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Hormone Therapy For Prostate Cancer Not Working

How Can I Lower My Testosterone With Surgery

Intermittent Hormone Therapy for Prostate Cancer 101 | Ask a Prostate Expert, Mark Scholz, MD

The majority of the testosterone in your body is made by your testicles. You can lower your testosterone with an operation called an orchiectomy. An orchiectomy is a simple and effective way to lower the amount of testosterone in your body. However, it is a permanent form of hormone therapy.

Your surgery

Some men are concerned about how their body will look after their testicles are removed. There are testicular prostheses , or artificial testicles, that can be placed in your scrotum to replace the testicles removed during your surgery. The prostheses make your scrotum look like it did before surgery. If youare concerned about how your body will look, speak with your doctor or health care team about artificial testicles.

After surgery

Your scrotum may feel a little bit sore and may be swollen. You will be given medicines to relieve the soreness. You may use ice packs for the first day or two after your orchiectomy to help with the swelling. Remember, do not put the ice pack directly on your scrotum. Put a towel or piece of clothing over your scrotum, then place the ice pack on top of it. You will need to keep your incision clean and dry. Your doctor and health care team will tell you how to clean your incision. You will need to avoid heavy lifting or hard activity for one to two weeks following your surgery.

Follow-up tests

Possible side effects

More hormone treatment

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.

Will Side Effects Limit What I Can Do

What you are able to do will depend on which side effects you have and how bad they are. Many men are able to work, cook meals, and enjoy their usual daily activities when they have hormone therapy for their prostate cancer. Other men find that they need more rest than before they started hormone therapy so they cant do as much. You should try to keep doing the things you enjoy as long as you don’t get too tired.

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Are There Alternative Treatments

Even with prostate cancer spreading, hormone therapy will continue as it will help lower testosterone production. Other treatment options will include chemotherapy, radiotherapy, steroids, anti-androgens, clinical trials, etc.

The treatment options recommended by your doctor will be based on several factors

  • The kind of symptoms you are experiencing and how the treatment will impact them.
  • The side effects you might experience for the treatment and their effect on your overall health
  • The period of time that first hormone therapy was effective.
  • The extent of the spread and any underlying health conditions.
  • After analyzing these factors, your doctor will recommend treatment but they will also put your thoughts into consideration. They will lay out the facts for you and then ask for your opinion on the possible side effects and how the treatment would affect your daily life.

    How Effective Is Hormone Therapy At Treating Prostate Cancer

    Hormone Therapy  Does It Treat Prostate Cancer?

    While hormone therapy cant cure your prostate cancer, it can stop or slow the growth of the prostate cancer cells in your body. Hormone therapy is remarkably effective, says Dr. Ornstein. Probably over 90 percent of patients will have a nice drop in their PSA while they are on androgen deprivation therapy. The cancer should not grow or spread, because there is no more fuel, he explains.

    In many men, however, some cells gain the ability to grow even in the low-testosterone environment created by hormone therapy. As these hormone therapy-resistant prostate cancer cells continue to multiply, the hormone therapy, not surprisingly, has less and less effect on the growth of the tumor.

    Prostate cancer that is no longer responding to hormone therapy is referred to as castration-resistant prostate cancer.

    Fortunately, men with castration-resistant prostate cancer have more options for treatment than ever before. At that point, we can add something new, such as a newer hormonal agent, chemotherapy, or a different chemotherapy, if you had one up front, or an immunotherapy, explains Ornstein.

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    Functionalization Of Agnps With Glucosamine

    After synthesis, the functionalization of AgNPs with glucosamine was done by ligand exchange.29 For that, 1 mg of AgNPs was redispersed with 2 mL of 2 mM sodium citrate containing 5 mM glucosamine hydrochloride, and the solution was stirred for 24 h at room temperature. Finally, the resulting G-AgNPs were washed, redispersed in MQ-water, and stored at 4 °C.

