If Treatment Does Not Work
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for some people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
How Is Prostate Cancer Treated
Treatment for prostate cancer depends upon the stage of the prostate cancer and an understanding of the pros and cons of treatment. Treatment options include:
- Watchful waiting. No active treatment is started. This may be appropriate for older men with other serious medical conditions
- Active watching. May involve regular PSA tests and prostate biopsies
- Brachytherapy. Small radioactive pellets are placed permanently into the prostate gland
Side Effects Of Adt With Prostate Cancer
Some men may need to make lifestyle changes because of the side effects of ADT. It is important to discuss these issues with your doctor and your partner before choosing ADT. Disturbing the body’s balance of sex hormones can lead to undesirable and upsetting side effects.Side effects of ADT may include:
- erectile dysfunction , usually as a result of surgery and other treatments
- reduced bone substance and muscle mass
- increased body fat
- changes to breast tissue
- cognitive changes, such as reduced concentrating ability
Men should discuss with their doctor appropriate monitoring of their bones with a bone density study, and the need to take calcium and vitamin D supplements to reduce the risk of osteoporosis. Because ADT may increase the risk of developing diabetes or heart disease, it is important that men speak with their doctor about their own health profiles, including blood pressure, cholesterol and blood glucose levels.All men should be encouraged to stop smoking, and to maintain a healthy diet. Regular exercise is important to maintain muscle and bone health, and to keep body weight within the healthy range.
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What Is Intermittent Adt
Researchers have investigated whether a technique called intermittent androgen deprivation can delay the development of hormone resistance. With intermittent androgen deprivation, hormone therapy is given in cycles with breaks between drug administrations, rather than continuously. An additional potential benefit of this approach is that the temporary break from the side effects of hormone therapy may improve a mans quality of life.
Randomized clinical trials have shown similar overall survival with continuous ADT or intermittent ADT among men with metastatic or recurrent prostate cancer, with a reduction in some side effects for intermittent ADT .
Prostap Injections And Abnormal Heart Rhythm
You may be more likely to experience an abnormal heart rhythm while you’re having Prostap injections if you take certain other medicines, including:
- medicines to treat abnormal heart rhythms , eg amiodarone, procainamide, quinidine, disopyramide, dronedarone
- certain antidepressants, eg clomipramine, citalopram, escitalopram
- certain antimalarials, eg halofantrine, chloroquine, quinine, Riamet, mefloquine
- certain antimicrobials, eg erythromycin given by injection, telithromycin, levofloxacin, moxifloxacin, voriconazole or pentamidine
- certain antipsychotics, eg amisulpride, thioridazine, chlorpromazine, sertindole, haloperidol, pimozide, zuclopenthixol, sulpiride
- arsenic trioxide
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How Should I Use Eligard
Take Eligard exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.
Different brands or strengths of leuprolide are used to treat different conditions. It is very important that you receive exactly the brand and strength your doctor has prescribed. Always check your medication to make sure you have received the correct brand and type prescribed by your doctor.
Eligard is injected under the skin or into a muscle, once every month or once every 3 to 6 months. A healthcare provider can teach you how to properly use the medication by yourself.
Read and carefully follow any Instructions for Use provided with your medicine. Do not use Eligard if you don’t understand all instructions for proper use. Ask your doctor or pharmacist if you have questions.
Your symptoms may become temporarily worse as your hormones adjust to leuprolide.
Keep using the medicine as directed, and tell your doctor if your condition is still worse after 2 months of using Eligard.
You may need frequent medical tests while using leuprolide.
Store Eligard in the refrigerator. Do not freeze. You may take the medicine out and allow it to reach room temperature before mixing and injecting your dose. Mixed medicine must be used within 30 minutes.
You may also store Eligard in its original packaging at room temperature for up to 8 weeks.
Before Receiving Degarelix Injection
- tell your doctor and pharmacist if you are allergic to degarelix injection, any other medications, or any of the ingredients in degarelix injection. Ask your pharmacist or check the patient information for a list of the ingredients.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amiodarone , disopyramide , quinidine, procainamide, or sotalol . Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have or have ever had long QT syndrome high or low levels of calcium, potassium, magnesium, or sodium in your blood or heart, liver, or kidney disease.
- women who are or who may become pregnant should not receive degarelix injection. Degarelix injection may harm the fetus. If you receive degarelix injection while you are pregnant, call your doctor immediately. If you are breastfeeding, talk to your doctor before you receive degarelix injection.
