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.
What Are The Signs And Symptoms Of Prostate Cancer
Prostate cancer usually doesnt cause symptoms in its early stages. In fact, most men dont know they have prostate cancer until it is found during a regular medical exam. When unusual symptoms are noticed, theyre most often problems with urinating. But these same symptoms can also be caused by an enlarged prostate, so its important to talk with your doctor.
Typically, noticeable symptoms of prostate cancer dont occur until the cancer has begun to spread beyond the prostate, or its metastasized to the lymph nodes or other parts of the body. At this point, prostate cancer signs and symptoms can include:
- Not being able to urinate at all
- Having a hard time starting or stopping the flow of urine
- Having to urinate often, especially at night
- Having pain or burning during urination
- You have difficulty having an erection
- You have deep and frequent pain in your lower back, belly, hip or pelvis
Anytime you experience unusual symptoms especially any of the symptoms mentioned above make an appointment with your family doctor or urologist. They can talk with you about your symptoms, do a physical exam if necessary and work with you to create a treatment plan, if necessary.
Experiencing symptoms of prostate problems? Dont delay getting the care you need.
If the cancer is small and localized, a doctor may recommend:
Watchful waiting or monitoring
Surgery
Radiation therapy
Treatment will depend on various factors. A doctor will discuss the best option for the individual.
What Is Prostate Cancer
Cancer can start any place in the body. Prostate cancer starts in the prostate gland. It starts when cells in the prostate grow out of control.
Cancer cells can spread to other parts of the body. Cancer cells in the prostate can sometimes travel to the bones or other organs and grow there. When cancer cells do this, its called metastasis. To doctors, the cancer cells in the new place look just like the ones from the prostate.
Cancer is always named for the place where it starts. So when prostate cancer spreads to the bones , its still called prostate cancer. Its not called bone cancer unless it starts from cells in the bone.
Ask your doctor to use this picture to show you where your cancer is.
The prostate
The prostate is a gland found only in men, so only men can get prostate cancer.
The prostate is just below the bladder and in front of the rectum . The tube that carries pee goes through the prostate. The prostate makes some of the fluid that helps keep the sperm alive and healthy.
There are a few types of prostate cancer. Some are very rare. Most prostate cancers are a type called adenocarcinoma. This cancer starts from gland cells. Your doctor can tell you more about the type you have.
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Drugs To Prevent Prostate Cancer
Men with benign prostatic hyperplasia are often treated with dihydrotestosterone -lowering drugs called finasteride or dutasteride. These drugs have been studied extensively to determine whether they can prevent prostate cancer, and results suggest that they could reduce cancer risk by about 25 percent. Patients who develop cancer while on the drugs are more likely to get an aggressive form of the disease, so discuss the advantages and disadvantages with your doctor.
Family History And Genetics
Your family history is information about any health problems that have affected your family. Families have many common factors, such as their genes, environment and lifestyle. Together, these factors can help suggest if you are more likely to get some health conditions.
Inside every cell in our body is a set of instructions called genes. These are passed down from our parents. Genes control how the body grows, works and what it looks like. If something goes wrong with one or more genes , it can sometimes cause cancer.
Is prostate cancer hereditary?
If people in your family have prostate cancer or breast cancer, it might increase your own risk of getting prostate cancer. This is because you may have inherited the same faulty genes.
My father had prostate cancer. What are my risks?
- You are two and a half times more likely to get prostate cancer if your father or brother has had it, compared to a man who has no relatives with prostate cancer.
- Your chance of getting prostate cancer may be even greater if your father or brother was under 60 when he was diagnosed, or if you have more than one close relative with prostate cancer.
- Your risk of getting prostate cancer may also be higher if your mother or sister has had breast cancer.
Do you have a family history of prostate cancer?
If youâre over 45 and your father or brother has had prostate cancer, you may want to talk to your GP. Our Specialist Nurses can also help you understand your hereditary risk of prostate cancer.
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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.
At What Age Should You Start Getting Prostate Cancer Screenings
Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. Approximately one out of eight men will be diagnosed with prostate cancer in their lifetime and one in 41 will die from it. In 2022 alone, the American Cancer Society recorded nearly 270,000 new cases of prostate cancer. Of those, almost 35,000 were fatal .
The silver lining is that comparable to most cancers, the survival rate of prostate cancer is high. While individual cases can vary, many doctors believe that the earlier prostate cancer is caught, the more likely it is that the patient can make a full recovery. In fact, statistics show that in 80 to 85% of prostate cancers detected in stages 1, 2, or 3, most of the men will be disease-free within five years .
Given the chances of developing prostate cancer, as well as the potential of successful treatment if caught early, its important that men get regular screenings . However, most men dont consider getting screened for prostate cancer until it is too late so when is the right age for men to be taking prostate cancer screening seriously? The answers can vary, and there are factors to consider.
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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.
Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.
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Screening For Prostate Cancer
At UCSF, we believe in testing men so they know if they have prostate cancer, but that doesn’t mean every man diagnosed should have aggressive treatment. Screening is the only way to detect high-risk, potentially life-threatening prostate cancer early, while it can still be cured.
Most prostate cancers in the U.S. are identified through the following screening tests:
- Prostate-specific antigen . This simple blood test checks levels of prostate-specific antigen, a protein produced by prostate cells. The higher the PSA level, the more likely prostate cancer is present. But PSA elevations can also occur in benign conditions, most commonly benign prostatic hyperplasia, in which the prostate enlarges, as occurs in most men over their lifetime.
