Complications Of Hormonal Therapy
E. David Crawford, MD, Professor of Surgery and Radiation Oncology, Head of the Section of Urologic Oncology at the University of Colorado, and Chairman of the 16th International Prostate Cancer Update, provided an excellent overview of complications of hormonal therapy and their treatment. He began this discussion by outlining not only the benefits but also the complications of androgen deprivation, the latter including osteoporosis, hot flushes, gastrointestinal side effects, anemia, gynecomastia, sarcopenia, central nervous system effects, change in body weight, sexual dysfunction, loss of bone density, and increased risk of bone fracture and hot flushes .
Prostate Cancer : : Unexpected Weight Loss During Hormone Therapy
My 65 yr old brother was diagnosed with PC last December and has been receiving hormone therapy injections since then.He recently commented that hed lost about a stone in weight since January and I started worrying. Since doing some research on the net, Im still worried as I can only find weight gain mentioned as a common side effect of this therapy. The only mention of weight loss is in connection with other symptoms such as loss of appetite due to sickness, bone pain etc in more advanced cancer. So far he hasnt had any of those and his only symptoms, apart from a few hot flushes, are an increased need to pee and taking longer to do so. He hasnt been on a strict diet and, although hes been more careful in what he eats for several years, he hasnt been able to shift much weight until now. He still has a healthy appetite.I dont know whether were worrying unnecessarily or whether he should have a word with the doctor.
Origins Of The Concern
The basis for the fear that testosterone therapy increases the risk of prostate cancer originated with the work of Charles B. Huggins, a urologist at the University of Chicago. Huggins was initially interested in the medical condition called benign enlargement of the prostate, called benign prostatic hyperplasia , which causes frequent and urgent urination and also can occasionally cause complete obstruction of the urine passageway. Benjamin Franklin was reported to have suffered from BPH and was credited with inventing a tube he inserted through the urine channel to relieve the obstruction.
Curiously, dogs are the only species we know of other than humans that naturally develop prostate problems on a regular basis. At the turn of the twentieth century, there were reports that castration was successful in treating some men with severe obstruction from BPH, and Huggins began experimenting on the effects of castration on BPH in dogs. Not only did the dogs prostates shrink after castration, but Huggins made an additional far-reaching observation. Huggins noticed that the microscopic appearance of prostates of some of these dogs contained areas that were indistinguishable from human prostate cancers. Even more importantly, after castration, dogs with these cancerous-appearing areas also demonstrated shrinkage of their prostates. Indeed, when their prostates were removed, the dogs had no further evidence of the cancerous-appearing areas.
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Hormone Therapy After Novasure Procedure For Severe Cramping
I have been suffering from severe cramps for several months now. They are so painful I can’t move or hardly talk I’m dripping with sweat and feel like I’m going to pass out. I was set up to have the Novasure procedure done, when the doctors office called and said insurance won’t cover it till I do 3 months of hormone therapy. I’ve heard nothing good about the hormone therapy if someone can give me their experiences with it?
Dr Kathy Maupin And Brett Newcomb Discuss How Testosterone Replacement Affects Prostate Cancer In Men
One of the most prevalent fears of disease that men encounter as they age is prostate cancer. Common wisdom states that if a man lives long enough, he will get prostate cancer, andif nothing else kills him firsthe will die from it. However, most men wrongly believe that testosterone, which they require to stay young and virile, is the cause of prostate cancer. We are presenting the truth behind the fiction in this weeks healthcast.
Many men have been reluctant to replace their declining testosterone because there has been an unsubstantiated belief among most men and some physicians that replacing testosterone increases the likelihood of prostate cancer. That myth, however, has been laid to rest by some recent research results.
This week, my friend Brett Newcomb and I will be discussing this research and spreading the good news that there is absolutely no causation established between replacing testosterone lost to aging, and the development of prostate cancer. If you are genetically programmed to get prostate cancer, you will eventually get it if you live long enough. Contradictory evidence has been uncovered that proves that replacing testosterone can prevent men with low levels of T from developing it.
Listen to our podcast to hear more about this good news and then contact your doctor to see if testosterone replacement might be right for you.
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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.
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.
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Confirming What Weve Practiced For Years
- What was the grade of the cancer?