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Surgery To Remove The Testicles
Surgery to remove your testicles isnt a common way of lowering the amount of testosterone you make.
You usually only have surgery to remove your testicles if you need your testosterone reduced urgently. For example, if your cancer has spread to your bones and is pressing on your spinal cord, your doctors might want to reduce the amount of testosterone quickly.
Your doctors might also suggest surgery as an option if you don’t want to have injections or tablets.
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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Controversies In Hormone Therapy
The use of hormone therapy requires as much art as science. Physicians do not always agree about when it is best to start treatment, whether it needs to be continuous or can be stopped and started up again periodically, and whether monotherapy or combination therapy is best. Here are the salient issues, what the studies say and what I believe and follow in my own practice.
Different Approaches To Starting Hormone Therapy
Experts debate how early treatment with hormone therapy should be started. Some argue that the benefits of hormone therapy for prostate cancer should be offered to men earlier in the course of the disease. Others assert that there’s little evidence that getting treatment early is better than getting it later.
“Unfortunately, there are still some doctors who are offering hormonal therapy earlier in the course of the disease than is commonly recommended,” Brooks says. Given that the side effects can be serious, Brooks argues that starting treatment with hormone therapy so early may not be a good idea.
However, Holden argues that early treatment may be helpful. “I think one of the reasons that the death rate from prostate cancer is going down is that we’re using hormone therapy early,” he tells WebMD. “We haven’t proved that early treatment improves overall survival yet, but I think we will.”
Researchers are also looking at “intermittent therapy,” starting and stopping hormone treatment for months at a time. The big advantage is that men could go off therapy temporarily and thus be free of the side effects. Early study results have been promising.
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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.
What Types Of Hormone Therapy Are There
There are two basic kinds of hormone therapy for prostate cancer. One class of drugs stops the body from making certain hormones. The other allows the body to make these hormones, but prevents them from attaching to the cancer cells. Some doctors start treatment with both drugs in an effort to achieve a total androgen block. This approach goes by several names: combined androgen blockade, complete androgen blockade, or total androgen blockade.
Here’s a rundown of the techniques.
Hormone therapy for prostate cancer can cause bone thinning osteoporosis, which can lead to broken bones. However, treatment with bisphosphonates — like Aredia, Fosamax, and Zometa — may help prevent this condition from developing, says Holden.
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Types Of Hormonal Therapies
There are 3 types of hormonal therapies for the treatment of prostate cancer. They may be used alone or together.
- Luteinizing hormone-releasing hormone agonists block the signal from your pituitary gland that tells your testicles to make testosterone. Leuprolide and goserelin are LHRH agonists. Theyre given by injection either once a month or every 3, 4, or 6 months.
- Anti-androgens are medications that block testosterone from attaching to cancer cells. This keeps it from helping cancer cells grow. One example of an anti-androgen is bicalutamide . This is a pill you take once a day.
- If youre taking bicalutamide, make sure you take it at the same time every day, with or without food.
- Your healthcare team will tell you when to start taking this medication.
Appendix: Summary Of Fda
The following table shows which treatments are appropriate for treating advanced prostate cancer, depending on whether the cancer is sensitive to androgen deprivation therapy and whether distant metastases are present. Please note that these are general guidelines and final decisions are made by the health care provider in consultation with the patient.
Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA recurrence or biochemical recurrence.
Checking Your Hormone Therapy Is Working
You have regular blood tests to check the level of a protein called prostate specific antigen . PSA is a protein made by both normal and cancerous prostate cells. It is in the blood in small amounts in all men, unless you have had the prostate gland completely removed.
While the hormone therapy is working, the level of PSA should stay stable or may go down. But if prostate cancer starts to grow and develop, the level of PSA may go up. This is hormone resistant prostate cancer or castrate resistant prostate cancer. Then your doctor may need to change your treatment. They will discuss this with you
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How Will I Know That My Hormone Therapy Is Working
Doctors cannot predict how long hormone therapy will be effective in suppressing the growth of any individual mans prostate cancer. Therefore, men who take hormone therapy for more than a few months are regularly tested to determine the level of PSA in their blood. An increase in PSA level may indicate that a mans cancer has started growing again. A PSA level that continues to increase while hormone therapy is successfully keeping androgen levels extremely low is an indicator that a mans prostate cancer has become resistant to the hormone therapy that is currently being used.
How Is Hormone Therapy Used To Treat Hormone
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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