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Hormone Injections For Prostate Cancer

Scientists Make A Prostate Cancer Breakthrough

Hormone Therapy for Prostate Cancer

By Gwyn Wright via SWNS

A prostate cancer breakthrough could stop the tumor from spreading after it becomes resistant to current therapy, scientists say.

Anti-hormonal treatment blocks the signal sent out by testosterone that stimulates tumor growth.

But eventually, the cancer cells become resistant and the growth spreads through the body becoming fatal.

An international research team led by Dutch scientists found proteins that normally regulate the circadian rhythm, or body clock, dampen the effects of the anti-hormonal therapy.

The breakthrough means current drugs could be repurposed and has saved a decade of testing.

The exact process of how tumor cells become resistant to hormone therapy had been a mystery until now.

For the study, the team looked at tissue from 56 people with high-risk prostate cancer who had undergone three months of anti-hormonal therapy before their surgery.

The team examined the tissue at DNA level after the three months were up.

Genes keeping the cells alive despite the treatment were controlled by a protein that normally regulates the body clock.

This protein was found to make prostate cancer cells more sensitive to anti-hormonal therapy in the lab as well as in mice.

The researchers say there is no evidence to suggest people with out-of-kilter body clocks, such as night shift workers, could be at a higher risk of the disease.

“These ‘circadian clock’ proteins acquire an entirely new function in the tumor cells upon hormonal therapy.

How To Tell If Hormone Therapy Is Working

If you are taking hormone therapy for prostate cancer, you will have regular PSA tests. If hormone therapy is working, your PSA levels will stay the same or may even go down. But, if your PSA levels go up, this may be a sign that the treatment is no longer working. If this happens, your doctor will discuss treatment options with you.

If you are taking hormone therapy for breast cancer, you will have regular checkups. Checkups usually include an exam of the neck, underarm, chest, and breast areas. You will have regular mammograms, though you probably wont need a mammogram of a reconstructed breast. Your doctor may also order other imaging procedures or lab tests.

What Is Advanced Prostate Cancer

When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.

Prostate cancer is often grouped into four stages.

  • Stages I & II: The tumor has not spread beyond the prostate. This is often called early stage or localized prostate cancer.
  • Stage III: Cancer has spread outside the prostate, but only to nearby tissues. This is often called locally advanced prostate cancer.
  • Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs. This stage is often called advanced prostate cancer.

When an early stage prostate cancer is found, it may be treated or placed on surveillance . If prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer. Stage IV prostate cancer is not curable, but there are many ways to control it. Treatment can stop advanced prostate cancer from growing and causing symptoms.

There are several types of advanced prostate cancer, including:

Biochemical Recurrence

If your Prostate Specific Antigen level has risen after the first treatment but you have no other signs of cancer, you have biochemical recurrence.

Castration-Resistant Prostate Cancer

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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.

Why Is This Medication Prescribed

Figure 1

Degarelix injection is used to treat advanced prostate cancer . Degarelix injection is in a class of medications called gonadotropin-releasing hormone receptor antagonists. It works by decreasing the amount of testosterone produced by the body. This may slow or stop the spread of prostate cancer cells that need testosterone to grow.

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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 The Researchers Did

Dr. Crawfords team reviewed clinical data from nearly 23,000 men who were given ADT injections between 2007 and 2016. Each mans treatment varied by how their ADT was formulated. Some types of ADT are given once a month, and others are given at three-, four-, or six-month intervals. The researchers wanted to know how many men were late on their ADT treatments, and how that would affect the amounts of testosterone in their blood.

During this research, the investigators defined month in two ways: either as one lasting 28 days, which is how months were defined during the clinical trials that set dosing schedules for ADT, or as a calendar month lasting 31 days. ADT was deemed late if it was given after day 28 by the first definition or after day 32 by the second definition.

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Good Prostate Cancer Care

Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.

You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.

You should also be told about any clinical trials you may be eligible for.

If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.

Medical Research Council Study

Hormone therapy and chemotherapy – prostate cancer

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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Risk Of Other Health Problems

Evidence suggests that having hormone therapy might increase the chance of developing heart disease, stroke and type-2 diabetes. There is also some research that suggests having hormone therapy can increase your risk of getting blood clots and anaemia. But more research is needed to help us understand the links between these conditions.

Research shows that hormone therapy can cause:

  • an increase in weight, particularly around the waist
  • an increase in cholesterol levels
  • changes in insulin.

Talk to your hospital doctor and GP about how often you should have general health checks. You may be weighed and have your blood pressure checked regularly. You may also have blood tests to check for diabetes and to measure your cholesterol levels. Your GP may suggest you have these checks about every six months. Or you can ask for them yourself at your GP surgery.

If you already have heart problems or diabetes, talk to your doctor before you start hormone therapy. They will work with you to manage these conditions.

While the risk of getting these conditions may be worrying, its important to remember that hormone therapy helps men to live longer by controlling the cancer.

What can help?

A healthy lifestyle can help reduce your risk of heart disease, stroke and type-2 diabetes. This includes:

  • eating a healthy diet

Read more about diet and physical activity.

Prostate Cancer Hijacks Biorhythm Of Tumor Cell To Bypass Hormone Therapy

Hormone therapy can keep metastatic prostate cancer well under control, but sooner or later tumor cells become resistant to it. Unexpectedly, a possible solution has now emerged: drugs that are not designed to fight cancer at all, but which influence the day-and-night rhythm of a cell. Professor Wilbert Zwart is part of the international team of researchers, led by the Antoni van Leeuwenhoek institute, that is publishing a report on this discovery in the renowned journal Cancer Discovery today.

