How Does Hormone Therapy Work Against Prostate Cancer
Early in their development, prostate cancers need androgens to grow. Hormone therapies, which are treatments that decrease androgen levels or block androgen action, can inhibit the growth of such prostate cancers, which are therefore called castration sensitive, androgen dependent, or androgen sensitive.
Most prostate cancers eventually stop responding to hormone therapy and become castration resistant. That is, they continue to grow even when androgen levels in the body are extremely low or undetectable. In the past, these tumors were also called hormone resistant, androgen independent, or hormone refractory however, these terms are rarely used now because the tumors are not truly independent of androgens for their growth. In fact, some newer hormone therapies have become available that can be used to treat tumors that have become castration resistant.
The Future Of Hormone Therapy For Prostate Cancer
Some experts aren’t sure how much further we can improve hormone therapy for prostate cancer.
“I’m not saying that we’ve reached the end of what we can do with hormonal therapy,” Thrasher tells WebMD, “but there are only so many ways to shut down the hormonal effects. The cancer will still eventually escape.”
Brooks argues that, overall, prostate cancer is only moderately affected by hormones. “You can only do so much manipulating the levels of hormones,” says Brooks. “We have to find better ways to fight the basis of the cancer cells.”
Thrasher and Brooks have more hope that the next breakthroughs will come with different approaches, like chemotherapy or vaccines.
But Holden remains optimistic about the future of hormone therapy for prostate cancer.
“Cancer cells eventually figure out how to survive, how to overcome a specific hormone therapy,” he says. “But if we have enough types of drugs and can keep changing the hormone therapy, we might be able to keep the cancer cells in a state of confusion. We could change therapies before they have a chance to adapt.”
“It’s like an endless chess game,” he says. “You may not ever win, but you might be able to prolong the game indefinitely. I think that hormone therapy still has a lot of promise. We just need to develop better anti-androgens, and more varieties of them.”
Hormone Therapy In Older Patients
The backbone of prostate cancer treatment is hormonal therapy, which aims to limit the activation of the androgen receptor with testosterone. This limitation of AR activation may occur through agents that decrease circulating testosterone, such as gonadotropin-releasing hormone agonists or antagonists. The use of these agents also decreases testosterone precursors and other off-target effects of testosterone. Agents such as nonsteroidal anti-androgens block AR activation and yet preserve circulating testosterone levels.
Providers must carefully consider the toxicities of androgen deprivation therapy in a physiologically older population. These patients have less reserve to absorb additional imbalances or conditions that will impact their current steady state. In general, agents that result in a hypogonadal state can lead to toxicities within the following domains: metabolic and body composition sexual health and mood and central nervous system symptoms .
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Survival For All Stages Of Prostate Cancer
Generally for men with prostate cancer in England:
- more than 95 out of 100 will survive their cancer for 1 year or more
- more than 85 out of 100 will survive their cancer for 5 years or more
- almost 80 out of 100 will survive their cancer for 10 years or more
Survival for prostate cancer is also reported in Scotland and Northern Ireland. But it is difficult to compare survival between these countries because of differences in the way the information is collected.
Cancer survival by stage at diagnosis for England, 2019Office for National Statistics
These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account the background mortality that they would have experienced if they had not had cancer.
Outlook For Locally Advanced Prostate Cancer
Many men with locally advanced prostate cancer have treatment that aims to get rid of their cancer. For some men, this treatment can be very successful and they may live for many years without their cancer coming back or causing them any problems. For others, treatment may be less successful and the cancer may come back. If this happens, you might need further treatment. Read more about the risk of your cancer coming back.
Some men with locally advanced prostate cancer will have treatment that aims to help keep their cancer under control rather than get rid of it completely. For example, if you have hormone therapy on its own, it can help to keep the cancer under control, usually for several years. And there are other treatments available if your hormone therapy stops working.
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What Type Of Hormone Therapy Works Best
Unfortunately, understanding the details of hormone therapy for prostate cancer can be difficult. Which drug or combination of drugs works best? In what order should they be tried? Research hasn’t answered these questions yet.
“Right now, there’s a level of art to figuring out which agents to use,” says Durado Brooks, MD, MPH, director of prostate cancer programs at the American Cancer Society. “We don’t have clear evidence yet.”
