What Are Estrogen And Progesterone Receptors
Normal breast cells and some breast cancer cells contain receptors that attach to estrogen and progesterone. These 2 hormones often fuel the growth of breast cancer cells. An important step in evaluating a breast cancer is to test the cancer removed during the biopsy to see if it has estrogen and progesterone receptors.
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Systemic Therapy For Metastatic Disease
The most common use of hormone therapy today is to treat men whose prostate cancer has metastasized to other parts of the body. If prostate cancer cells escape the prostate, they migrate first to surrounding structures, such as the seminal vesicles and lymph nodes, and later to the bones or, rarely, to other soft tissues.
Hormone therapy is recommended as a palliative treatment, to relieve symptoms such as bone pain. And while hormone therapy is not a cure, in that it cant eliminate prostate cancer completely, it often extends life for many years. By reducing testosterone levels, hormone therapy can shrink a prostate tumor and its metastases and slow further progression of the cancer for so long that sometimes a man with this disease dies of something other than prostate cancer.
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.
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What Side Effects May I Have After I Start Hormone Therapy
The side effects that you may have after you start hormone therapy include: erectile dysfunction or impotence , lower sexual desire , hot flashes, fatigue , weight gain, breast enlargement, osteoporosis, anemia, memory loss, and cardiovascular problems. The following side effects can happen as soon as you start your treatment.
Erection problems
Difficulty getting or keeping an erection is a common side effect of hormone therapy for prostate cancer. This is also called impotence. Hormone therapy lowers the amount of testosterone in your body or stops your body from making testosterone.
Lower sex drive
Hot flashes and sweating
Breast tenderness or growth
Some men may find that their chest becomes sore and that their breasts get a little bit swollen. This is called gynecomastia . There are medicines and treatments that you doctor or health care team can give you to help with this side effect.
Fatigue
The drop in your testosterone level may make you feel very tired. You may feel tired all the time or you may get tired more easily when you do your daily activities. This is known as fatigue or tiredness. There are things you can do to help deal with this treatment side effect.
Tumor flare pain
The following side effects may happen if you take hormone treatment for a long period of time. These are:
Weight gain
Memory problems
Anemia
Bone thinning
There are several ways you can help to lower your osteoporosis risk
Cardiovascular problems
How Long Does Hormone Therapy Work To Stop Cancer Progression
On average, hormone therapy can stop cancer progression for 1-2 years before the prostate cancer becomes resistant. Hormone therapy can stop working over time as the prostate cancer begins to grow again .
When this occurs, doctors may offer other therapies. Since they cant predict how long hormone therapy will work, they may perform regular blood tests to check PSA and testosterone levels. If PSA levels start to increase and testosterone levels are low, these may be signs that the cancer has started to grow again.
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Therapies That Interfere With Androgen Function
Taken daily as pills, antiandrogens bind to the androgen receptor proteins in the prostate cells, preventing the androgens from functioning. In addition to preventing a flare reaction, antiandrogens may be added to your treatment plan if an orchiectomy, LHRH agonist or LHRH antagonist is no longer working by itself. Commonly prescribed antiandrogens include flutamide and bicalutamide .
Enzalutamide is a newer type of antiandrogen that blocks the signal that the receptor normally sends to the cells control center to trigger growth and division. This antiandrogen may be used to treat castration-resistant prostate cancer.
Degarelix Injection May Cause Side Effects Tell Your Doctor If Any Of These Symptoms Are Severe Or Do Not Go Away:
- pain, redness, swelling, hardness, or itching in the place where the medication was injected
- excessive sweating or night sweats
- difficulty falling asleep or staying asleep
- enlargement of the breasts
- painful, frequent, or difficult urination
- fever or chills
Degarelix injection may cause your bones to become weaker and more brittle than they were at the beginning of your treatment. Talk to your doctor about the risks of taking this medication.
Degarelix injection may cause other side effects. Call your doctor if you have any unusual problems while receiving this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .
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Hormonal Therapy For Aggressive Prostate Cancer: How Long Is Enough
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Men weighing treatment options for intermediate- or high-risk cancer that is still localized to the prostate can face a tricky question. A standard approach in these cases is to give radiation to the prostate along with drugs that block testosterone, a hormone that makes the cancer cells grow faster. For how long should this hormone therapy last? Thats not entirely clear. The drugs have side effects, such as fatigue, impotence, and a loss of muscle mass. But radiation doesnt control prostate cancer effectively without them. Doctors therefore aim to give hormone therapy only for as long as it takes to help their patients, without causing any undue harm.
Now, newly published results from a phase 3 clinical trial are providing some needed guidance.
What To Expect During Hormone Therapy
As you go through hormone deprivation therapy, youâll have follow-up visits with your cancer doctor. Theyâll ask about side effects and check your PSA levels.
Doctors donât know how long hormone therapy works to keep prostate cancer in check. So, while you take it, your doctor will regularly draw blood to check your PSA levels. Undetectable or low PSA levels usually mean that the treatment is working. If your PSA levels go up, itâs a sign that the cancer has started growing again. If this happens, your cancer is considered castrate-resistant, and hormone deprivation therapy is no longer an effective treatment.
Youâll also get other blood tests to see if the cancer is affecting other parts of your body like your liver, kidneys, or bones. Scans will show how well your cancer is responding to hormone therapy.
To lessen the side effects of hormone therapy drugs, researchers suggest that you take them for just a set amount of time or until your PSA drops to a low level. If the cancer comes back or gets worse, you may need to start treatment again.
