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.
Early Versus Delayed Treatment
For men who need hormone therapy, such as men whose PSA levels are rising after surgery or radiation or men with advanced prostate cancer who dont yet have symptoms, its not always clear when it is best to start hormone treatment. Some doctors think that hormone therapy works better if its started as soon as possible, even if a man feels well and is not having any symptoms. Some studies have shown that hormone treatment may slow the disease down and perhaps even help men live longer.
But not all doctors agree with this approach. Some are waiting for more evidence of benefit. They feel that because of the side effects of hormone therapy and the chance that the cancer could become resistant to therapy sooner, treatment shouldnt be started until a man has symptoms from the cancer. This issue is being studied.
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.
Recommended Reading: How To Determine Enlarged Prostate
Prediction Of Treatment Efficacy
Predictive markers are useful for selecting optimal cancer treatment regimens. If the response to a previous drug can predict the response to subsequent drugs, this information can help in the selection of an effective treatment. However, validated markers for predicting the efficacy and safety of new therapeutics have not been identified. Response to previous treatments could not predict the efficacy of subsequent treatments., , , , , However, accumulating clinical experience allows us to identify subgroups of patients who will benefit from each treatment. For example, patients with rapid progression to CRPC had a reduced OS and poorer response to second-line hormone therapies, including AA and EZL. Simple classification based on serological values might be able to predict the response to AA. The neutrophil/lymphocyte ratio â¤5 and restricted metastatic spread to either bone or lymph nodes were each associated with better PSA response and OS for patients received AA. Androgen-AR-targeted drugs, such as AA or EZL, are likely to be preferable for men with asymptomatic or mildly symptomatic disease, slowly progressive disease, and low tumor volume with no visceral metastases, chemotherapy-naïve patients or patients that poorly tolerate chemotherapy. In contrast, for men with rapid progressing disease and a large volume tumor, low PSA levels for high tumor volume, visceral metastases or poor response to ADT, early treatment with chemotherapy might be indicated.
Heres What You Should Know About This Treatment Option
Men who get diagnosed with prostate cancer have several options to choose from for their next step. Many men with slow-growing, low-risk cancer follow active surveillance, a wait-and-see approach that monitors the cancer for changes.
But if the cancer shows higher risk or has already begun to spread, other treatments are recommended. There are two options: surgery to remove the prostate or radiation to destroy the cancer cells.
Studies comparing these two approaches demonstrate no advantage of one over the other with respect to cancer control. Your path will depend on factors like your current health, the specifics of your cancer, and personal preference. Yet for many men, radiation can be the better option.
Its much more precise than the traditional radiation used for other kinds of cancer, and research also has found that long-term quality of life is often better, with fewer adverse health effects compared to surgery, says Dr. Anthony DAmico, a radiation oncologist with Harvard-affiliated Dana-Farber Cancer Institute and Brigham and Womens Hospital.
There are two main ways to deliver radiation to the prostate: external beam radiation and brachytherapy.
Don’t Miss: Can Teens Get Prostate Cancer
Immune Checkpoint Inhibitor Therapy
Immune checkpoint inhibitor therapy has shown clinical benefit in a number of solid tumors , but unfortunately these observations have not been replicated in patients with mCRPC . Factors such as low tumor mutational burden , loss of tumor suppressors , low prevalence of DDR genetic defects, and silencing of major histocompatibility complex-1 expression may all contribute to mCRPCs relative lack of response to ICI therapy . Two early phase-3 studies of the anti-cytotoxic T lymphocyte-associated protein-4 antibody ipilimumab both failed to meet their primary endpoint of improved OS however, recent studies investigating the efficacy of the programmed death-1 inhibitor pembrolizumab have shown promising responses in patients with mCRPC. In a single-site cohort of 48 patients with mCRPC treated with pembrolizumab, 17% had50% PSA decline with 8% having90% PSA decline as best response . These exceptional responders were found to have molecular changes , TMB-high, and mutation in LRP1b), which predispose to anti-PD-1 responses.
Completed and ongoing clinical trials investigating different ICI agents in patients with mPC have been summarized . Although monotherapy ICIs have not been successful, there are many ongoing trials to combine ICIs with standard chemotherapies or targeted therapies in order to improve clinical outcomes.
Table 3 Ongoing clinical trials investigating the administration of immune checkpoint inhibitor agents in patients with mPC
Early Evidence Regarding Combinations Of Parp Inhibitors With Standard Mcrpc Therapies
There is conflicting evidence supporting the use of PARP inhibitors in mCRPC patients without mutations in DNA repair genes. The potential utility of PARP inhibitors in this setting will likely only be in combination with another effective agent. Preclinical studies have shown that inhibiting the androgen pathway can induce cell sensitivity to PARP inhibition, suggesting a synergy between androgen pathway blockade and PARP inhibitorsforming the hypothesis of multiple clinical trials . Ongoing phase 2/3 controlled clinical trials investigating PARP inhibitors in mCRPC with or without the concurrent administration of another agent have been summarized .