- Digital rectal exam . For this physical examination, your doctor inserts a lubricated gloved finger into your rectum to feel for any irregular or abnormally firm areas. While most prostate cancers are detected by PSA screening, some cancers produce little PSA but are detected by DRE.
In some circumstances, your doctor may order a repeat PSA or other tests to help determine whether a benign condition led to an elevated PSA. These tests may include:
- Multiparametric MRI
An MRI exam of the prostate is helpful and can allow for a more targeted biopsy.
Can Prostate Cancer Be Prevented
There are no clear prevention strategies for prostate cancer. There is some conflicting evidence that a healthy diet composed of low fat, high vegetables and fruits may help reduce your risk of prostate cancer. Routine screening, with PSA blood test and physical exam, is important to detect prostate cancer at an early stage. A healthy diet and regular exercise are also critical in maintaining good health and preventing disease in general.
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Why Does Prostate Cancer Happen
The causes of prostate cancer are largely unknown. However, certain things can increase your risk of developing the condition.
The chances of developing prostate cancer increase as you get older. Most cases develop in men and anyone with a prostate aged 50 or older.
For reasons not yet understood, prostate cancer is more common in men and anyone with a prostate of African-Caribbean African descent. It’s less common in men and anyone with a prostate of Asian descent.
Men and anyone with a prostate who have first-degree male relatives affected by prostate cancer are also at a slightly increased risk.
Read more about the causes of prostate cancer
What Are The Treatments For Prostate Cancer
Your treatment options usually depend on your age, your general health, and how serious the cancer is. Your treatment may include one or more of options:
- Observation,which is mostly used if you are older, your prostate cancer isnt likely to grow quickly, and you dont have symptoms or you have other medical conditions. Your doctor will keep checking on your cancer over time so to see whether you will need to start treatment for the cancer. There are two types of observation:
- Watchful waiting means having little or no testing. If symptoms begin or change, you will get treatment to relieve them, but not to treat the cancer.
- Active surveillance means having regular tests to see if your prostate cancer has changed. If the tests show the cancer is starting to grow or if you develop symptoms, then you will have treatment to try to cure the cancer.
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After Prostate Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Prostate Or To Other Parts Of The Body
The process used to find out if cancer has spread within theprostate or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnoseprostate cancer are often also used to stage the disease. In prostate cancer, staging tests may not be done unless the patient has symptoms or signs that the cancer has spread, such as bone pain, a high PSA level, or a high Gleason score.
The following tests and procedures also may be used in the staging process:
Side Effects Of Treatment
Treatment for prostate cancer can cause a variety of side effects which can affect your mind, your body and your relationships. All of this can impact your sex life, some more than others. You can read about sex and prostate cancer here.
Some men experience urinary problems after prostate cancer treatment, including leakage of urine . You can read information about this here.
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Take Time To Make A Treatment Decision
Most prostate cancers grow relatively slowly, so immediate treatment is rarely necessary. Many men can safely take months to decide what to do. The decision process can be complicated. The chosen treatment can significantly affect your life, which makes it especially important to take time to educate yourself and confidently choose the approach that is most appropriate for you.
How Prostate Cancer Develops
However, sometimes something goes wrong within prostate cells, and cancer develops.
In general, cancer is a condition in which a normal cell becomes abnormal and starts to grow and/or reproduce uncontrollably without having the signals or brakes that stop typical cell growth. Prostate cancer occurs when a normal prostate cell begins to grow out of control. In many cases, prostate cancer is a slow-growing cancer that does not spread beyond the prostate gland before the time of diagnosis.
Once prostate cancer forms, it feeds on androgens and uses them as fuel for growth. This is why one of the backbones of treatment for men, especially with advanced prostate cancer, is to lower a mans androgen levels with drugs collectively termed hormone therapy.
Not all prostate cancer cells are alike. Prostate cancers that are composed of very abnormal cells are much more likely to both divide quickly and spread, or metastasize, from the prostate to other regions of the body. Often, prostate cancer spreads first to tissues that are near the prostate, including the seminal vesicles and nearby lymph nodes.
Researchers have identified various biological and genetic subtypes of prostate cancer. Although these subtypes are typically not yet used to guide treatment recommendations, they are the subject of active research funded by the Prostate Cancer Foundation.
Help support PCFs research into causes and treatments of prostate cancer: Donate Today!
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Eight Types Of Standard Treatment Are Used:
Watchful waiting or active surveillance
Watchful waiting and active surveillance are treatments used for older men who do not have signs or symptoms or have other medical conditions and for men whose prostate cancer is found during a screening test.
Watchful waiting is closely monitoring a patients condition without giving any treatment until signs or symptoms appear or change. Treatment is given to relieve symptoms and improve quality of life.
Active surveillance is closely following a patient’s condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests, including digital rectal exam, PSA test, transrectal ultrasound, and transrectal needle biopsy, to check if the cancer is growing. When the cancer begins to grow, treatment is given to cure the cancer.
Other terms that are used to describe not giving treatment to cure prostate cancer right after diagnosis are observation, watch and wait, and expectant management.
Surgery
Patients in good health whose tumor is in the prostategland only may be treated with surgery to remove the tumor. The following types of surgery are used: