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How Is Hormone Therapy For Prostate Cancer Administered

Hormone Therapy Can Cause Side Effects

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

Because hormone therapy blocks your bodys ability to produce hormones or interferes with how hormones behave, it can cause unwanted side effects. The side effects you have will depend on the type of hormone therapy you receive and how your body responds to it. People respond differently to the same treatment, so not everyone gets the same side effects. Some side effects also differ if you are a man or a woman.

Some common side effects for men who receive hormone therapy for prostate cancer include:

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Does Msk Offer Proton Therapy For Prostate Cancer

Some men with prostate cancer may choose to receive another form of external-beam radiation therapy called proton therapy. Proton therapy can deliver a high radiation dose to the prostate while lowering the radiation dose to normal surrounding tissue. It is unclear if there is any advantage to proton therapy compared with IMRT. We are now studying how these approaches compare in terms of side effects and outcomes at the New York Proton Center. These efforts are being led by radiation oncologist Daniel Gorovets.

Hormone Therapy With Radiotherapy

You have this if:

  • your cancer hasnt spread to other parts of the body but is at a high risk of coming back, eg the cancer has grown through the covering of your prostate
  • you have a very high prostatic specific antigen level
  • you have a high Gleason score

You might have hormone therapy before, during and after radiotherapy. Doctors usually recommend that you have the treatment for between 3 months and 3 years. How long depends on the risk of your cancer coming back and how many side effects you get.

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Cancers Treated With Hormone Therapy

Hormone therapy is used to treat prostate and breast cancers that use hormones to grow. Hormone therapy is most often used along with other cancer treatments. The types of treatment that you need depend on the type of cancer, if it has spread and how far, if it uses hormones to grow, and if you have other health problems.

Intermittent Therapy For Locally Advanced And Advanced Prostate Cancer

Current and Emerging Therapies for Bone Metastatic Castration

Instead of taking the drugs continuously, you may stop taking the drugs for a while and then start taking them again. This is called intermittent hormonal therapy. It means you get a break from the side effects of hormonal therapy. This is not suitable for everyone. It should only be done following your doctors advice.

Intermittent hormonal therapy may be helpful when certain side effects are difficult to cope with. Your doctor or nurse will explain the possible advantages and disadvantages. If your PSA level begins to rise or your symptoms get worse, your doctor will advise starting hormonal therapy again.

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Surgical Implications Of Nadt

Neoadjuvant androgen deprivation therapy has been demonstrated to decrease prostate volume by 20-50%. The initial hope was that shrinking the gland would make radical prostatectomy technically easier, with less blood loss. The findings in this regard have been inconsistent.

In the multicenter, randomized T2bN0M0 trial, surgeons rated the difficulty of dissection, presence of seminal vesicle adherence, and extent of blood loss and found that seminal vesicle adherence to the periprostatic tissues was more common in patients pretreated with NADT than in those treated with surgery alone . They also recorded the operating time and amount of blood transfused. Surgical dissection was more difficult in pretreated patients. No significant difference in operating time, blood loss, or transfusion requirement occurred.

Although more dissections that were difficult were reported with NADT in this study, no operative complications occurred in the NADT group, whereas 6 intraoperative injuries were reported in patients who underwent surgery alone.

The authors believe that interference with apical dissection is potentially the most difficult problem caused by NADT. Also of serious concern is the fact that NADT-induced fibrosis can make intraoperative evaluation of the extent of the tumor more difficult, which in turn may compromise the extent of resection if the surgeon relies on intraoperative findings to determine performance of a nerve-sparing operation.

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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Why It Is Done

For prostate cancer, this therapy is administered to stop testosterone production. Testosterone is a hormone that essentially fuels prostate cancer cell growth. By stopping production, this therapy may help to inhibit the growth of cancer cells.

The following are the most common reasons to consider hormone therapy for prostate cancer:

  • Your cancer is advanced
  • PSA levels are high after undergoing cancer treatment
  • You are at a high risk of recurrence
  • It may increase the effectiveness of external beam radiation

Hormone Treatment Fights Prostate Cancer

Hormone Therapy for Prostate Cancer

Hormone therapy for prostate cancer has come a long way in the past few decades. Not so long ago, the only hormonal treatment for this disease was drastic: an orchiectomy, the surgical removal of the testicles.

Now we have a number of medicationsâ available as pills, injections, and implants â that can give men the benefits of decreasing male hormone levels without irreversible surgery.

âI think hormonal therapy has done wonders for men with prostate cancer,â Stuart Holden, MD, Medical Director of the Prostate Cancer Foundation.

Hormone therapy for prostate cancer does have limitations. Right now, itâs usually used only in men whose cancer has recurred or spread elsewhere in the body.

But even in cases where removing or killing the cancer isnât possible, hormone therapy can help slow down cancer growth. Though it isnât a cure, hormone therapy for prostate cancer can help men with prostate cancer feel better and add years to their lives.

On average, hormone therapy can stop the advance of cancer for two to three years. However, it varies from case to case. Some men do well on hormone therapy for much longer.