Table 1 Ongoing phase 2/3 controlled trials investigating PARP inhibitors in mCRPC
Also Check: Best Supplement For Prostate Problems
Hormonal Therapy And Chemotherapy In Metastatic Disease
It has been recently demonstrated that the use of chemotherapy can improve outcomes in patients with metastatic hormone naive prostate cancer. It appears that some patients initiating hormonal therapy may actually be better candidates for cytotoxic therapy at this stage of disease than when their disease becomes castration resistant .
It has been controversial as to whether or not early chemotherapy in hormone naive patients would be beneficial. There have been arguments for and against this approach. In favor is the idea that attacking de novo testosterone independent clones early should allow ADT to keep prostate cancer in remission longer. In addition, there is the possibility that some patients at the time of progression may be too frail to receive chemotherapy.
Alternatively, ADT may take cells out of cycle and make them less responsive to cytotoxics. The fact that some patients respond for long periods to ADT and never need chemotherapy is the other argument against early chemotherapy.
Since the early 80s several studies tried to clarify these differing viewpoints, investigating the addition of chemotherapy with hormonal therapy in patients with metastatic prostate cancer .
None of the trials reported positive results, concluding that androgen suppression remains the preferred first line treatment in metastatic prostate cancer and that there was no cytotoxic regimen with consistent activity against hormone-sensitive prostate cancer.
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:
Recommended Reading: What Is A Prostate Exam
Surgery In Metastatic Disease
Physicians have suggested that the benefits seen from radiation to the prostate point to the benefits of local therapy, raising the question of whether radical prostatectomy might have the same results. Trials are ongoing, and at present the use of surgery should be considered investigational and conducted only within the context of a trial. However, transurethral resection is sometimes needed in men who develop obstruction secondary to local tumor growth. Bilateral orchiectomy can be used to produce androgen deprivation in patients with widely advanced and metastatic prostate cancer.
Since the introduction of LHRH agonist and antagonist therapies, surgical intervention has been practiced less often. An indication for immediate bilateral orchiectomy is spinal cord compression, because it avoids the potential flare response that can occur during the first 3 weeks of treatment with an LHRH agonist.
Also Check: How To Lose Hormonal Belly
How The Study Was Performed
During the study, scientists randomized 1,071 men with intermediate- or high-risk localized prostate cancer into four groups. One group received radiation and six months of an anti-testosterone drug called leuporelin, and the second group received radiation plus 18 months of leuporelin therapy. Two other groups were treated with the same regimens of either radiation plus six or 18 months of leuporelin therapy, along with another drug called zoledronic acid, which helps to limit skeletal pain and related complications should cancer spread to the bones. Study enrollment occurred between 2003 and 2007 at 23 treatment centers across New Zealand and Australia.
Also Check: Does Estrogen Cause Cancer To Grow
Also Check: Are Colon Cancer And Prostate Cancer Related
Radiation Therapy: What It Is
This therapy, also known as radiotherapy, is a cancer treatment procedure that uses high doses of radiation to kill cancerous cells and shrink the tumor as well. At low doses, this procedure is used as an x-ray.
This therapy can be internal or external or both form. For external beam, a machine that is outside your body aims at the cancerous cells. For internal therapy, the radiations are placed inside your body inside or near the cancer.
For radiotherapy for prostate cancer, high-energy rays are used to kill the cancer cells. This treatment procedure does not cause pain. However, it may result in various side effects that might cause pain and make you feel uncomfortable. The good thing is that there are numerous ways to manage radiotherapy side effects with the help of your radiation oncologist.
Recommended Reading: How Much Does Estrogen Cost For Transgender
How Hormone Therapy Is Used Against Cancer
Hormone therapy is used for two main reasons.
- Treat cancer. Hormone therapy can stop or slow cancer’s growth and reduce the chance it will return.
- Ease cancer symptoms. Hormone therapy may be used to reduce or prevent symptoms in men with prostate cancer who are not able to have surgery or radiation therapy.
Recommended Reading: What Is Carcinoma Of Prostate
Extragonadal Precursor Steroids In Crpc
The increasingly strong evidence of an important role for androgen signaling in the progression of CRPC raised the question of how this androgen signaling is mediated. That this progression happens despite continuing suppression of circulating testosterone during ADT led researchers to look for other potential sources of androgens. Multiple studies have demonstrated several key points . Namely, xenograft studies as well as studies of patient primary tumors and CRPC metastases demonstrated that CRPC tumors have elevated potent androgen levels sufficient to maintain AR signaling. Moreover, expression of steroidogenic enzymes responsible for the production of potent androgens appears to be upregulated in CRPC tumors .
Pathways and enzymes to production of DHT. Steroid metabolism pathways and key enzymes for production of DHEA in the adrenal glands and conversion of DHEA to the potent androgen DHT in the prostate. Note that there are numerous isoforms of 17-hydroxysteroid dehydrogenase types 3 and 5 in particular are thought to be the important enzymes with reductive preference in prostate cancer .
