What Precautions Or Health Checks Could Be Recommended Before Starting Chemotherapy
The health care provider or oncologist may suggest the following tests and precautions, before administering chemotherapy drugs for prostate cancer.
- Dental checkup Chemotherapy can cause mouth sores and dry mouth. Hence, it is good to have thorough dental check before starting chemotherapy.
- Echocardiogram Some cancer drugs may cause affect the heart. ECG is recommended to know the state of heart and if the cancer medications can cause further harm.
- Reproductive health Some anti-cancer drugs can reduce the fertility of men. Hence, if a patient wants children, it is better to inform the same to the healthcare provider. The treatment option would be considered accordingly.
- Blood counts Chemotherapy affects blood counts therefore, blood counts should be done at the beginning of the treatment and repeated during treatment.
Lhrh Agonists And Antagonists
LHRH agonist and antagonist medications stop your body from producing testosterone.
These medications are injected under your skin or into a muscle monthly, every three months or every six months. Or they can be placed as an implant under your skin that slowly releases medication over a longer period of time.
These medications include:
- Leuprolide
- Goserelin
- Histrelin
- Degarelix
Testosterone levels may increase briefly for a few weeks after you receive an LHRH agonist. Degarelix is an exception that doesn’t cause a testosterone flare.
Types Of Hormone Therapy For Prostate Cancer
Hormone therapy may be part of prostate cancer treatment if the cancer has spread and cant be cured by surgery or radiation therapyor if the patient isnt a candidate for these other types of treatment. It may also be recommended if cancer remains or returns after surgery or radiation therapy, or to shrink the cancer before radiation therapy.
Additionally, hormone therapy may be combined with radiation therapy initially if theres a high risk of cancer recurrence. It can also be given before radiation therapy to shrink the cancer and make other treatments more effective. Other types of hormone therapy for prostate cancer include:
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Male Hormones And Prostate Cancer
Androgens are male sex hormones. Testosterone is one main type of androgen. Most testosterone is made by the testicles. The adrenal glands also produce a small amount.
Androgens cause prostate cancer cells to grow. Hormone therapy for prostate cancer lowers the effect level of androgens in the body. It can do this by:
- Stopping the testicles from making androgens using surgery or medicines
- Blocking the action of androgens in the body
- Stopping the body from making androgens
Medications For Prostate Cancer
Other names: Cancer, Prostate Carcinoma of Prostate
Prostate cancer is a cancer that occurs in the prostate, which is a small, walnut-sized gland that is located just below the bladder in men and which surrounds the urethra .
Prostate cancer is common, and many men have a slow-growing form of prostate cancer. Death, when it happens, is usually from other causes rather than the cancer itself. However, some prostate cancers are aggressive and can quickly spread outside the confines of the prostate. These are associated with a lower rate of survival.
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How Does Hormonal Therapy Affect Prostate Cancer
Hormonal therapy for prostate cancer depends on stopping the male hormone testosterone from interacting with cancer cells.
The prostate is the male gland in the pelvis that wraps around the urethra and produces the fluid portion of semen. Prostate cancer is one of the most common cancers in men.
Prostate cancer is highly sensitive to and dependent on, the level of the male hormone testosterone, which drives the growth of prostate cancer cells in all but the very high-grade or poorly-differentiated forms of prostate cancer. Testosterone belongs to a family of hormones called androgens, and today front-line hormonal therapy for advanced and metastatic prostate cancer is called androgen deprivation therapy .
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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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 many 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.
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
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What Is The Most Effective Treatment For Prostate Cancer
The good news is that there are many effective treatments that can result in positive outcomes for prostate cancer patients. For example, for localized prostate cancer, external beam radiation therapy can have an up to 95% efficacy. Radical prostatectomy has also been found to achieve an over 90% efficacy against prostate cancer. The decision of which treatment plan or plans to follow is ultimately a personal decision that should be based on the recommendations of your doctor.
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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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 .
