Treatments To Control Advanced Prostate Cancer
If youve just been diagnosed with advanced prostate cancer, you may be offered the following treatments:
- chemotherapy with hormone therapy
- clinical trials.
Chemotherapy with hormone therapy
Chemotherapy uses anti-cancer drugs to kill cancer cells, wherever they are in the body. It wont get rid of your prostate cancer, but it aims to shrink it and slow down its growth. You might be offered chemotherapy at the same time as, or soon after, you start having hormone therapy. This helps many men to live longer, and may help delay symptoms such as pain.
You need to be quite fit to have chemotherapy. This is because it can cause side effects that are harder to deal with if you have other health problems. Read more about chemotherapy.
Hormone therapy will be a life-long treatment for most men with advanced prostate cancer.
Prostate cancer usually needs the hormone testosterone to grow. Hormone therapy works by either stopping your body from making testosterone, or stopping testosterone from reaching the cancer cells. This usually causes the cancer to shrink, wherever it is in the body. Hormone therapy can also help control symptoms of advanced prostate cancer, such as bone pain.
Hormone therapy can cause side effects speak to your doctor or nurse about ways to manage these. Read more about hormone therapy, and its side effects.
When Hormone Therapy Is Indicated
HT can be administered before, during or after a localized treatment, such as radical prostatectomy, radiation, high-intensity focused ultrasound or cryotherapy. When given before a localized treatment, it is called neoadjuvant therapy. When given after localized treatment without evidence of prostate cancer recurrence, it is called adjuvant therapy. When HT is prescribed after localized treatment for a prostate cancer recurrence, it is called salvage therapy. If a patient’s PSA starts rising after a radical prostatectomy, HT is typically given in combination with radiation therapy. Treatment recommendations are based on each patient’s specific circumstances.
Sometimes we give neoadjuvant HT while the patient is deciding on his primary treatment or to reduce the tumor’s size before starting primary treatment. Neoadjuvant HT will usually slow or stop cancer growth for a period of time.
Many radiation oncologists use HT along with radiation treatment in the belief that HT weakens cancer cells so that they’re more susceptible to destruction by the radiation. Clinical studies have suggested a synergy between radiation therapy and hormone therapy meaning they work better together. Clinical trials have shown improved outcomes for patients who receive combined therapy.
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:
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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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.
When Hormone Therapy Is Recommended
Hormone therapy is typically given to patients with intermediate- or high-risk prostate cancer. It may be used in the following ways:
- In combination with radiation, mostly for patients with high Gleason scores or other high-risk factors.
- After radiation or surgery when PSA rises, indicating a recurrence.
- As therapy for patients unsuitable for radiation or surgery.
- As therapy for metastatic prostate cancer . It may be given instead of or in combination with chemotherapy.
HT is usually not prescribed for:
- Patients choosing a localized treatment for low-risk prostate cancer
- Low-risk patients preferring to monitor their cancer on an active surveillance program
HT may be an option for patients who are not candidates for surgery, radiation or other localized treatment because of age, pre-existing health conditions or concerns about potential side effects of localized treatments.
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Is The Active Ingredient In Equelle Also Found In Foods
The active ingredient in Equelle is S-equol. Trace amounts of S-equol are found in animal-based foods due to the fact its produced by gut bacteria in animals. Richer food sources of S-equol include popular and traditional fermented tofu products in Taiwan known as chou-doufu. S-equol has also been added to some food bars in the US.
What Causes Hot Flashes
According to research from several studies, 70%80% of men who receive hormone therapy experience hot flashes.1 The low testosterone produced by the therapy causes this, but scientists don’t know exactly how reduced testosterone results in hot flashes. Most research points to the thermal control center in the part of the brain known as the hypothalamus.2 The normal way the nervous system sends out signals in our thermal control center is disrupted by the sudden hormonal imbalance caused by ADT.
