Figure : How Hormone Therapy Affects The Androgen Cascade
The male sex hormones are known as androgens. Probably the best known hormone in this family is testosterone. Most androgens are produced in the testicles.
Androgens fuel the growth of prostate cells, including prostate cancer cells. Hormone therapy also known as androgen-deprivation therapy seeks to cut off the fuel supply. But different therapies work in different ways.
A. The hypothalamus releases pulses of LHRH, which signals the pituitary gland to release the hormones FSH and LH.
B. LH travels through the bloodstream. When it reaches the testicles, it binds to specialized cells that secrete testosterone into the bloodstream.
C. In the prostate, the enzyme 5-alpha-reductase converts testosterone and other types of androgens into dihydrotestosterone , which stimulates the growth of prostate cells and fuels the growth of cancer, if it is present.
Centrally acting agents
LHRH agonists flood the pituitary gland with messages to crank out LH. This causes a temporary surge of testosterone until receptors in the pituitary are overloaded. Then testosterone levels drop sharply.
The GnRH antagonist jams receptors in the pituitary gland so that it cannot respond to the pulses of LHRH sent by the hypothalamus. This prevents the LH signal from being sent and no testosterone is made in the testicles.
DES inhibits secretion of LHRH from the hypothalamus.
Peripherally acting therapies
Orchiectomy removes the testicles, preventing testosterone production.
How Will I Know If My Treatment Is Working
You will have regular appointments to check how well your treatment is working and monitor any side effects. These will involve regular prostate specific antigen blood tests to measure the amount of PSA in your blood.
PSA is a protein produced by cells in your prostate and also by prostate cancer cells, even if they have spread to other parts of your body. The PSA test is a good way to check how well your treatment is working.
How your treatment is monitored will depend on whether youre having hormone therapy as part of treatment that aims to cure your prostate cancer, or having life-long hormone therapy to keep advanced prostate cancer under control.
You can contact your nurse at the hospital, or our Specialist Nurses, between appointments if you have any side effects or symptoms that youd like to talk about.
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Consecutive Months Without A Period
Once your body has gone a full 12 months without a menstrual cycle, youve reached menopause. During this time of hormonal change and lack of a menstrual cycle, a womans ovaries stop releasing eggs and estrogen levels remain low, leading to a wide range of menopausal symptoms that could include:
Stage 3 Postmenopause
A hot flash is a sudden feeling of warmth/heat, often in your upper body .
- A hot flash can make you flushed or cause you to sweat.
- You may have a feeling that your heart is racing or you may feel anxious.
- When the flash passes, you may have chills.
- A hot flash may last as little as 30 seconds or for up to 10 minutes.
- They can happen at any time of day, even while you are sleeping which can cause you to wake up.
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Questions To Ask Your Doctor Or Nurse
- What is the aim of treatment?
- What type of hormone therapy are you recommending for me and why?
- How often will I have my injections or implants?
- How will my treatment be monitored?
- How long will it be before we know if the hormone therapy is working?
- What are the possible side effects, and how long will they last?
- What will happen if I decide to stop my treatment?
- Are there any clinical trials that I could take part in?
Types Of Hormonal Therapy And Their Side Effects
When a patient over age 70 and his physician together decide to initiate hormonal therapy, the standard mode of treatment is the administration of an LHRH analog. The simultaneous administration of the antiandrogens bicalutamide or flutamide was found in a meta-analysis of 27 prospective phase III trials to reduce overall lethality by about 2.9% . It follows that patients should be informed in detail about the possible side effects before MAB is initiated.
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Kinds Of Hormone Therapy
Hormone therapy is a category encompassing a number of treatments. In some conditions or diseases, certain hormones are prescribed in order to increase their levels. This is frequently referred to as hormone replacement therapy . Hormones can be natural or synthetic, meaning produced commercially . Patients who do not have prostate cancer but have symptoms from low testosterone levels, such as fatigue, may be prescribed testosterone as a type of HRT. In certain cases, patients with prostate cancer under control may receive this type of hormone therapy however, because of the risk of activating the cancer, some doctors advise against it. Male children or adults with hypogonadism are prescribed testosterone as HRT.
As mentioned previously, HT in prostate cancer aims to reduce production of the hormone testosterone, rather than increase it, thereby interfering with cancer cells ability to use it to grow.
The hormone therapies that have become standard prostate cancer treatments are the ones we discuss in detail in this guide. All decisions regarding these treatments should be carefully made by the patient and doctor together.
How Effective Is Hormone Therapy For Prostate Cancer
In the initial years of diagnosis, hormone therapy for prostate cancer can help patients with their symptoms and add years to their lives.
For men who need hormone therapy, such as men whose prostate-specific antigen levels are rising after surgery or radiation or men with advanced prostate cancer who dont yet have symptoms, its not always clear when the best time is to start hormone treatment:
- Some doctors think that hormone therapy works better if its started as soon as possible, even if the patient feels well and is not exhibiting any symptoms. Studies have shown that hormone treatment may slow down the disease and perhaps even help men live longer.
