for advanced prostate cancer in adult males*. Palliative treatment means that the drug works to help manage pain and other symptoms of this condition. It wont treat or cure advanced prostate cancer, but it may help improve a persons quality of life.
* Use of the terms male and female within this article refers to a persons sex assigned at birth.
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Diagnosis Of Prostate Cancer
Prostate cancer is diagnosed using a number of tests, which may include:
- Prostate-specific antigen test the prostate makes a protein called PSA. Large quantities of PSA in the blood can indicate prostate cancer or other prostate problems.
- Digital rectal examination using a gloved finger in the rectum, the doctor feels for enlargement and irregularities of the prostate.
- Biopsy six to 12 tissue samples are taken from the prostate and examined in a laboratory for the presence of cancer cells.
If prostate cancer is diagnosed, more tests may be needed to see if the cancer has spread to other areas of the body. These may include computed tomography scans, magnetic resonance imaging scans and bone scans.
Test results can take a few days to come back. It is very natural to feel anxious while waiting to get your results. It can help to talk to a close friend or relative about how you are feeling. You can also contact the Cancer Council Helpline on 13 11 20 and speak with a cancer nurse.
Eligard Withdrawal And Dependence
Researchers havent investigated whether Eligard can cause drug dependence, and Eligard isnt known to cause it. Dependence is when your body needs the drug to feel normal.
Eligard also isnt known to cause any withdrawal symptoms when a person stops taking it. Withdrawal symptoms are side effects that may occur after you stop using a medication that your body has become dependent on.
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What Form Does This Medication Come In
7.5 mg vialEligard 7.5 mg is supplied in two separate prefilled, sterile syringes whose contents are mixed immediately prior to administration. The two syringes are joined and the single dose product is mixed until it is homogenous. One syringe contains the Atrigel Delivery System, and the other contains leuprolide acetate. The Atrigel Delivery System is a polymeric delivery system consisting of a biodegradable, 34% poly polymer formulation dissolved in a biocompatible solvent, 66% N-methyl-2-pyrrolidone . PLG is a copolymer with a 50:50 molar ratio of DL-lactide to glycolide containing carboxyl end groups. The second syringe contains 10.2 mg lyophilized leuprolide acetate and is designed to deliver 7.5 mg of leuprolide acetate at the time of subcutaneous injection. Eligard 7.5 mg is available in a single use pouch packaging. The pouch packaging contains the two-syringe mixing system, a 20-gauge half-inch needle, and a silicone desiccant pouch to control moisture uptake.
How Long Does It Take Eligard To Work
Eligard takes a few weeks to begin working.
Within the first 1 to 2 weeks of treatment with Eligard, your testosterone levels will actually increase. This may cause your tumor to grow and symptoms to worsen at the beginning of treatment. This is known as a tumor flare.
Tumor flares tend to decrease within 2 to 4 weeks after starting treatment with Eligard. So you may notice symptoms of your prostate cancer begin to improve at this time.
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What Side Effects Are Possible With This Medication
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
Stop taking the medication and seek immediate medical attention if any of the following occur:
- signs of a heart attack
- signs of stroke
- symptoms of a severe allergic reaction
- symptoms of severely increased blood pressure
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Side Effects Requiring Immediate Medical Attention
Along with its needed effects, leuprolide may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking leuprolide:
For adults
- Bone, muscle, or joint pain
- chest tightness
- numbness or tingling of the hands or feet
- puffiness or swelling of the eyelids or around the eyes
- sudden, severe decrease in blood pressure and collapse
- trouble breathing
- Arm, back, or jaw pain
- bloody or cloudy urine
- difficult, burning, or painful urination
- difficulty with moving
- increased urge to urinate during the night
- muscle pain or stiffness
- pain in the arms or legs
- pain in the joints
- waking to urinate at night
Rare
- Pain in the groin or legs
Incidence not known
- burning, numbness, tingling, or painful sensations
- weakness in the arms, hands, legs, or feet
For females only
- pain or redness at the injection site
- runny or stuffy nose
- Burning, itching, or swelling at the injection site
Incidence not known
For females only expected in first few weeks
Rare
- white vaginal discharge
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What Are The Results Of Using Proton Therapy In Patients
For patients facing prostate cancer, treatments and side effects present unique challenges in choosing a therapy. Proton radiation for prostate cancer treats the disease with successful outcomes and a low risk of side effects.
For thousands with cancer of the prostate, proton therapy has offered an effective, virtually painless option for prostate cancer treatment. Since the University of Florida Health Proton Therapy Institute opened in 2006, thousands have undergone proton therapy for prostate cancer, and prostate cancer patients at the UF Health Proton Therapy Institute enjoy a close-knit community of fellow patients, caregivers and spouses. Today, prostate cancer is one of many types of cancer treated at the Institute.