- Was it at the edge of the removed prostate gland?
- Was it in the attached seminal vesicles or extending beyond the capsule?
- Was there cancer in any removed lymph nodes?
- What is the trend of serum PSA since surgery?
- How old is the patient, what are his other medical issues, and what are his goals?
When Is Hormone Therapy Used For Prostate Cancer
On its own, hormone therapy can be a good way to control the growth of your prostate cancer. It can also be used with another prostate cancer treatment to help it work better. You should keep in mind that the following things will affect when you have hormone therapy and if you have hormone therapy along with another type of prostate cancer treatment:
- The grade of your prostate cancer
- Your Gleason score
- The stage of your prostate cancer
- Your PSA level
- Your age
- Your general health
Your stage, grade, and Gleason score are determined by a pathologist. A pathologist is a specially trained physician who reviews biopsy results in order to find changes in your body caused by cancer. When you had your prostate biopsy, the pathologist looked at the tissue samples taken from your prostate gland and prepared your biopsy report. The report tells you and your doctor the following information:
- The grade tells you what your prostate cancer cells look like.
- The Gleason score. The Gleason score tells you what your prostate cancer cells look like compared to healthy cells and gives you an idea of how quickly your cancer is growing. Your Gleason score will range from 2 to 10.
- The stage tells how much prostate cancer you have and where your cancer is located.
This information is used to help your doctor chose the most effective type of hormone therapy for you. The types of hormone therapy include:
Neoadjuvant hormone therapy
Adjuvant hormone therapy
Salvage hormone therapy
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When During Cancer Treatment Is Hormonal Therapy Given
Hormonal therapy is often given in conjunction with other treatments. The timing varies depending on the tumor, its stage and its location, among other factors:
- Neoadjuvant hormonal therapy is when hormones are given before surgery or radiotherapy. The goal is to make a tumor shrink, so its smaller, which can make it easier to treat.
- Adjuvant hormonal therapy is given after the patient has received surgery, radiation therapy or chemotherapy. Given after treatment, hormones decrease the risk of cancer recurring or spreading.
What Can You Do To Protect Yourself
The first step is to have your blood work done and the results evaluated by a healthcare professional experienced in hormone supportive therapy. If your prolactin levels are higher than they should be, there are medications available and over-the-counter supplements to keep prolactin levels low. As with any hormonal supportive therapy, it is very important to carefully monitor that therapys effect on your other hormones. Frequent screening is important.
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What Have I Learned By Reading This
You learned about:
- Why you may need hormone therapy
- How hormone therapy works
- Ways to get hormone therapy
- What to expect when you have hormone therapy
- What side effects you may have from hormone therapy
If you have any questions, please talk to your doctor or healthcare team. It is important that you understand what is going on with your treatment. This knowledge will help you take better care of yourself and feel more in control so that you can get the most from your treatment..
Will I Need To See My Doctor During And After Hormone Therapy
Yes, you will need regular medical checkups while getting hormone therapy. During these checkups your doctor will look at your medical history and give you a physical exam. Your checkup may include blood tests and imaging tests. For example:
- Some hormone therapy medicines can cause problems with your liver. So your doctor will watch your liver function with a blood test before you start treatment and at regular time points during the first four months of your treatment, and at regular times after that.
- Other hormone therapy medicines can cause you to get diabetes or become insulin resistant. In this case, your doctor may watch your blood sugar during your treatment. Insulin is a hormone produced by your body that helps change the food you eat into energy. When you are insulin resistant your body needs to make more and more insulin. Over time, this can cause you to have diabetes.
- Some hormone therapy medicines can increase your risk for cardiovascular problems. When your testosterone level drops your blood pressure and cholesterol may increase. This can put you at risk for cardiovascular problems such as a heart attack. Your doctor will watch your blood pressure and cholesterol.
- Your doctor will also check to make sure you dont have anemia. This is done with a simple blood test.
- Your doctor may also order a bone density test to check if you have osteoporosis.
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Side Effects Of Hormonal Therapy
Reducing the level of testosterone can cause different side effects. There are different ways hormonal side effects can be managed or treated. Your doctor or nurse will explain these to you. Some side effects are only likely to affect you when you have hormonal therapy for over 6 months.