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Radiation Therapy Side Effects
Because the prostate is close to several vital structures, radiation therapy can disrupt normal urinary, bowel, and sexual functioning.Short-term ComplicationsYou may experience some temporary urinary symptoms, such as waking up in the night and needing to urinate, needing to urinate more often during â¦
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What Are The Side Effects Of Hormone Therapy For Prostate Cancer
Because androgens affect many other organs besides the prostate, ADT can have a wide range of side effects , including:
- loss of interest in sex
Studer UE, Whelan P, Albrecht W, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer Trial 30891. Journal of Clinical Oncology 2006 24:18681876.
Zelefsky MJ, Eastham JA, Sartor AO. Castration-Resistant Prostate Cancer. In: Vincent T. DeVita J, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology, 9e. Philadelphia, PA: Lippincott Williams & Wilkins 2011.
Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. European Urology 2021 79:150158.
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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 .
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How Is Hormone Therapy Used To Treat Cancer
Doctors often use hormone therapy along with other types of cancer treatment, such as radiation therapy, chemotherapy, or surgery. If a person cannot have those treatments because of other health problems, hormone therapy may be used alone.
Hormone therapy can be used in different ways at different times. These include:
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Before surgery or radiation therapy to shrink a tumor. This is called neoadjuvant therapy.
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After other cancer treatments to reduce the risk that cancer will come back. This is called adjuvant therapy.
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For cancer that comes back after treatment, called recurrent cancer.
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For cancer that has spread to other parts of the body, called metastatic cancer.
The goal of hormone therapy depends on the type of cancer and how far it has spread. Sometimes, the goal is to keep cancer from coming back after treatment. Or the goal may be to stop or slow cancer growth.
Hormone therapy may also be used to help prevent or manage cancer symptoms. Relieving side effects is an important part of cancer care and treatment. This is called palliative care or supportive care. Be sure to ask your doctor why a specific hormone therapy is being recommended for you and how the therapy will contribute to your cancer treatment plan.
Treatment To Lower Androgen Levels From Other Parts Of The Body
LHRH agonists and antagonists can stop the testicles from making androgens, but cells in other parts of the body, such as the adrenal glands, and prostate cancer cells themselves, can still make male hormones, which can fuel cancer growth. Some drugs can block the formation of androgens made by these cells.
Abiraterone blocks an enzyme called CYP17, which helps stop these cells from making androgens.
Abiraterone can be used in men with advanced prostate cancer that is either:
- Castration-resistant
This drug is taken as pills every day. It doesnt stop the testicles from making testosterone, so men who havent had an orchiectomy need to continue treatment with an LHRH agonist or antagonist. Because abiraterone also lowers the level of some other hormones in the body, prednisone needs to be taken during treatment as well to avoid certain side effects.
Ketoconazole , first used for treating fungal infections, also blocks production of androgens made in the adrenal glands, much like abiraterone. It’s most often used to treat men just diagnosed with advanced prostate cancer who have a lot of cancer in the body, as it offers a quick way to lower testosterone levels. It can also be tried if other forms of hormone therapy are no longer working.
Ketoconazole also can block the production of cortisol, an important steroid hormone in the body, so men treated with this drug often need to take a corticosteroid .
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Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. This condition causes pain in the lower back and groin area, and may cause urinary retention. Symptoms include leaking and discomfort. In severe cases, a catheter may be required to relieve the symptoms. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. If these do not work, your symptoms could progress and become chronic.
An acute bacterial infection can cause a burning sensation. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. The symptoms of acute bacterial prostatitis are similar to those of CPPS. Patients may experience a fever or chills as a result of the infection.
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The Side Effects Of Anti
Most men tolerate anti-androgen therapy well.
- Bone density loss
- Irritability or mood swings
- Enlargement of breasts
- Starting patients on Vitamin D and calcium, providing consultation with our endocrinology team about preserving bone health, and getting baseline bone density scans when indicated
- Encouraging men to commit to active physical therapy and aerobic exercise to limit weight gain, preserve muscle composition, and even retain urinary function and control it better
- Recommending medications to help with hot flashes and mood changes that can arise during hormone therapy
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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.
Treating Prostate Cancer With Combined Hormonal
Androgens, the family of male sex hormones that includes testosterone, function as a fuel for growth in normal development. However, in some men they can also drive the progression of prostate cancer. Hormonal therapy treats prostate cancer by dramatically reducing levels of testosterone and other androgens.
Hormonal therapy is sometimes given in conjunction with external beam radiation to boost the effectiveness of treatment. Hormonal therapy may also be used to shrink the size of large prostate glands before brachytherapy takes place, to enable proper placement of the radioactive seeds.
Combination hormonal/radiation therapy is now a standard option for men with cancer that has extended beyond the prostate or whose cancer is considered high-risk based on other clinical findings, with studies showing that it reduces the risk of dying from prostate cancer and other causes more than with either treatment given alone..
Combination therapy can also be considered for men with localized prostate cancer in the intermediate-risk category. Whether men with low-risk prostate cancer would benefit from a hormonal therapyradiation combination is uncertain.
Image: sturti/Getty Images
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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.
Heres What The Results Showed
After a median follow-up of just over 10 years, 9.7% of men who were treated with radiation and leuporelin for 18 months had died from prostate cancer, compared to 13.3% of the men treated with radiation and leuporelin for six months. Adding zoledronic acid made no difference in either case.
The authors concluded that hormonal therapy is more effective at preventing prostate cancer death when its given for 18 months rather than six. And similar benefits were noted for other endpoints as well. For instance, prostate tumors were less likely to metastasize, or spread, among men in the longer duration treatment group, and it took longer for their cancers to become resistant to hormone therapy if it was reinitiated later.
In earlier clinical research, scientists discovered that hormonal therapy given for three years protects against prostate cancer death more effectively than a six-month treatment regimen. But three years of hormone therapy isnt easily tolerated, and evidence so far shows that 10-year survival rates after either 18 months or three years of hormonal therapy are similar, the authors of the new study claim.
About the Author
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
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