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Types Of Hormone Therapy For Prostate Cancer

Your team will walk you through the types of available prostate cancer hormone therapy treatments and clinical trials, so you get the most advanced therapy possible. Types of hormone therapy include:

  • Medications that lower the amount of testosterone made by the testicles: Certain medications called luteinizing hormone-releasing hormone or gonadotropin-releasing hormone agonists and antagonists prevent your body’s cells from receiving messages to make testosterone. As a result, your testicles stop producing testosterone. Blocking testosterone slows the rate of growth of the cancer.
  • Medications that block testosterone from reaching cancer cells: Another class of oral drugs called anti-androgens work by preventing your body and the cancer cells from using testosterone. Anti-androgen usually is given in conjunction with LHRH agonists because LHRH agonists can cause a temporary increase in testosterone before testosterone levels decrease.
  • Surgery to remove the testicles : Removing your testicles reduces testosterone levels in your body quickly and significantly. But unlike medication options, surgery to remove the testicles is permanent and irreversible.

While hormone therapy may extend life, it is not a cure for prostate cancer. Your team will discuss with you the advantages and risks associated with hormone therapy as part of your prostate cancer treatment plan.

Contact the cancer team 24/7 by calling 777-4167.

How Much Hormone Therapy Costs

The cost of hormone therapy depends on:

  • the types of hormone therapy you receive
  • how long and how often you receive hormone therapy
  • the part of the country where you live

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for hormone therapy for their members. To learn more, talk with the business office where you go for treatment. You can also go to the National Cancer Institute database, Organizations that Offer Support Services and search âfinancial assistance.â Or call toll-free 1-800-4-CANCER to ask for help.

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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.

Kinds Of Hormone Therapy

Gonadotropin

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.

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If Treatment Does Not Work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

Hormonal Therapy For Endometrial Cancer

Cancer of the uterus or its lining, the endometrium, may respond to hormone therapy with progestins. Other types of hormone therapy for endometrial cancer include:

  • Aromatase inhibitors

When and why theyre used: Hormone therapy is typically reserved for advanced uterine or endometrial cancer, or for cancer that has returned after treatment. Its often combined with chemotherapy.

Risks: Side effects are similar to those seen with hormone treatment for other types of cancer.

Expert

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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.

Heres What The Results Showed

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

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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External Beam Radiation Therapy

This is the most common type of radiation therapy, and it is painless. Before treatment, your radiation team will use computerized tomography scans and magnetic resonance imaging scans to map out the location of the prostate and tumor cells.

During each treatment session, X-ray beams are focused on the targeted cancer areas. Oncologists can change the intensity of doses and radiation beams to better deliver high doses of radiation to tumor cells while delivering lower doses to surrounding healthy tissues.

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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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    Radiation Therapy For Prostate Cancer

    Radiation therapy is an effective treatment that kills prostate cancer cells by using high energy rays or particles. The radiation can be delivered in several ways, including brachytherapy and external beam radiation that projects the energy through the skin. Radiation therapy for prostate cancer is best delivered by experienced radiation oncologists who work in high volume centers of excellence.

    Radiation therapy can:

    • Treat both early stage cancers of the prostate gland and more advanced cancers that may have spread beyond the prostate
    • Be used alone or with other treatments such as hormone deprivation
    • Treat recurrent prostate cancer following surgery
    • Treat men with limited spreading prostate cancer to reduce the tumors size and improve survival and quality of life
    • Slow cancer growth, reduce fracture risk
    • Be used as a palliative treatment to address pain from advanced cancer

    Combined Androgen Blockade: Pro And Con

    What You Should Know About Prostate Cancer Treatment Progression

    Pro:

    Crawford ED, Eisenberger MA, McLeod DG, et al. A Controlled Trial of Leuprolide With and Without Flutamide in Prostatic Carcinoma. New England Journal of Medicine 1989 321:41924. PMID: 2503724.

    Con:

    Eisenberger MA, Blumenstein BA, Crawford ED, et al. Bilateral Orchiectomy With or Without Flutamide for Metastatic Prostate Cancer. New England Journal of Medicine 1998 339:103642. PMID: 9761805.

    Two large meta-analyses that reviewed many studies comparing combined androgen blockade to monotherapy concluded that the combination offered only a small survival advantage and even that finding was inconsistent between the two analyses. One analysis, which reviewed 27 randomized studies involving 8,275 men, estimated that combined androgen blockade improved five-year survival by only 2% to 3%, at most. However, an advantage of only 2% to 3%, when applied to thousands of men undergoing treatment, translates into hundreds of lives extended obviously an important benefit to the men who gain months and even years of life as a result. That is why I use combined therapy for all of my patients who undergo hormone treatments.

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    Prostate Cancer Hijacks Biorhythm Of Tumor Cell To Bypass Hormone Therapy

    Hormone therapy can keep metastatic prostate cancer well under control, but sooner or later tumor cells become resistant to it. Unexpectedly, a possible solution has now emerged: drugs that are not designed to fight cancer at all, but which influence the day-and-night rhythm of a cell. Professor Wilbert Zwart is part of the international team of researchers, led by the Antoni van Leeuwenhoek institute, that is publishing a report on this discovery in the renowned journal Cancer Discovery today.

    Prostate cancer is a type of cancer that grows under the influence of hormones, primarily testosterone. Patients with metastatic prostate cancer are therefore often treated with anti-hormonal therapy, which inhibits the growth-stimulating signal of testosterone and, therefore, tumor growth.

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