How Does Hormone Therapy Work Against Prostate Cancer
Early in their development, prostate cancers need androgens to grow. Hormone therapies, which are treatments that decrease androgen levels or block androgen action, can inhibit the growth of such prostate cancers, which are therefore called castration sensitive, androgen dependent, or androgen sensitive.
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. In the past, these tumors were also called hormone resistant, androgen independent, or hormone refractory however, these terms are rarely used now because the tumors are not truly independent of androgens for their growth. In fact, some newer hormone therapies have become available that can be used to treat tumors that have become castration resistant.
Drugs That Lower Androgen Levels
The most common treatment is to take drugs that lower the amount of androgens made by the testicles. They are called luteinizing hormone-releasing hormone analogs and anti-androgens . These drugs lower androgen levels just as well as surgery does. This type of treatment is sometimes called “chemical castration.”
Men who receive androgen deprivation therapy should have follow-up exams with the doctor prescribing the drugs:
- Within 3 to 6 months after starting therapy
- At least once a year, to monitor blood pressure and perform blood sugar and cholesterol tests
- To get PSA blood tests to monitor how well the therapy is working
LH-RH analogs are given as a shot anywhere from once a month to every 6 months. These drugs include:
LH-RH antagonists are another class of treatments, including degarelix and relugolix . They reduce androgen levels more quickly and have fewer side effects. LH-RH antagonists are used in men with advanced cancer.
Some doctors recommend stopping and restarting treatment . This approach appears to help reduce hormone therapy side effects. However, it is not clear if intermittent therapy works as well as continuous therapy. Some studies indicate that continuous therapy is more effective or that intermittent therapy should only be used for select types of prostate cancer.
What Should You Ask Your Doctor About Treatments
The American Cancer Society recommends that you ask questions like these:
- What treatment might be best for me?
- What are the possible benefits of getting it?
- How soon would I need to start treatment?
- Will I need to get surgery as part of my treatment? If so, what will it be like and who will do it?
- Will I need other treatments, too? If so, how might they benefit me?
- What side effects could my treatments cause? And what should I do if I get them?
- Is there a clinical trial that might be a good option for me?
- Can you review any vitamins or diet Iââ¬â¢m on to make sure it wonââ¬â¢t interfere with my cancer treatment?
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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.
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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What To Expect During Hormone Therapy
As you go through hormone deprivation therapy, youâll have follow-up visits with your cancer doctor. Theyâll ask about side effects and check your PSA levels.
Doctors donât know how long hormone therapy works to keep prostate cancer in check. So, while you take it, your doctor will regularly draw blood to check your PSA levels. Undetectable or low PSA levels usually mean that the treatment is working. If your PSA levels go up, itâs a sign that the cancer has started growing again. If this happens, your cancer is considered castrate-resistant, and hormone deprivation therapy is no longer an effective treatment.
Youâll also get other blood tests to see if the cancer is affecting other parts of your body like your liver, kidneys, or bones. Scans will show how well your cancer is responding to hormone therapy.
To lessen the side effects of hormone therapy drugs, researchers suggest that you take them for just a set amount of time or until your PSA drops to a low level. If the cancer comes back or gets worse, you may need to start treatment again.
How Might I Feel During Hormone Therapy
Nearly all men being treated for prostate cancer say that they feel emotionally upset at different times during their hormone therapy. It’s not unusual to feel anxious, depressed, afraid, angry, frustrated, alone, or helpless. Hormone therapy may affect your emotions because it lowers the amount of testosterone in your body.
Some men find it helps to learn about their disease and treatment because it makes them less afraid of their treatment. Find out as much as you want to know. Do not be afraid to ask questions. Your emotional health is as important as your physical health.
Talking with an understanding friend, relative, minister or another patient may be helpful. Your doctors office may be able to give you a list of local prostate cancer support groups. There will be men in the support groups who have had hormone therapy. You may also contact the American Cancer Society at 1-800-227-2345 or the National Cancer Institutes Cancer Information Line at 1-800-422-6237 to find out about cancer resources in your local community.