Oral Selective Estrogen Receptor Degrader
Elacestrant demonstrated a 30% improvement in survival duration without cancer progression and a 45% improvement in patients with mESR1 mutations. Overall, 22% of Elacestrant treated patients survived beyond 12 months after starting treatment compared to 9% of those treated with SOC. This was further improved in patients with the mESR1 mutation. Elacestrant was fairly well-tolerated with only 6% of patients discontinuing due to side effects. Gastrointestinal side effects including nausea, vomiting, decreased appetite, and constipation with the main concerns.
Recommended Reading: Cancer Returns After Prostate Removal
Promising Outcomes Of Neoadjuvant Nhas For High
About 20% of patients with localized prostate cancers have characteristics placing them at high risk of cancer recurrence and progression. Even after treatment with surgery, radiation, and standard hormonal therapy, men with these high-risk prostate cancers are more likely to have unfavorable outcomes. About half of patients with HRPC will have biochemical recurrence , based on rising prostate-specific antigen levels. About two-thirds of deaths from prostate cancer occur in men with HRPCs.
Recent studies have evaluated the use of NHAs as initial therapy for HRPC, with the goal of shrinking the tumor before prostate cancer surgery . A clinical trial is underway to compare the outcomes of neoadjuvant NHA versus standard hormone therapy. However, it won’t answer the question of whether neoadjuvant NHA therapy followed by RP can improve outcomes, compared to initial RP.
To address this issue, Dr. Taplin and colleagues compared outcomes in two groups of patients with HRPC. One group included 259 men with HRPC treated from 2010 to 2016, who underwent RP without any neoadjuvant therapy. The other group consisted of 112 men who received neoadjuvant therapy with NHAs before surgery . The main outcomes of interest were BCR and survival without cancer progression . The analysis included adjustment to minimize differences in characteristics between groups.
The Pi3k/akt/mammalian Target Of Rapamycin Pathway
The PI3K pathway is one of the most critical in human cancer. Various growth factors, including insulin-like growth factor and fibroblast growth factor , regulate this pathway, leading to activation of PI3K and the formation of PIP3. PIP3 activates AKT via phosphorylation and phosphorylated Akt activates multiple molecules involved in cell survival and proliferation, including MDM2, c-myc, GSK3, nuclear factor-B and mTOR. Phosphatase and tensin homolog deleted on chromosome 10 is a lipid phosphatase that functions as the main inhibitor of PI3K/Akt signaling. Genetic alterations of the PI3K signaling pathway occur in 42% and 100% of primary and metastatic prostate cancers, respectively, suggesting this pathway is crucial in the development of CRPC.
Additional experiments showed that after 7 days of enzalutamide treatment of Ptenloxp/loxp mice, despite decreased AR transcriptional activity the tumors had not significantly regressed and were histologically similar to those before treatment, although the treatment was much more effective in transgenic mice with inducible c-myc. Further studies revealed increased Akt phosphorylation at Ser473 in the Ptenloxp/loxp mice and in LNCaP and LAPC4 AR-positive cells after castration and enzalutamide treatment, respectively. The same treatment did not increase pAkt in PC-3 cells, which are AR negative.
Recommended Reading: Can You Cure Prostate Cancer
What Is Hormonal Therapy For Prostate Cancer
Hormonal therapy for prostate cancer is a treatment to lower the levels of the hormone testosterone in the body. Prostate cancer needs testosterone to grow. Testosterone is mainly made by the testicles. Hormonal therapies reduce the amount of testosterone in the body, or stop it reaching the prostate cancer cells.
Testosterone is important for:
- muscle development and bone strength.
Hormonal therapies are drugs that can be given as injections or as tablets.
Read Also: Orchiectomy Vs Hormone Therapy Prostate Cancer
Hormonal Agents Improve Survival In Mcspc But Novel Targets Are Needed For Further Drug Development
In Partnership With:
Neeraj Agarwal, MD, discusses the role of docetaxel in the frontline setting, the emergence of novel hormonal agents in the paradigm, and efforts being made with combination regimens to potentially treat patients with resistant disease.
Although intensified therapy with hormonal agents like apalutamide , enzalutamide , and abiraterone acetate has improved survival in patients with metastatic castration- sensitive prostate cancer , new targets and novel approaches are necessary for those who progress on these agents, according to Neeraj Agarwal, MD.
Research efforts dedicated to improving outcomes include further examination of PARP inhibitors for patients with metastatic castration-resistant prostate cancer who harbor mutations in DNA repair genes, as well as novel immunotherapy combination regimens like cabozantinib plus atezolizumab , and pembrolizumab plus olaparib .
Hormone therapy for prostate cancer increases the risk of cardiovascular disease-related death especially in older men, according to a population study involving more than 13,000 patients.
The paper, published today in the peer-reviewed journal The Aging Male, found an elevated risk of death from cardiovascular disease for men with prostate cancer treated with hormone-lowering drugs compared with those who were not.
After making suitable adjustments to the data, the researchers found:
Explore further
Don’t Miss: Prostate Problems Cause Erectile Dysfunction