What Is Intermittent Adt
Researchers have investigated whether a technique called intermittent androgen deprivation can delay the development of hormone resistance. With intermittent androgen deprivation, hormone therapy is given in cycles with breaks between drug administrations, rather than continuously. An additional potential benefit of this approach is that the temporary break from the side effects of hormone therapy may improve a mans quality of life.
Randomized clinical trials have shown similar overall survival with continuous ADT or intermittent ADT among men with metastatic or recurrent prostate cancer, with a reduction in some side effects for intermittent ADT .
Hormone Therapy: Immediate Versus Delayed
Medical Research Council Prostate Cancer Working Party Investigators Group. Immediate Versus Deferred Treatment for Advanced Prostatic Cancer. British Journal of Urology 1997 79:23546. PMID: 9052476.
Messing EM, Manola J, Sarosdy M, et al. Immediate Hormonal Therapy Compared with Observation after Radical Prostatectomy and Pelvic Lymphadenectomy in Men with Node-Positive Prostate Cancer. New England Journal of Medicine 1999 341:17818. PMID: 10588962.
Messing EM, Manola J, Yao J, et al. Immediate Versus Deferred Androgen Deprivation Treatment in Patients with Node-Positive Prostate Cancer after Radical Prostatectomy and Pelvic Lymphadenectomy. Lancet Oncology 2006 7:4729. PMID: 16750497.
Nair B, Wilt T, MacDonald R, Rutks I. Early Versus Deferred Androgen Suppression in the Treatment of Advanced Prostatic Cancer. Cochrane Database of Systematic Reviews 2002 CD003506. PMID: 11869665.
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Is There A Cure For Prostate Cancer With Androgen Deprivation
Unfortunately, long-term clinical trials later showed what we now know to be the case: prostate cancer eventually becomes resistant to androgen deprivation therapy and progresses. As the COVID-19 pandemic continues to rage in parts of the world, it is slowly receding in the United States
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How Testosterone Helps Prostate Cancer Grow
Testosterone travels through the bloodstream and eventually reaches prostate cancer cells, where it helps the cancer grow. Up to a point, the more testosterone the cancer cells have, the more the cancer can grow and eventually spread to other parts of the body. Hormone therapy is designed to prevent testosterone from fueling the growth of these cancer cells.
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Hormonal Therapy On Its Own
Doctors do not usually advise having hormonal therapy instead of a prostatectomy or radiotherapy. Hormonal therapy alone cannot cure early or locally-advanced prostate cancer.
Depending on your general health and preferences, you may decide to have hormonal therapy on its own. For example, if you:
- are not well enough to have a prostatectomy or radiotherapy
- do not want to have a prostatectomy or radiotherapy
- are monitoring prostate cancer, for example having watchful waiting and the cancer starts to grow.
Hormonal therapy can slow down or stop the cancer cells growing for many years. It can also improve any symptoms. Not having surgery or radiotherapy means you avoid the side effects of these treatments. But hormonal therapy also causes side effects. It is important to talk to your doctor or nurse before you decide.
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Confirming What Weve Practiced For Years
- What was the grade of the cancer?
- Was it at the edge of the removed prostate gland?
- Was it in the attached seminal vesicles or extending beyond the capsule?
- Was there cancer in any removed lymph nodes?
- What is the trend of serum PSA since surgery?
- How old is the patient, what are his other medical issues, and what are his goals?
Hormone Therapy Can Cause Side Effects
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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How Hormone Therapy Is Given
Hormone therapy may be given in many ways:
- Oral. Hormone therapy comes in pills that you swallow.
- Injection. The hormone therapy is given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly.
- Surgery. You may have surgery to remove organs that produce hormones. In women, the ovaries are removed. In men, the testicles are removed.
Table : Survival Benefits Of Early Treatment
An analysis of 98 men with prostate cancer that had spread to the lymph nodes, who were randomly assigned to receive immediate hormone therapy or to forgo it until the disease spread further to bones or lungs, found that early treatment saved lives.
Deaths from prostate cancer 21 Source: Lancet Oncology 2006 7:4729. PMID: 16750497.