Survivor Spotlight
What Is The Prognosis For People Who Have Prostate Cancer
Because prostate cancer tends to grow slowly, most men die from something other than the disease. Early detection is key to better outcomes. Almost all men 97% to 98% diagnosed with localized cancer that hasnt spread outside of the prostate live at least five years after diagnosis. When metastatic cancer has spread outside of the gland, one-third of men continue to survive after five years.
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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.
If Youre Having Radiation Therapy To The Pelvis
Radiation therapy to the pelvis can cause side effects such as:
- Bladder problems
- Fertility problems
- Changes in your sex life
You might also have some of the same problems people get from radiation to the abdomen, such as nausea, vomiting, diarrhea, or constipation.
Bladder problems
Radiation to the pelvis can cause problems with urination, including:
- Pain or burning sensations
- Blood in the urine
- An urge to urinate often
Most of these problems get better over time, but radiation therapy can cause longer-term side effects as well:
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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.
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.
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Can I Exercise While Im Using Eligard
Yes, you can exercise while youre using Eligard. In fact, a study of males* taking hormone therapy such as Eligard for prostate cancer showed that exercise may be beneficial. Exercise can lead to positive changes, such as fat loss and increased muscle strength.
However, taking Eligard may make you feel uncomfortable or tired, so you might not feel like exercising. You also may not be able to work out easily if you have back pain or certain other symptoms from prostate cancer.
Talk with your doctor about exercising safely during your treatment with Eligard. Theyll be able to recommend the right amount of exercise for you to get during your treatment.
* Use of the terms male and female within this article refers to a persons sex assigned at birth.
What Is Advanced Prostate Cancer
Advanced or metastatic prostate cancer is a stage of cancer that has spread from the prostate gland to other parts of the body. Prostate cancer most commonly spreads to the bones and lymph nodes, but it can spread to other areas of the body, too.
This is not all the information you need to know about Eligard for safe and effective use. Review the full Eligard information here, and discuss this information and any questions you have with your doctor or other health care provider.
- Eligard Product Information. Tolmar Pharmaceuticals. Fort Collins, CO.
- Eligard.com. About Eligard. Accessed Feb. 10, 2021 at https://eligard.com/about-eligard/
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Swelling Bruising Or Tenderness Of The Scrotum
Symptoms generally resolve on their own within three to five days. Oral anti-inflammatory medications such as ibuprofen are usually sufficient for pain relief, if necessary. You should avoid hot tubs and Jacuzzis for at least two to three days after the procedure. Postpone bike riding until the tenderness is gone.
What Is Androgen Deprivation Therapy
GnRH agonists are often referred to as androgen deprivation therapy . These drugs work by stopping production of the male hormone testosterone in the testicles. Interrupting the supply of testosterone can help cancer cells to grow more slowly or die.
GnRH agonist therapy like Eligard can be used in advanced prostate cancer that has spread in the body to shrink and slow the growth of cancer, which may help to relieve your symptoms. Hormone therapy can be used alone or with other treatments such as chemotherapy, radiation or surgery.
Eligard is a long-acting injected suspension. It is injected under your skin once every month, or once every 3, 4 or 6 months. You and your doctor can determine the dosing schedule that works best for you. You will receive this injection in the doctors office, a clinic or in the hospital. You do not give this injection to yourself.
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Medical Versus Surgical Castration
Reducing the male sex hormone testosterone helps stop the growth of prostate cancer cells. This is done via a process known as castration, which is a type of hormone therapy that involves the removal of testicular function either surgically or medically. Surgical removal of the testicles is the simplest and the least expensive method of castration. Because it is permanent, however, it is not preferable to most patients. Medical castration, on the other hand, is done by administering medications that block testosterone production. In exchange for keeping the testes intact, doses of these drugs must be repeated regularly for an indefinite period of time to maintain castration status.
How Long Will Eligard Work
Studies have shown that continuation of therapy with leuprolide acetate maintains testosterone below castrate levels for up to seven years. This effect on testosterone suppression may be reversed if the drug is stopped. But in some patients, over time, hormone therapy may no longer work to slow prostate cancer growth. If this happens, your doctor can recommend other treatment options.
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When To Consider Hormone Therapy
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 .
Will Eligard Cure Prostate Cancer
No, Eligard wont cure advanced prostate cancer. Currently, theres no cure for this condition. However, medications such as Eligard can help reduce your symptoms of prostate cancer, which may improve your quality of life.
Talk with your doctor about the best treatment options for your advanced prostate cancer.
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