Targeted Therapy Medications Learn More > > More > >
| DRUG | ||
|---|---|---|
| Lynparza | olaparib |
Lynparza is a PARP inhibitor approved for the treatment of advanced ovarian cancer in previously treated people with harmful BRCA mutations, maintenance treatment of ovarian cancer in people responding to chemotherapy, previously treated HER2-negative metastatic breast cancer in people with BRCA mutations, maintenance treatment of pancreatic cancer in people with BRCA mutations and previously treated metastatic castration-resistant prostate cancer in people with BRCA or other faulty DNA repair mutations. |
| Rozlytrek | entrectinib |
Rozlytrek is approved for the treatment of solid tumors anywhere in the body that have NTRK gene fusions and for ROS1-positive non-small-cell lung cancer. |
| Rubraca | rucaparib |
Rubraca is a PARP inhibitor approved for maintenance treatment of people with recurrent ovarian, fallopian tube or primary peritoneal cancer that is responding to chemotherapy, for previously treated ovarian cancer in patients with harmful BRCA mutations and for previously treated metastatic castration-resistant prostate cancer in people with harmful BRCA mutations. |
| larotrectinib |
Vitrakvi is a TRK inhibitor that works against cancers anywhere in the body with NTRK gene fusions. |
| GENERIC NAME leuprolide |
| DRUG INDICATION
Lupron is a GnRH agonist approved for palliative treatment of advanced prostate cancer. It is also used to treat breast and ovarian cancer, though it is not FDA-approved for these indications. |
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Surgery To Remove The Testicles
Surgery to remove your testicles isnt a common way of lowering the amount of testosterone you produce.
You usually only have surgery to remove your testicles if you need your testosterone reduced urgently. For example if your cancer has spread to your bones and is pressing on your spinal cord, your doctors might want to reduce the amount of testosterone quickly.
Your doctors might also suggest surgery as an option if you don’t want to have injections or tablets.
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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What Is Androgen Deprivation Therapy
In the past, this was accomplished by surgical castration called bilateral orchiectomy. In that procedure, the testes were both removed. Today, doctors can block the function of the testes in a controllable and most often reversible fashion with drugs that prevent the production of testosterone . These agents can result in shrinkage of the prostate gland, can stop prostate cancer cells from growing for up to several years, and can relieve pain caused by prostate cancer that has spread or metastasized into the bones by shrinking cancer. The use of ADT does not produce a cure. Over time, the prostate cancer cells will develop an ability to grow despite the lack of hormones . Another form of hormonal therapy is the use of androgen receptor blockers these medications prevent testosterone from attaching to the prostate cancer cell and being absorbed into the cell where it can help the cell survive and grow.
Hormonal treatment today is primarily used in the treatment of locally advanced and metastatic prostate cancer. It may be used in conjunction with primary curative therapies to shrink cancer/prostate to increase the likelihood of cure of the treatment, neoadjuvant therapy, and with radiation therapy for several years after treatment . However, the primary role of ADT is in the treatment of widespread or metastatic prostate cancer. While it is not a curative treatment in that setting, it can both reduce symptoms and slow down the growth of prostate cancer to prolong life.
How Is Prostate Cancer Treated
Treatment for prostate cancer depends upon the stage of the prostate cancer and an understanding of the pros and cons of treatment. Treatment options include:
- Watchful waiting. No active treatment is started. This may be appropriate for older men with other serious medical conditions
- Active watching. May involve regular PSA tests and prostate biopsies
- Radiation
- Brachytherapy. Small radioactive pellets are placed permanently into the prostate gland
- Surgery
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Prostate Cancer Hijacks Tumor Cells Circadian Rhythm To Evade Hormone Therapy
Microscopic image of prostate cancer that has spread to a patients lymph node. Credit: Netherlands Cancer Institute
Therapy sensitivity in prostate cancer halted by protein regulating circadian rhythm.
Hormone treatment is successful at controlling metastatic prostate cancer, but the tumor cells eventually develop resistance to it. An unexpected potential solution has now emerged in medicines that are not designed to fight cancer, but rather to target proteins that regulate a cells circadian rhythm.
An international team of scientists led by the Netherlands Cancer Institute will publish this discovery today in the renowned journal Cancer Discovery, a journal of the American Association for Cancer Research.