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Tips For Dealing With Hot Flashes
- Use a fan or air conditioning to keep your room at a cooler temperature
- Wear clothing in layers so you can remove a layer when you overheat
- Wear underwear and clothing made of natural fibers instead of synthetic fibers
- Take a shower or bath using lukewarm water instead of hot water
- If you sweat a lot while sleeping, put a towel on your bed
- Use a cooling pad to help keep you cool
- Drink alcohol in moderation, alcohol negatively impacts your body’s thermal control center
- Put a damp towel in the freezer and wrap around your neck when you are experiencing a hot flash
Have you found something that works well in helping you deal with hot flashes? Let us know in the comments!
Side Effects From Drug Therapy For Hot Flashes And Night Sweats May Develop
Side effects of non-hormonal drug therapy may include the following:
- Antidepressants used to treat hot flashes over a short period of time may cause nausea, fatigue, dry mouth, and changes in appetite. Some antidepressants may change how other drugs, such as tamoxifen, work in the body.
- Anticonvulsants used to treat hot flashes may cause fatigue, dizziness, and trouble concentrating.
- Clonidine may cause dry mouth, fatigue, constipation, and insomnia.
Side effects from drug therapy may vary from person to person, so treatment and dose will be specific to your needs. If one medicine does not improve your symptoms, switching to another medicine may help.
Drugs That Stop Androgens From Working
For most prostate cancer cells to grow, androgens have to attach to a protein in the prostate cancer cell called an androgen receptor. Anti-androgens are drugs that also connect to these receptors, keeping the androgens from causing tumor growth. Anti-androgens are also sometimes called androgen receptor antagonists.
Drugs of this type include:
They are taken daily as pills.
In the United States, anti-androgens are not often used by themselves:
- An anti-androgen may be added to treatment if orchiectomy or an LHRH agonist or antagonist is no longer working by itself.
- An anti-androgen is also sometimes given for a few weeks when an LHRH agonist is first started. This can help prevent a tumor flare.
- An anti-androgen can also be combined with orchiectomy or an LHRH agonist as first-line hormone therapy. This is called combined androgen blockade . There is still some debate as to whether CAB is more effective in this setting than using orchiectomy or an LHRH agonist alone. If there is a benefit, it appears to be small.
- In some men, if an anti-androgen is no longer working, simply stopping the anti-androgen can cause the cancer to stop growing for a short time. This is called the anti-androgen withdrawal effect, although it is not clear why it happens.
Enzalutamide , apalutamide and darolutamide are newer types of anti-androgens. They can sometimes be helpful even when older anti-androgens are not.
These drugs are taken as pills each day.
How Is Equelle Naturally Derived
The active ingredient in Equelle, S-equol, is derived naturally through a patented process in which soy germ is fermented.
Fermented soy germ is when soy germ undergoes a process with bacteria that allows for production of key compounds. The type of bacteria used in this process is commonly found in diet through foods that undergo fermentation processes such as cheese. It may also be found in the human gut of some individuals.
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Cooling Down Hot Flashes
While hot flashes can be frustrating and uncomfortable, there are several things you can do to cool down. Making changes to your daily lifestyle as well as exploring which medications can help is key.
Also, talk to your doctor or care team so that they can recommend helpful lifestyle changes and medications.
Why Do Some Prostate Cancer Patients Experience More Hot Flashes Than Others
- H. Lee Moffitt Cancer Center & Research Institute
- Androgen deprivation therapy is a common treatment option for patients with advanced stage prostate cancer. But nearly 80 percent of patients who receive ADT report experiencing hot flashes during and after treatment. Researchers are working to determine what genetic factors and other characteristics might make prostate cancer patients more likely to experience hot flashes during and after therapy.
Androgen deprivation therapy is a common treatment option for patients with advanced stage prostate cancer. But nearly 80 percent of patients who receive ADT report experiencing hot flashes during and after treatment. Moffitt Cancer Center researchers are working to determine what genetic factors and other characteristics might make prostate cancer patients more likely to experience hot flashes during and after therapy.
Cancer therapies often are associated with unwanted side effects. Some side effects can be so debilitating that patients decide to quit therapy and risk disease recurrence or progression. More than 25 percent of prostate cancer patients report that hot flashes are the most distressing side effect of ADT. Often, patients experience hot flashes for years after ADT is complete. Researchers wanted to determine which patients were more likely to experience hot flashes to help physicians make treatment decisions.