LHRH agonists remain the usual first treatment. But in some cases, doctors are trying anti-androgens first. Anti-androgens may be especially appealing to younger men who are still sexually active, since these drugs don’t completely shut down sex drive. When anti-androgens stop working — based on PSA tests — a person then might shift onto an LHRH agonist.
Other doctors prefer to begin therapy with a combination of two or even three drugs, especially for patients with symptoms or advanced disease, says Holden.
Researchers originally hoped that combined androgen blockade would significantly add to the benefits of LHRH agonists. However, the results, to date, have been mixed. Some studies have shown slightly longer survival with combined androgen blockade, but the results haven’t been as dramatic as many experts had hoped. Other studies have shown no benefit. A possible explanation may be the type of anti-androgen used, but further studies are needed to answer this question.
What Are The Stages Of Prostate Cancer
Cancer staging is first described using what is called a TNM system. The “T” refers to a description of the size or extent of the primary, or original, tumor. “N” describes the presence or absence of, and extent of spread of the cancer to lymph nodes that may be nearby or further from the original tumor. “M” describes the presence or absence of metastases — usually distant areas elsewhere in the body other than regional lymph nodes to which the cancer has spread. Cancers with specific TNM characteristics are then grouped into stages, and the stages are then assigned Roman numerals with the numerals used in increasing order as the extent of the cancer being staged increases or the cancer prognosis worsens. Prognosis is finally reflected by considering the patient’s PSA score at presentation as well as their Gleason score in assigning a final stage designation.
The American Joint Commission on Cancer system for prostate cancer staging is as follows:
Traditionally, advanced prostate cancer was defined as disease that had widely metastasized beyond the prostate, the surrounding tissue, and the pelvic lymph nodes and was incurable. However, a more contemporary definition includes patients with lower grade disease with an increased risk of progression and/or death from prostate cancer in addition to those with widely metastatic disease.
The National Cancer Institute and the National Comprehensive Cancer Network guidelines on prostate cancer version 2.2017 indicate the following:
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How Third Stage Prostate Cancer Manifests Itself
At this stage the tumour has already grown outside the prostate gland. There are no distant metastases and no pain associated with them yet, but the patient may experience symptoms of obstruction, that is, compression of the urinary tract:
- frequent and difficult urination
- the need to push yourself when you go to the bathroom
- imperative, i.e. very intense, almost unbearable urges
- nighttime urge to pee, or nocturia
- a feeling of incomplete bladder emptying.
If the tumour has grown into the bladder neck, you may develop urinary incontinence or haematuria blood in the urine. Sometimes the patient experiences pain because the tumour is compressing the surrounding tissues. Due to the obstruction, some patients may develop renal failure or hydronephrosis enlargement of the renal pelvis.
Treatment Options For Localized Prostate Cancer
If you are diagnosed with low-risk prostate cancer, you may be presented with a number of different treatment options. The most common include:
- Active Surveillance: Your doctor may want to monitor your disease to see if treatment is necessary. With active surveillance, you will have regular check-ups with your doctors, and he or she may perform biopsies regularly. If your test results change, your doctor will discuss your options for starting treatment.
- Watchful Waiting: While some doctors use the terms active surveillance and watchful waiting interchangeably, watchful waiting usually means that fewer tests are done. You will still visit your doctor regularly, but your doctor will discuss changes in your health as they relate to managing your symptoms, not curing your disease.
- Prostatectomy: Removal of the prostate, called prostatectomy, is an option that has a strong likelihood of removing your cancer since you are removing the gland where it is located. However, this is an invasive procedure that can lead to other issues, which will be covered later.
- Radiation: Your doctor may suggest radiation as a means of therapy that targets tumors with radiation, usually through daily treatments in a hospital or clinic over multiple weeks.
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Life Expectancy And Localized Prostate Cancer
So how do these treatments affect life expectancy? In one study, researchers in Switzerland examined the treatment and outcomes of 844 men diagnosed with localized prostate cancer. They compared men who had been treated with prostatectomy, radiotherapy and watchful waiting and found that at five years from diagnosis, the type of treatment made little difference to survival. When the researchers went to 10 years from diagnosis, they did find a difference in survival based on treatment, but it was fairly small.
After 10 years, 83 percent of the men who had gotten a prostatectomy were still living, compared to 75 percent who had undergone radiotherapy and 72 percent who took a watchful waiting approach.
