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.
Factors That Increase Risk Of Recurrence
There are many different factors that can help you determine what your risk of recurrence is. Your doctor will go over these during the initial course of treatment, therefore stressing the importance of follow up appointments.
One factor is the involvement of your lymph nodes. If your cancer has metastasized to your lymph nodes, recurrence is more likely. Similarly, the larger the tumor, the more likely that you are to experience complications and rates of recurrence. If the tumor is intertwined or growing into other areas of your body, this also increases risk. The Gleason score is a system of grading your prostate cancer based on severity and localization. The higher the grade, the more likely youll experience recurrence. Finally, the stage of prostate cancer affects recurrence rates. When caught early, recurrence is not as likely as cancers that are in stage three or four.
Cancer can be extremely aggressive and will change your life forever. Make sure that youre doing everything you can to avoid potential problems. Eat well, exercise regularly, and get enough sleep. Strengthening your immune system is a great way to reduce your risk of recurrence.
First Line Treatment For Advanced Prostate Cancer
The established first line approach is to control the progression of the disease by reducing levels of testosterone in the body. This is because testosterone increases the speed at which prostate cancer cells reproduce.
There are two different ways to lower testosterone levels. Hormone therapy lowers the levels of testosterone in the body by taking tablets or having injections. It is sometimes referred to as medical castration. The surgical option involves removing the testicles, known as surgical castration or orchidectomy, although this is now rarely used.
Another approach is called anti-androgen treatment. Androgens have to bind to a protein in the cell called an androgen receptor to work. Anti-androgens are drugs that bind to these receptors so the androgens cant, effectively blocking them. The main side-effects are gynaecomastia breast enlargement and breast pain, although a single radiotherapy dose to the breasts can help this side-effect.
Combining anti-androgens with testosterone reduction is known as Maximum Androgen Blockade and may be used if hormone treatment alone is not working sufficiently.
Treating with chemotherapy at the same time as the start of hormone deprivation was found to increase survival by 13 months in all patients and 17 months in men with high-volume disease.
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Your Cancer Care Team
People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.
Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
- the type and size of the cancer
- what grade it is
- whether the cancer has spread to other parts of your body
What Happens If My Psa Rises After Surgery
If your PSA starts to rise after youve undergone prostatectomy, salvage radiation therapy might be a good option to explore, and has been shown to improve outcomes over time. With this approach, external beam radiation is delivered to the area immediately surrounding where the prostate was , with the aim of eradicating any remaining prostate cells that have been left behind. Depending on your PSA level, the addition of hormone therapy can improve outcomes with salvage radiation for details, please see Therapies for Locally Recurrent Prostate Cancer in PCFs Prostate Cancer Patient Guide. Clinical trials are investigating more aggressive systemic therapies.
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General Prostate Cancer Survival Rate
According to the American Cancer Society:
- The relative 5-year survival rate is nearly 100%
- The relative 10-year survival rate is 98%
- The 15-year relative survival rate is 91%
Note: Relative survival rate means the percentage of patients who live amount of years after their initial diagnosis.
Keep in mind, however, that because the compiled list figures are of cancers diagnosed up to 15 years ago, you may have an even greater chance of survival than these indicate due to advances in prostate cancer treatment technology
Performance Status And Predicted Life Expectancy
Performance status and predicted life expectancy are both critical elements to incorporate into individualized clinical decision-making in men with advanced prostate cancer. Performance status remains a key factor in treatment decision-making, particularly among men with advanced prostate cancer. Indeed, performance status has been found to be strongly associated with survival among men with mCRPC, 35-38 and has been used to define index patients in prior versions of this guideline. Performance status generally describes an individual patientâs level of functioning and how oneâs disease impacts a patientâs activities of daily living. The first of two commonly used scales to evaluate performance status include the Eastern Cooperative Oncology Group scale from 0 to 5 where 0 is fully functional and 5 is dead. The second is the Karnofsky scale where 10 represents a moribund individual and 100 represents an individual with no limitations.
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What Does Psa Velocity Mean
PSA velocity or PSA doubling time, both of which measure the rate at which your PSA rises, can be a very significant factor in determining is the aggressiveness of your cancer. Men with a shorter PSA doubling time or a more rapid PSA velocity after initial therapy tend to have more aggressive disease, and are therefore more likely to need more aggressive therapies. Likewise, men who have recurrence soon after surgery have a higher risk of aggressive disease.
Risks Of Mortality Among Men With Biochemical Recurrence After Radical Prostatectomy
- The Journal of Urology
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How Common Is Recurrence
The recurrence of prostate cancer depends on when it was caught and treated the first time. If your doctor was able to remove the cancer while it was still confined in the prostate gland, your chances of recurrence are fairly low. If your cancer spread before treatment, such as in the case of about 10% of men, recurrence is more likely to occur. Recurrence, therefore, occurs if not all of the cancer cells were treated the first time or if the cancer was more advanced than originally believed.
How Long Can You Live After Prostate Cancer Recurrence
Given this long natural life expectancy, events occurring 15 years or later after recurrence can influence overall survival. Indeed, among patients with a slow to intermediate PSADT , given a 15-year follow-up, 41% of patients were expected to die, with 78% of deaths attributable to prostate cancer.
What are the chances of a man surviving prostate cancer?
The SEER database tracks 5-year relative survival rates for prostate cancer in the United States, based on how far the cancer has spread.Prostate cancer 5-year relative survival rates.
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What are the signs of prostate cancer returning?
The first involves the development of symptoms of recurrence such as leg edema, blood in the urine, progressive fatigue, bone pain and back pain. The second is referred to as a biochemical recurrence, and it involves a rise in the mans PSA levels.