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Treatment Advances Bring More Choice
If your rectal exams shows an abnormality or your PSA levels are elevated, your doctor will probably recommend a biopsy of the prostate and may recommend an MRI or other imaging studies as well.
If youre diagnosed with prostate cancer, you have a range of treatment options to consider based on your age, overall health and how early your cancer was caught the stages of prostate cancer vary depending on how it has advanced.
The treatment landscape is rapidly evolving, McKay said. In the last decade theres been the introduction of many more drugs that work better and make people live longer and live better.
Treatment options include prostate cancer surgery, radiation therapy, chemotherapy and hormone treatment. Your doctor could also recommend active surveillance, which involves monitoring your cancer for signs that its progressing.
Ask your provider any questions, Yu said, and take charge of your own health discussion.
This story was updated on November 6, 2020.
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Aug 05, 2015 · Prostatecancer cells may also have the ability to produce testosterone. ADT reduces the levels of male hormones in the body or blocks their effects on prostatecancer cells, which are usually sensitive to hormonetherapy, at least initially. Chemotherapy is typically started only after the patient no longer . . Hormone therapy treats prostate cancer wherever it is in the body. It cant cure the cancer, but it can keep it under control, sometimes for several years. It can also help manage the symptoms of advanced cancer, such as bone pain. Hormone therapy shrinks the cancer and slows down its growth, even if. 2022. 1. 27. ·Hormone therapy may be recommended at various points during prostate cancer treatment, including: 2. As an initial treatment along with radiation therapy. As a first-line therapy to shrink tumors, prior to radiation. When prostate cancer has metastasized and cant be treated surgically or with radiation.
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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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Evidence For Combining Hormone Therapy And Radiation Treatment
Bolla M, Collette L, Blank L, et al. Long-Term Results with Immediate Androgen Suppression and External Irradiation in Patients with Locally Advanced Prostate Cancer : A Phase III Randomised Trial. Lancet 2002 360:1036. PMID: 12126818.
Bolla M, Gonzalez D, Warde P, et al. Improved Survival in Patients with Locally Advanced Prostate Cancer Treated with Radiotherapy and Goserelin. New England Journal of Medicine 1997 337:295300. PMID: 9233866.
DAmico AV, Schultz D, Loffredo M, et al. Biochemical Outcome Following External Beam Radiation Therapy With or Without Androgen Suppression Therapy for Clinically Localized Prostate Cancer. Journal of the American Medical Association 2000 284:12803. PMID: 10979115.
DAmico AV, Manola J, Loffredo M, et al. Six-Month Androgen Suppression Plus Radiation Therapy Versus Radiation Therapy Alone for Patients with Clinically Localized Prostate Cancer: A Randomized Controlled Trial. Journal of the American Medical Association 2004 292:8217. PMID: 15315996.
Denham JW, Steigler A, Lamb DS, et al. Short-Term Androgen Deprivation and Radiotherapy for Locally Advanced Prostate Cancer: Results from the Trans-Tasman Radiation Oncology Group 96.01 Randomised Controlled Trial. Lancet Oncology 2005 6:84150. PMID: 16257791.
Nesslinger NJ, Sahota RA, Stone B, et al. Standard Treatments Induce Antigen-Specific Immune Responses in Prostate Cancer. Clinical Cancer Research 2007 13:1493502. PMID: 17332294.
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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.
Screening And Data Extraction
Four reviewers will work in pairs to review abstracts and full text reports from search results independently and in duplicate against the eligibility criteria using Distiller SR software to identify relevant articles. Both stages of screening will begin with a calibration exercise of approximately 50 abstracts and 10 full text reports to ensure consistent application of eligibility criteria. Study selection will be documented using a preferred reporting items for systematic reviews and meta-analysis flow diagram . Once all studies are identified, data extraction will be performed using a standardized extraction form which will be piloted by the reviewers on a small number of studies. We will collect data related to key items including patient demographics , interventions , etc.), and outcomes as described above. We will use the Cochrane Risk of Bias Tool for randomized controlled trials to establish the risk of bias of each included study a summary of findings from these assessments will be provided, and they will also be used to consider sensitivity analyses.
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