Know Your Priorities When Deciding On Prostate Cancer Treatment
While this one study showed that people who get a prostatectomy may live longer, it’s important to understand the risks involved with each and to know your priorities. You may be quick to want to remove your prostate or get radiation treatment to get rid of the cancer right away, however, there are many quality of life issues to take into account:
- With active surveillance, your cancer may grow and spread.
- Choosing not to treat your cancer right away could lead to anxiety.
- Men who undergo radiation are more likely to have bowel problems.
- There is a chance you may lose bladder control after surgery.
- You may lose your ability to have an erection after surgery.
The decision about how you will treat your prostate cancer is not one to be taken likely. Discussing the risks and complications with your physician and your family, and thoroughly considering your priorities, can help you make a decision that feels right for you.
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Advanced Prostate Cancer Life Expectancy And Prognosis
Typically, each stage of prostate cancer has different prognosis. In general, the advanced stages of the disease are much more difficult to treat than when the disease is still at early stage not yet spread. What are factors that affect the outlook and life expectancy of patient? The following are some statistics for each stage of this disease.
You might also like to know more about how fast prostate cancer spreads and what are the most common sites /organs of the body for the metastasis of this cancer in this section, before continuing
One thing you need to clearly understand that there is no any statistic that can be detail enough to tell you about what will happen. In other words, this statistic is only purposed for general information! In fact, each case of cancer is unique. So, there is always a chance and a hope for anyone who diagnosed with cancer.
Advanced prostate cancer symptoms
The symptoms of the disease are more likely to occur when the disease at advanced stage. This is the most challenging for doctors, because the early warning signs that are more likely to not occur will increase the number of patients diagnosed with the disease at later stages.
Once the cancerous tumor is bigger in size and also spreads to nearby sites or even other distinct organs of the body, there will be more complications that can be generated. These may include:
Understanding n-years survival statistics
The major factors that affect the outlook of patients
Surgically Removing The Prostate Gland
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.
It’s 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, you’ll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.
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How Often You Have Hormone Therapy
You usually have hormone therapy that you take all the time . Or you may have a few months of treatment and then a break . It’s thought that having intermittent therapy might reduce the side effects you get, but more research needs to be done to look into this.
You might have:
- one hormone therapy drug on its own
- two hormone therapies together
- hormone therapy with chemotherapy, such as docetaxel
Your doctor will talk to you about which hormone therapy they recommend and for how long you might have take it for.
Treating Advanced Prostate Cancer
If the cancer has reached an advanced stage, it’s no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.
Treatment options include:
- hormone treatment
- chemotherapy
If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.
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Treatments To Control And Prevent Further Cancer Spread In Patients With Castrate Refractory Advanced Prostate Cancer:
At BPC we offer:
- Hormones , Enzalutamide , Diethylstilboestrol)
- Chemotherapy .
- Radium-223
Other treatment options ongoing clinical studies:
- Autologous cellular immunotherapy, which is in late trial stage and although not currently available outside a trial setting in the UK, is likely to be licensed soon.
- Cabozantinib
My Dad Has Advanced Prostate Cancer Metastatized To Bone
Hello,
I’ve come here because I’m not sure where else to go. I’ve just found out in the past week that my Dad has prostate cancer, which has metasised to his pubic bone. His PSA levels were extrremely high, 164, and his Gleason score is 10. He’s 72, but you wouldn’t think it. He is so fit and healthy and he only went to the doctors in the first place because he had a pain in his leg, which we now know is because it spread to his bone. I am an only child, I’m 26, I live near my parents and have been staying over since we find out.
My Dad is mostly postive, he has started his hormone therapy and in July he will have 6 rounds of chemo. They can manage but they can’t cure. They said it’s really agressive cancer, but they can keep him going, but for how long? I can’t bear to watch my Dad go through this pain, he’s the kindest, sweetest most generous man. And my Mum, my Dad is my mums world, she just keeps asking me “how are we going to cope” – she’s imagining herself all alone in this home they built together, and to be honest, so am I. I am trying to be strong and resume normality but this has changed everything. I thought my Dad would live to see me get married, go far in my career. I want him to be there, to watch me grow. I don’t want him to leave Mum all alone. I don’t have any siblings to share this with – my friends are supportive and my boyfriend too but, I just feel so hopeless. Would be reassured to hear of anyone else in the same boat.
Thank you
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