Many people don’t understand prostate cancer or its treatment. They may stay away from you because they’re not sure what to say or how to help. Try to be open when you talk to other people about your illness, treatment, needs, and feelings. People will often be willing to lend their support. If you get tired easily, limit your activities and do only the things that mean the most to you.
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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.
Kinds Of Hormone Therapy
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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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.
Drugs That Stop The Body From Making Androgens
Androgens can be produced in other areas of the body, such as the adrenal glands. Some prostate cancer cells can also make androgens. Three drugs help to stop the body from making androgens from tissue other than the testicles.
Two medicines, ketoconazole and aminoglutethimide , treat other diseases but are sometimes used to treat prostate cancer. The third, abiraterone treats advanced prostate cancer that has spread to other places in the body.
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Intermittent Hormonal Therapy For Locally Advanced Prostate Cancer
Intermittent hormonal therapy is where you stop taking the drugs and after a while start taking them again. This may be an option for locally-advanced prostate cancer. It gives you a break from the side effects of hormonal therapy.
Intermittent hormonal therapy is not suitable for everyone and should only be done on your doctors advice. Your doctor can explain more about this. They usually measure your PSA level using the PSA test every 3 months. If it goes up to a certain level or you get symptoms, your doctor will advise you to start hormonal therapy again.
How Prostate Cancer Is Treated
In cancer care, different types of doctorsincluding medical oncologists, surgeons, and radiation oncologistsoften work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.
The common types of treatments used for prostate cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health.
Cancer treatment can affect older adults in different ways. More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found another section of this website.
Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer:
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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 .
When Is Hormone Therapy Used For Prostate Cancer
Hormone therapy is an effective method for treating prostate cancer but only under certain circumstances. Included are situations in which:
- Cancer has spread from the prostate to other parts of the body to the point that surgical or radiation treatments would no longer be effective.
- Cancer has rebounded after an earlier round of treatment.
- Hormone therapy used in combination with another treatment would make it more effective, based on a medical indicator such as a high prostate-specific antigen score.
- Shrinkage of tumors by androgen deprivation sets the stage for radiation therapy.
Its important to realize that, by itself, hormone therapy isnt a cure for prostate cancer. Some cancer cells will continue to grow, even without the stimulation of testosterone and DHT. Beating prostate cancer often requires multiple therapies.
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What You Need To Know About The Prostate Hormone Therapy Prostate Cancer Drug Names
A enlarged prostate can also cause blockages in the urethra. A blocked urethra can also damage the kidneys. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. If the enlarged prostate is not completely removed, it will shrink.
While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Some men have minimal or no symptoms at all. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. Some men may have an enlarged prostate but not notice it. If they have an enlarged colon, their physician can perform a TURP procedure.
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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.
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Surgery To Remove The Testicles
You may be offered an operation to remove the testicles, or the parts of the testicles that make testosterone. This is called an orchidectomy . Its not used as often as other types of hormone therapy.
Surgery is very effective at reducing testosterone levels, which should drop to their lowest level very quickly usually in less than 12 hours. It also means that you wont need to have regular injections, so theres no risk that youll miss an injection.
Surgery cant be reversed, so its usually only offered to men who need long-term hormone therapy.
If youre thinking about having surgery, your doctor may suggest trying injections or implants for a while first. This will give you and your doctor a chance to see how you deal with the side effects of low testosterone.
Short-term side effects of an orchidectomy include swelling and bruising of the scrotum .
Some men find the thought of having an orchidectomy upsetting and worry about how theyll feel once their testicles are removed. Speak to your doctor if you have any concerns.
If you dont want an orchidectomy, you can usually have a different type of hormone therapy instead.
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
Androgen production in men. Drawing shows that testosterone production is regulated by luteinizing hormone and luteinizing hormone-releasing hormone . The hypothalamus releases LHRH, which stimulates the release of LH from the pituitary gland. LH acts on specific cells in the testes to produce the majority of testosterone in the body. Most of the remaining androgens are produced by the adrenal glands. Androgens are taken up by prostate cells, where they either bind to the androgen receptor directly or are converted to dihydrotestosterone , which has a greater binding affinity for the androgen receptor than testosterone.
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:
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