    Advising The Patient About Hormonal Therapy

    Finally, Mark Moyad, MD, Director of Complementary and Preventive Medicine, University of Michigan, Department of Urology and Oncology, delivered an excellent discussion of the 10 steps he takes in advising patients about initiation of androgen deprivation therapy. Step 1 is to introduce patients to the common and less common side effects of androgen deprivation therapy . Step 2 is to introduce the patient to moderate, practical, and realistic dietary and lifestyle changes that promote general health during the androgen deprivation therapy. Dr. Moyad stated that recommendations for cardiovascular well-being extrapolate well to provide benefit to patients receiving androgen deprivation therapy. Step 3 is to emphasize that when it comes to over-the-counter supplements and other alternative approaches, less is more. He emphasized that some of these agents might have adverse effects on surgery or radiation therapy and that patients should discontinue these agents at least 1 week before definitive treatment. Step 4 is to remind patients that there might be dyslipidemia associated with androgen deprivation therapy patients should be told, know your lipid levels as well as your PSA.

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    What Should Patients Know About Msks Approach To Treating Prostate Cancer

    At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease. There is no one specific therapy that is best for everyone.

    Our initial assessment includes a carefully evaluated biopsy and a very detailed MRI to show the location of the disease, the integrity or soundness of the capsule surrounding the prostate, and the amount of disease. We will often obtain next-generation imaging and do genomic testing. Then, based on that information and with input from the urologist, the radiation oncologist, and the medical oncologist we can provide a comprehensive recommendation.

    The radiotherapy we do here at MSK is state-of-the-art and unparalleled. We are one of the few centers in the world to do MRI-based treatment planning and one of the few centers in the US to offer MRI-guided treatment. When we give brachytherapy, we use computer software that provides us with real-time information about the quality and accuracy of the seed implant during the procedure. It requires a great deal of collaboration with our medical physics team to try to get the most accurate positioning of the prostate during the actual three or four minutes of the treatment.

    We make adjustments while the patient is still under anesthesia, so that when the procedure is completed, we have been able to achieve ideal placement of the radiation seeds. This translates into improved outcomes.

    Prostate Cancer Treatment: What Next After Hormone Therapy

    Hormone Therapy & Advanced Therapies for Prostate Cancer, Celestia Higano, MD | 2021 Mid-Year Update

    Hormone therapy is a form of prostate cancer treatment thats recommended for men with advanced localized cancer and metastatic cancer.1 This is where cancer spreads to the tissues surrounding the prostate like the lymph nodes and eventually the bones.

    Rather than cure cancer, its main focus is to control it by slowing its spread and is sometimes accompanied by chemotherapy.

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    Hormone Therapy And Prostate Cancer

    Prostate cancer is fueled by testosterone, a hormone produced in the testicles. The aim of HT is to interfere with either testosterone production or cancer cells’ ability to use testosterone. Medical evidence tells us that eliminating or substantially reducing testosterone production has a significant impact on controlling progression of the disease and may even halt progression. Testosterone is one of several hormones called androgens that are linked to sexual health and other processes in the body. This is why HT is often referred to as androgen deprivation therapy .

    To be clear, this is not the “hormone therapy” of which you often hear. Women get “hormone therapy” to supplement waning estrogen levels, and older men without prostate cancer may get “hormone therapy” that administers additional testosterone. The “hormone therapy” we are talking about for men with prostate cancer is more accurately described as androgyn deprivation therapy . It is given to lower testosterone levels.

    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.

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    What Kinds Of Medical Information Should I Keep

    It is important for you to keep a copy of your prostate cancer treatment records. You may not always see the same doctor for your follow-up care, so having this information to share with another doctor can be very helpful. The following is a list of medical information you may want to keep.