Prostate cancer is a form of tumor that develops under the influence of hormones, primarily testosterone. Patients with metastatic prostate cancer are frequently treated with anti-hormonal therapy, which inhibits the signal sent out by testosterone that stimulates tumor growth.
Drug repurposing could save a decade or research
Now that they have discovered the tumors escape route, the researchers will next work together with Oncode towards the development of novel strategies to block this process, and ultimately increase the efficacy of anti-hormonal therapy against prostate cancer even further.
Reference: 27 June 2022, Cancer Discovery.DOI: 10.1158/2159-8290.CD-21-0576
Prostate Cancer Treatment Options By Stage
Treatment options vary depending on what stage your cancer has progressed to when you’re diagnosed. Prostate cancer is rated using a Gleason score with a higher score indicating more progressed cancer. Lets take a closer look at treatment options by stage.
| Best medications for prostate cancer | |
|---|---|
| Stage I | |
| Transurethral resection of the prostate | X |
Continued active surveillance: This option is particularly viable for cancers that are growing very slowly, for men of advanced age who may have quality-of-life concerns or other illnesses, and often younger men as well to avoid unnecessary treatments.
Watchful waiting: Watchful waiting is much like active surveillance. However, with watchful waiting, there may be a more hands-off approach to testing because the patient may have more pressing medical concerns that need to be taken care of and waiting on treatment can help preserve the quality of life.
Radiation therapy: Radiation therapy involves a radiation oncologist utilizing targeted beams of radiation to eradicate diseased tissue. This can be in the form of an external beam , brachytherapy , or a combination of both. It is often used to help alleviate urinary incontinence. Its usually administered with or followed up by hormone therapy.
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Figure : How Hormone Therapy Affects The Androgen Cascade
The male sex hormones are known as androgens. Probably the best known hormone in this family is testosterone. Most androgens are produced in the testicles.
Androgens fuel the growth of prostate cells, including prostate cancer cells. Hormone therapy also known as androgen-deprivation therapy seeks to cut off the fuel supply. But different therapies work in different ways.
A. The hypothalamus releases pulses of LHRH, which signals the pituitary gland to release the hormones FSH and LH.
B. LH travels through the bloodstream. When it reaches the testicles, it binds to specialized cells that secrete testosterone into the bloodstream.
C. In the prostate, the enzyme 5-alpha-reductase converts testosterone and other types of androgens into dihydrotestosterone , which stimulates the growth of prostate cells and fuels the growth of cancer, if it is present.
Centrally acting agents
LHRH agonists flood the pituitary gland with messages to crank out LH. This causes a temporary surge of testosterone until receptors in the pituitary are overloaded. Then testosterone levels drop sharply.
The GnRH antagonist jams receptors in the pituitary gland so that it cannot respond to the pulses of LHRH sent by the hypothalamus. This prevents the LH signal from being sent and no testosterone is made in the testicles.
DES inhibits secretion of LHRH from the hypothalamus.
Peripherally acting therapies
Orchiectomy removes the testicles, preventing testosterone production.
Selective Estrogen Receptor Modulators
Selective estrogen receptor modulators including tamoxifen , raloxifene and toremifene selectively block estrogen from certain tissues, namely the breast, while increasing its availability in other areas such as the bones.
When and why theyre used: Doctors may recommend SERMs after surgery for early ER-positive breast cancer in men or women, to reduce the chances that it recurs. Theyre also approved to treat advanced breast cancer, and may be used to prevent breast cancer in high-risk individuals. Toremifene is only approved for advanced stage breast cancer that has spread.
Risks: In addition to more common side effects of hormone therapy such as hot flashes, tamoxifen risks may include blood clots, stroke, bone loss, mood changes, depression and loss of sex drive. Men who take tamoxifen may experience headaches, nausea, vomiting, rashes, impotence and loss of sex drive. Raloxifene may increase a patients chances of having a stroke or developing potentially fatal blood clots in the lungs or legs. Fortunately, these side effects are considered relatively rare. Have your doctor explain the potential side effects associated with each SERM when discussing the pros and cons of these medications with you.
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