Common side effects include the following:
- Erection difficulties and reduced sex drive
This usually improves after you stop treatment, but it may take a few months. If you have erectile dysfunction , there are drugs and treatments that may help.
- Hot flushes and sweats
Hot flushes and sweats may reduce as your body adjusts to treatment. They usually stop completely 3 to 6 months after treatment finishes.
- Tiredness and difficulty sleeping
Tiredness is common, and hot flushes may make sleeping difficult. Regular physical activity can help reduce tiredness.
- Mood changes
Talking to someone close to you or a counsellor may help.
Different hormonal therapies have different side effects. It is important to discuss these with your doctor or nurse before treatment so you know what to expect.
What Causes Prostate Cancer
Identifying a single cause of prostate cancer is difficult in most instances. A host of environmental and lifestyle factors influence the development of prostate cancer on a case-by-case basis.Some men are more prone to developing prostate cancer than others. The known risk factors for prostate cancer are:
- Age. Age is by far the single factor with the most direct correlation to prostate cancer risk. In fact, 80% of prostate cancer patients are 65 and older.
- Family history. If you have a direct relative with prostate cancer, your risk increases. This is due to the proven link between genetics and prostate cancer.
- Ethnicity. The data indicates that African Americans have higher incidences of prostate cancer in the United States and throughout North America.
- Diet. As with all forms of cancer, diet plays a huge role in the likelihood of developing prostate cancer. A healthy, whole-foods based diet delivers the nutrients that your immune system needs to eliminate unhealthy cells that could turn cancerous while tamping down a major risk factor for all cancers.
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Hormone Therapy Helps Some Prostate Cancer Survivors Live Longer
A study published in the New England Journal of Medicine in January 2017 indicates that men whose prostates are removed to treat prostate cancer are likely to survive longer if they take drugs to block the male hormone testosterone in addition to undergoing radiation therapy.
Unfortunately, its not that simple.
Association Vs Causation: A Crucial Distinction In Science
When assessing the potential risk that HGH therapy poses for cancer development, its vital that we understand the all-important scientific distinction between association and causation. While many studies have proven an association between HGH levels and prostate cancer incidence, none have demonstrated causality. This means that several confounding factors other than a direct catalyzing effect of HGH on cancer growth may better explain the link.
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Questions To Ask Your Doctor
These questions may be useful to you when you talk to your doctor about your hormone therapy:
About hormone therapy
- Why are you suggesting hormone therapy for me?
- What type of hormone therapy will be used?
About your treatment
- How often will I need this medicine?
- How long will I be on hormone therapy?
- Are there other choices of treatment in my case?
- Will I need regular blood tests while I am on hormone therapy?
- What will these tests tell us?
- Do I need to eat a special diet?
- Should I exercise?
About Side Effects
- Will I lose my sex drive and become impotent? Will this be temporary or will it last forever?
- What other side effects might I have?
- How long will these side effects last?
- When will these side effects happen?
- Are there any side effects I should tell you about right away?
- What can I do to manage my side effects?
About Contacting Your Doctor
- How do I get in touch with you or my health care team after your office is closed?
Selective Estrogen Receptor Modulators
Selective estrogen receptor modulators including tamoxifen , raloxifene and toremifene selectively block estrogen from certain tissues, namely the breast, while increasing its availability in other areas such as the bones.
When and why theyre used: Doctors may recommend SERMs after surgery for early ER-positive breast cancer in men or women, to reduce the chances that it recurs. Theyre also approved to treat advanced breast cancer, and may be used to prevent breast cancer in high-risk individuals. Toremifene is only approved for advanced stage breast cancer that has spread.
Risks: In addition to more common side effects of hormone therapy such as hot flashes, tamoxifen risks may include blood clots, stroke, bone loss, mood changes, depression and loss of sex drive. Men who take tamoxifen may experience headaches, nausea, vomiting, rashes, impotence and loss of sex drive. Raloxifene may increase a patients chances of having a stroke or developing potentially fatal blood clots in the lungs or legs. Fortunately, these side effects are considered relatively rare. Have your doctor explain the potential side effects associated with each SERM when discussing the pros and cons of these medications with you.
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