- Some doctors, however, donât agree with this approach. Because of the side effects and the risk of the cancer becoming resistant to therapy sooner, some doctors feel that treatment should not be started until cancer symptoms appear.
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How Do I Change My Next Delivery Date Or Skip An Order
To change your next delivery date, click the Account button located in the top navigation bar and log into your account. Click on Manage Subscription. Then select Cancel to the right of your next charge date. Dont worry, youre not actually going to cancel. Now click on Skip Next Delivery. You will then be given the option to select the number of days you would like to delay your next delivery. To skip an order, simply click on Delivery Schedule on the left-hand side menu. Then click Skip to the right of each delivery date you would like to skip.
What Causes Prostate Cancer
Cancer is the uncontrollable growth of cells. It occurs when a mutation or abnormal change occurs that upsets how our cells multiply and divide. This allows the cell to keep dividing, out-of-control, instead of dying and being replaced by a new cell. Sometimes these out-of-control cells cluster together and form a lump called a tumor. Tumors can form in almost any area of the body.
Experts arent sure why some men develop prostate cancer and others dont however, they have identified a few risk factors that make some men more likely to develop the condition. These include:
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About Hormonal Therapy For Prostate Cancer
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.
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Active Surveillance And Watchful Waiting
If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.
Active surveillance. Prostate cancer treatments may seriously affect a persons quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.
ASCO encourages the following testing schedule for active surveillance:
-
A PSA test every 3 to 6 months
-
A DRE at least once every year
-
Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years
Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.
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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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Summary Of The Evidence For Prostate Cancer Nutrition And Dietary Supplements
To assist readers in evaluating the results of human studies of integrative, alternative, and complementary therapies for cancer, the strength of the evidence associated with each type of treatment is provided wheneverpossible. To qualify for a level of evidence analysis, a study must:
- Report on a therapeuticoutcome or outcomes, such as tumorresponse, improvement in survival, or measured improvement in quality of life.
- Describe clinical findings in sufficient detail that a meaningful evaluation can be made.
Separate levels of evidence scores are assigned to qualifying human studies on the basis of statistical strength of the study design and scientific strength of the treatment outcomes measured. The resulting two scores are then combined to produce an overall score. For an explanation of the scores and additional information about levels of evidence analysis and scores, see Levels of Evidence for Human Studies of Integrative, Alternative, and Complementary Therapies.
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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
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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Hormonal Therapy Or Watchful Waiting In Men Over Age 70
The expression “watchful waiting” has come into common use to designate delayed hormonal therapy of patients with prostate cancer. Palliative hormonal therapy is started only if the patient develops tumor symptoms such as bone pain or renal failure secondary to ureteric obstruction. Watchful waiting is not the same thing as active surveillance, a management strategy in which no treatment is given as long as the carcinoma seems to be relatively inactive and the patients life expectancy is 15 years or more . The Gleason score is the most commonly used grading system for prostate cancer it is used, for example, in the European guideline of 2008. The two most common histological patterns seen in the biopsy specimen are added together to yield a Gleason score from 2 to 10.
The Gleason score was the dependent variable in the uncontrolled Connecticut observational study, in which only 7% of patients with a Gleason score of 4 or below died of tumor-related causes. The figure rose to 45% with a Gleason score of 7 and to 66% with a Gleason score of 8 or above. Age did not influence the tumor-specific lethality, but nearly half of the patients required hormonal treatment because of progression. Extensive comorbidity, as quantified with the Charlson comorbidity index , raised the overall but not the tumor-specific lethality 2) .
What Will I Learn By Reading This
You and your doctor may be talking about using hormone therapy to control your prostate cancer. It is important for you to learn about hormone therapy so that you will know what to expect and how best to take care of yourself before, during, and after treatment. You will learn:
It is important to think about how you will work these things into your everyday life if you and your doctor decide that hormone therapy is the best way for you to control your prostate cancer..
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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.
Use Of Hormone Therapy In Treating Prostate Cancer
Hormone therapy is used in several ways, and androgen deprivation in prostate cancer may be given using either medication or surgery. This prostate cancer treatment may be used to:
- Cause the testicles to produce less androgen
- Block androgens from doing their job throughout the body
- Block the body from producing androgens
Hormone therapy is often used for different stages of prostate cancer, including in men with low, intermediate and high risk of cancer growth and spread. This treatment is generally used:
- In cancers that have spread too extensively to be treated with radiation therapy or surgery
- In patients with pre-existing health conditions that prevent them from undergoing surgery or radiation therapy
- In cancers that recur after initial treatment or that werent completely removed by surgery or radiation therapy
- To help reduce a tumors size to make it easier to remove surgically
- For patients with a high risk of cancer recurrence
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How Does Equelle Work
Hormone-free Equelle, a non-prescription dietary supplement with naturally derived S-equol, provides menopause symptom relief by helping to reduce the frequency of hot flashes, supporting sleep quality, reducing vaginal irritation, soreness and itching, and alleviating mood swings. S-equol works by mimicking some of the actions of estrogen by preferentially binding to estrogen receptor betahelping to alleviate hot flash frequency and other symptoms associated with depleting estrogen levels during menopause.
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