Prostate cancer is a type of cancer that grows under the influence of hormones, primarily testosterone. Patients with metastatic prostate cancer are therefore often treated with anti-hormonal therapy, which inhibits the growth-stimulating signal of testosterone and, therefore, tumor growth.

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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
  • Youll have blood tests. This is because your liver enzymes may go up. If this happens, your doctor will discuss it with you and make a plan, if needed.
  • Alcohol may interfere with your medications. Please check with your healthcare providers if you want to drink alcohol.
  • About Hormonal Therapy For Prostate Cancer

    Why does hormone therapy worsen some prostate cancers?

    Testosterone is a male hormone. Its made when hormones from your pituitary gland cause your testes to make sperm. Testosterone can cause prostate cancer cells to grow.

    Hormonal therapy prevents prostate cancer cells from growing by:

    • Blocking the action of testosterone and other male hormones.

    Your doctor may recommend hormonal therapy in order to:

    • Make it easier for radiation to kill prostate cancer cells.
    • Relieve pain.

    Read Also: Prostate Cancer Pain In The Bones

    Early History Of Hormonal Therapy For Prostate Cancer

    The use of androgen deprivation as therapy for advanced prostate cancer began in 1941, when Huggins and Hodges first treated men with prostate cancer with either orchiectomy or estrogen.1 They monitored changes in prostate size and observed that improvements in acid and alkaline phosphatases were associated with cancer-related symptom relief. Largely due to the absence of other therapies, hormonal manipulation became a mainstay of treatment for symptomatic metastatic disease. Although it was originally hoped that suppression of testicular androgens would be curative, this proved not to be the case.

    Although the testes are the primary source of testosterone, the adrenal glands also produce androgens. As a result, many patients with castrate levels of testosterone continue to have measurable levels of dihydrotestosterone in the prostate, thereby allowing continued stimulation of prostate cancer cells.2 The importance of adrenal androgens in prostate cancer was observed by Huggins and Hodges in their pioneering study, as many patients continued to have measurable levels of serum acid phosphatase, a surrogate marker of the disease, following medical or surgical castration. The authors considered this a clear indication that androgen production by the adrenal glands was ongoing.1

    What Types Of Hormone Therapy Are Used For Prostate Cancer

    Hormone therapy for prostate cancer can block the production or use of androgens . Currently available treatments can do so in several ways:

    • reducing androgen production by the testicles
    • blocking the action of androgens throughout the body
    • block androgen production throughout the body

    Treatments that reduce androgen production by the testicles are the most commonly used hormone therapies for prostate cancer and the first type of hormone therapy that most men with prostate cancer receive. This form of hormone therapy includes:

    Treatments that block the action of androgens in the body are typically used when ADT stops working. Such treatments include:

    Treatments that block the production of androgens throughout the body include:

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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.

    Checking Your Hormone Therapy Is Working

    What is the Best Hormone Therapy for Prostate Cancer?

    Youll 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 they have had their 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 cells are starting to grow and develop, the level of PSA may go up. Then your doctor may need to change your treatment. They will discuss this with you.

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    Hormone Therapy With Radiotherapy

    You have this if:

    • your cancer hasnt spread to other parts of the body but is at a high risk of coming back, eg the cancer has grown through the covering of your prostate
    • you have a very high prostatic specific antigen level
    • you have a high Gleason score

    You might have hormone therapy before, during and after radiotherapy. Doctors usually recommend that you have the treatment for between 3 months and 3 years. How long depends on the risk of your cancer coming back and how many side effects you get.

    Hormonal Treatments For Prostate Cancer Are Often Given Late

    • By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

    Men with advanced prostate cancer are typically treated with drugs that cause testosterone levels to plummet. Testosterone is a hormone that fuels growing prostate tumors, so ideally this type of treatment, which is called androgen deprivation therapy , or hormonal therapy, will stall the disease in its tracks.

    For that to happen, ADT has to be administered correctly. But according to a new study, men frequently dont get ADT at the proper dosing intervals. Too many of them get the treatments later then they should, causing testosterone levels to rise unacceptably. Rapid increases in testosterone following delays in dosing could have implications for cancer progression, cautions Dr. David Crawford, a urologist at the University of California San Diego, who led the study.

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    Hormone Therapy Can Cause Side Effects

    Because hormone therapy blocks your bodys ability to produce hormones or interferes with how hormones behave, it can cause unwanted side effects. The side effects you have will depend on the type of hormone therapy you receive and how your body responds to it. People respond differently to the same treatment, so not everyone gets the same side effects. Some side effects also differ if you are a man or a woman.

    Some common side effects for men who receive hormone therapy for prostate cancer include:

    Surgically Removing The Prostate Gland

    Why does hormone therapy worsen some prostate cancers?

    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.

    A recent trial showed possible long-term side effects of radical prostatectomy may include an inability to get an erection and urinary incontinence.

    Before having any treatment, 67% of men said they could get erections firm enough for intercourse.

    When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.

    For urinary incontinence, 1% of men said they used absorbent pads before having any treatment.

    When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.

    Out of the men who were actively monitored instead, 4% were using absorbent pads at 6 months and 8% after 6 years.

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

    Its 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.

    After a radical prostatectomy, youll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.

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