Other studies have shown that starting hormone therapy early on increases survival times, delays cancer progression, and results in better quality of life. However, in a review of four studies involving 2,167 men with metastatic prostate cancer, the Cochrane Collaboration concluded that early hormone therapy had offered only a small overall survival advantage over deferred treatment, and cautioned that more research on the issue needs to be done.
Although debate on this issue continues, in most cases I advise my patients with metastatic disease to begin hormone treatment early on. This is particularly important for someone with spine metastases, because a bone fracture or extension of the cancer into the spinal cord area could lead to impaired mobility and even paralysis. Fortunately, this is a rare event.
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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 “financial assistance.” Or call toll-free 1-800-4-CANCER to ask for help.
What Is The Most Effective Treatment For Prostate Cancer
Radiation therapy is a good choice for many men with early-stage prostate cancer. It is also the best treatment for older men or those with other health conditions. There are different types of radiotherapy: External radiotherapy.
What happens when hormone treatment for prostate cancer stops working?
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.
Does hormone therapy kill cancer cells?
If hormone therapy is given before primary treatment, then it is called neoadjuvant therapy. These treatments help kill cancer cells. They also help improve the effectiveness of the main treatment, which is often surgery. If hormone therapy is given after primary treatment, then it is called adjuvant therapy.
What is the success rate of hormone therapy?
The 6-year survival rate for HRT users was 92% versus 80% for non-users . Figure 3 shows the survival curves of patients with tumors detected by palpation. The 6-year survival rate was 79% for HRT users versus 76% for non-users (P = 0,
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How Long Do You Take Hormonal Therapy For
For early prostate cancer this depends on the prostate cancer risk group. If the cancer is:
- intermediate-risk you may have hormonal therapy for a few months after radiotherapy
- high-risk you may be advised to have hormonal therapy for up to 2 to 3 years after radiotherapy.
For locally advanced prostate cancer you usually have hormonal therapy for 2 to 3 years after radiotherapy.
What Hormone Therapy Does
Hormone therapy can control or shrink the cancer and reduce symptoms. It can help you feel better and improve your quality of life for a time but it cant cure the cancer.
Most men with advanced prostate cancer have hormone therapy. If your cancer has spread when it is diagnosed, you might start hormone therapy straight away.
If you dont have symptoms, your doctor might suggest monitoring your symptoms and then starting treatment when needed. They call this watchful waiting.
Your doctor might offer you a choice of treatment. And you might have more than one type of hormone therapy at the same time.
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Intermittent Versus Continuous Hormone Therapy
Most prostate cancers treated with hormone therapy become resistant to this treatment over a period of months or years. Some doctors believe that constant androgen suppression might not be needed, so they advise intermittent treatment. This can allow for a break from side effects like decreased energy, sexual problems, and hot flashes.
In one form of intermittent hormone therapy, treatment is stopped once the PSA drops to a very low level. If the PSA level begins to rise, the drugs are started again. Another form of intermittent therapy uses hormone therapy for fixed periods of time for example, 6 months on followed by 6 months off.
At this time, it isnt clear how this approach compares to continuous hormone therapy. Some studies have found that continuous therapy might help men live longer, but other studies have not found such a difference.
What Are The Advantages Of Orchiectomy
First, it is a single, simple, surgical procedure with a very low risk of problems and 100 percent efficacy.
Second, it can be carried out in ways which are not physically evident. In other words, it is possible to carry out what is known as a subcapsular orchiectomy, in which the cores of the two testes are removed while the capsules remain in the scrotum. This means that the man still appears to be an intact male.
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When Does Hormone Therapy Fail For Prostate Cancer
Cancer cells are smart. When faced with a continuous stressor such as chemotherapy or hormone therapy, they eventually evolve and learn evasive maneuvers. When prostate cancer cells grow resistant or become insensitive to hormone therapy, the cancer is referred to as hormone refractory.
Hormone therapy may work to treat prostate cancer for many years. However, its only a temporary fix because eventually, the cancer becomes resistant. The risk of resistance goes up if the cancer has taken hold for a long time or if it has relapsed.
Heres What The Results Showed
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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How Long Can Hormone Therapy Work For Advanced Prostate Cancer
Though it isnt 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.
Hormone Therapy For Prostate Cancer
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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Drugs That Stop Androgens From Working
Anti-androgens
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.
Newer anti-androgens
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.
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.
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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 .