How do you prevent prostate cancer from coming back?
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Multidisciplinary Nature Of Treatment In Todays Advanced Prostate Cancer Care Paradigm
As the therapeutic landscape evolves to include increasingly complex combinations of systemic therapies with or without local therapies, advances in imaging, and germline and somatic genetic testing, treating men with advanced prostate cancer is increasingly one that must embrace multidisciplinary management approaches. Team members should include urologists, medical oncologists, and radiation oncologists at a minimum when supporting treatment decisions for advanced disease. Additional specialists may also include genitourinary pathology, genetic counseling, palliative care, and holistic specialists, as appropriate, in addition to primary care. Best practices must also include clinicians comfortable describing the use of germline and somatic genetic testing, and when advanced imaging techniques could be optimally used or avoided. Radiologists and nuclear medicine specialists are valuable in helping to accurately interpret scans. Palliative care team members may also play a key role when treating men with symptomatic metastatic disease. Palliative care itself is an interdisciplinary, holistic approach to managing an advanced disease such as prostate cancer with a guarded prognosis. It can include controlling symptoms that are physical, psychological, spiritual, and social. The goal of palliation is to prevent and relieve suffering and to support the best possible QOL for the patient and family.
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How Is Hormone Therapy Used To Treat Hormone
Hormone therapy may be used in several ways to treat hormone-sensitive prostate cancer, including:
Early-stage prostate cancer with an intermediate or high risk of recurrence. Men with early-stage prostate cancer that has an intermediate or high risk of recurrence often receive hormone therapy before, during, and/or after radiation therapy, or after prostatectomy . Factors that are used to determine the risk of prostate cancer recurrence include the grade of the tumor , the extent to which the tumor has spread into surrounding tissue, and whether tumor cells are found in nearby lymph nodes during surgery.
The use of hormone therapy before prostatectomy has not been shown to be of benefit and is not a standard treatment. More intensive androgen blockade prior to prostatectomy is being studied in clinical trials.
Relapsed/recurrent prostate cancer. Hormone therapy used alone is the standard treatment for men who have a prostate cancer recurrence as documented by CT, MRI, or bone scan after treatment with radiation therapy or prostatectomy.
Hormone therapy is sometimes recommended for men who have a “biochemical” recurrencea rise in prostate-specific antigen level following primary local treatment with surgery or radiationespecially if the PSA level doubles in fewer than 3 months.
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What Types Of Hormone Therapy Are Used For Prostate Cancer
Hormone therapy for prostate cancer can block the production or use of androgens . Currently available treatments can do so in several ways:
- reducing androgen production by the testicles
- blocking the action of androgens throughout the body
- block androgen production throughout the body
Treatments that reduce androgen production by the testicles are the most commonly used hormone therapies for prostate cancer and the first type of hormone therapy that most men with prostate cancer receive. This form of hormone therapy includes:
Treatments that block the action of androgens in the body are typically used when ADT stops working. Such treatments include:
Treatments that block the production of androgens throughout the body include:
Watchful Waiting And Active Surveillance
Watchful waiting is an adequate approach in patients who are at low risk of death from prostate cancer because of their limited life expectancy due to severe comorbidities., Watchful waiting resulted in similar overall survival when compared with radical prostatectomy, but disease-specific survival was better in patients who had undergone surgery. For some patients it turns out to be hard to persist on a watchful waiting policy, and many men drop out and seek active treatment within several years, mostly when PSA elevation is noted.
Active surveillance is a novel and fascinating approach to distinguish between patients who are at higher risk and need active therapy and patients who are at low risk for disease progression., This approach avoids the risks of therapy while allowing early detection of those patients who are prone to progress. In these high-risk individuals, delayed active treatment is offered. Periodic monitoring of the PSA serum level, digital rectal exam, and repeated prostate biopsies are performed in patients who are on active surveillance, and active therapy is started when predefined threshold values are reached. This concept makes it possible to offer curative treatment to individuals who are at high risk for disease progression as indicated by active surveillance parameters.
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Who Is More Likely To Get Prostate Cancer
Prostate cancer is more likely to develop in men who are 65 or older. African American men are more likely to develop prostate cancer than men of other races. Having one or more close relatives with prostate cancer also increases a mans risk.
What is it like to live with prostate cancer?
Urinary problems. Being unable to hold urine,or experiencing urine leakage,is common after treatment,especially if youve had surgery.
What is Stage 4 of prostate cancer?
Stage I : The Gleason score is 6 or less,and the PSA level is less than 10.
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.
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How Are Hormone Therapies For Prostate Cancer Administered
LHRH agonists, the most commonly used drug class for hormone therapy, are given in the form of regular shots: once a month, once every three months, once every four or six months, or once per year. These long-acting drugs are injected under the skin and release the drug slowly over time. LHRH antagonists include degarelix and relugolix, an oral form.
Evaluation Of Patients With Bcr
Biochemical recurrence may signify local or metastatic recurrence. Patients with localized recurrence may be managed with localized salvage therapies. In contrast, patients with metastatic recurrence require systemic salvage therapies. Thus, the evaluation of patients with BCR is primarily to attempt stratification into local or metastatic recurrence, using strategies described below.
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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, such as urinary incontinence and erectile dysfunction.
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.
Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.
You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation .
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 healthcare provider and your family, and thoroughly considering your priorities, can help you make a decision that feels right for you.
U.S. Department of Health and Human Services Agency for Healthcare Research and Quality. Treating localized prostate cancer.
Brawley S, Mohan R, Nein CD. Localized prostate cancer: treatment options. Am Fam Physician 97:798805.
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