    • The results of any tests you have taken such as your Prostate-Specific Antigen test.
    • When you found out you had prostate cancer.
    • Information on the kinds of treatment you have had for your prostate cancer including:
    • The places and dates where you had your treatment.
    • What type of treatment you had. And,
    • Any medicines you took before, during, and after your prostate cancer treatment.
  • Contact information for all your doctors and the other members of your health care team who helped with your prostate cancer treatment and followup care.
  • Any side effects or problems you had during and after your prostate cancer treatment.
  • Any supportive care you got during your treatment. Supportive care is treatment given to keep, control, or make your side effects better and to make your life better. For example, pain medicine, emotional support, and nutritional supplements.
  • Orchiectomy Surgical Removal Of The Testicles

    Anti

    Once a common treatment, orchiectomy is rarely used now, thanks to the development of advanced ADT drugs. The procedure removes the testicles the source of most testosterone production. The scrotal sac is left intact, and patients can have testicular prostheses implanted for cosmetic purposes. Orchiectomy is effective in drastically reducing levels of testosterone, but it has several downsides. Removal of the testicles is permanent and irreversible. Loss of the testicles makes it challenging to have intermittent hormone therapy, an advantageous treatment. And there is a psychological effect: Many patients feel distress related to the idea of lost masculinity if they undergo this procedure.

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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.

    What Have I Learned By Reading This

    You learned about:

    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..

    • The results of any tests you have taken such as your Prostate-Specific Antigen test.
    • When you found out you had prostate cancer.
    • Information on the kinds of treatment you have had for your prostate cancer including:
    • The places and dates where you had your treatment.
    • What type of treatment you had. And,
    • Any medicines you took before, during, and after your prostate cancer treatment.
  • Contact information for all your doctors and the other members of your health care team who helped with your prostate cancer treatment and followup care.
  • Any side effects or problems you had during and after your prostate cancer treatment.
  • Any supportive care you got during your treatment. Supportive care is treatment given to keep, control, or make your side effects better and to make your life better. For example, pain medicine, emotional support, and nutritional supplements.
    • What hormone therapy is

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    Medical Research Council Study

    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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    Hormone Therapy For Prostate Cancer

    Hormone Therapy Basics | Ask a Prostate Cancer Expert, Mark Scholz, MD

    Jump to a section

    Hormone therapy is also called androgen suppression therapy. The goal of this treatment is to reduce levels of male hormones, called androgens, in the body, or to stop them from fueling prostate cancer cell growth.

    Androgens stimulate prostate cancer cells to grow. The main androgens in the body are testosterone and dihydrotestosterone . Most androgens are made by the testicles, but the adrenal glands as well as the prostate cancer cells themselves, can also make androgens.

    Lowering androgen levels or stopping them from getting into prostate cancer cells often makes prostate cancers shrink or grow more slowly for a time. But hormone therapy alone does not cure prostate cancer.

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    Biochemical Recurrence And Hormone Therapy

    Hormone therapy is the standard of care for patients with metastatic prostate cancer, but for patients whose only sign of cancer recurrence is a rising PSA level , the benefits are less clear.

    Some doctors think that hormone therapy works better if its started as soon as possible, even if a man is not having any symptoms. Other doctors feel that, because of the side effects of hormone therapy and the chance that the cancer could become resistant to the therapy, treatment shouldnt be started until symptoms develop. This issue is being actively studied.

    What Are Male Sex Hormones

    Hormones are substances that are made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs.

    Androgens are a class of hormones that control the development and maintenance of male characteristics. The most abundant androgens in men are testosterone and dihydrotestosterone .

    Androgens are required for normal growth and function of the prostate, a gland in the male reproductive system that helps make . Androgens are also necessary for prostate cancers to grow. Androgens promote the growth of both normal and cancerous prostate cells by binding to and activating the androgen receptor, a protein that is expressed in prostate cells . Once activated, the androgen receptor stimulates the expression of specific genes that cause prostate cells to grow .

    Almost all testosterone is produced in the testicles a small amount is produced by the adrenal glands. Although prostate cells do not normally make testosterone, some prostate cancer cells acquire the ability to do so .

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