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.
Short Term Side Effects
Patients who receive any type of radiation therapy to treat their prostate cancer can have side effects. Short term side effects are ones that start during or shortly after your radiation treatment. Below is a list of possible short term side effects. Treatments can affect each patient differently, and you may not have these particular side effects. Talk with your care team about what you can expect from your treatment
Other Problems With Prostate Drugs:
Alpha blockers have several other side effects that are also worrisome.
Terazosin has been linked to: fatigue, lack of energy and loss of strength. In addition to dizziness this drug could cause sleepiness, nasal congestion and erectile dysfunction . Other symptoms may include fluid retention in extremities like ankles, headache, shortness of breath, arrhythmias and anxiety.
Tamsulosin can lower libido and affect ejaculation. In addition to dizziness and lack of energy this alpha antagonist can also cause nasal congestion, runny nose, sore throat and sinusitis. Irregular heart rhythms have also been reported.
Doxazosin, like other alpha blockers can cause dizziness, fatigue, sleepiness, fluid retention, shortness of breath, nausea, headache, and irregular heart rhythms. In addition, it may contribute to a dry mouth and blurred vision.
Alfuzosin, one of the newer alpha blockers, may be a bit better tolerated, though it too can cause dizziness, headache and fatigue. And like every drug in the class it can cause orthostatic hypotension. Standing up quickly can cause some men to feel dizzy, disoriented and fall.
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When Hormone Therapy Stops Working
After some months or years the hormone treatment usually stops working and the cancer starts to grow again. Your doctor might recommend stopping or changing hormone treatment at this stage.
If you’re having anti androgens and your PSA level has started to rise again your doctor might get you to stop taking them. In some cases this can cause the cancer to shrink and stop growing for some time. This is called anti androgen withdrawal response .
There are different treatment options for when hormone therapy stops working, such as chemotherapy or steroids.
Which Hormone Therapies Are Used To Treat Prostate Cancer
Hormone therapy used in the treatment of prostate cancer is also known as androgen-deprivation therapy. Androgens are male sex hormones which include testosterone and dihydrotestosterone. They play an important role in the normal development of males. However, when prostate cancer develops, the androgens support the tumor growth and proliferation. Hormone therapy is prescribed to stop the body from producing androgens, or block the effect of the androgens. This therapy is used in advanced cancer stages, to shrink the cancer and retard its growth. When prescribed to men suffering from early-stage cancer, hormone therapy help in shrinking the tumor before radiation therapy.
The options of hormone therapy include:
Drugs to lower androgen levels
Drugs that stop the androgens from functioning – These drugs prevent testosterone from acting on the cancer cells, and therefore limit the growth of the cancer. These include flutamide, bicalutamide and nilutamide.
Enzalutamide is a newer drug under this category. It blocks the effect of the androgen at a point beyond its binding to its receptor or site of action on the cancer cells. It is prescribed for castration-resistant prostate cancer.
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Possible Side Effects Of Radiation Treatment For Prostate Cancer
The radiation used to destroy cancer cells can also hurt normal cells in the nearby area. Side effects from radiation treatment are related to the area of the body being treated. Patients start to have side effects a few weeks into their treatment. While side effects may be unpleasant, there are treatments to help deal with them. Most side effects are temporary and slowly start to go away once treatment is done.
You will be seen by your radiation oncology providers often during treatment. These visits are a chance to ask questions and to talk about any side effects and how to best manage them. You can also call your providers to speak about any side effects.
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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Do Zoladexs Side Effects Vary Depending On The Condition Its Used To Treat
Yes, some of the common side effects of Zoladex vary, depending on the condition being treated.
For example, mood changes and depression are more common side effects in people having the treatment for endometriosis or breast cancer. Mood-related side effects werent commonly reported in studies of the drug for prostate cancer.
For more information, see More common side effects above. If you have questions about the side effects that Zoladex can cause for people with your condition, talk with your doctor.
How Is Chemotherapy Given
Chemo drugs for prostate cancer are typically given into a vein , either as an infusion over a certain period of time. This can be done in a doctors office, chemotherapy clinic, or in a hospital setting. Some drugs, such as estramustine, are given as a pill.
Often, a slightly larger and sturdier IV is required in the vein system to administer chemo. They are known as central venous catheters , central venous access devices , or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing.
Many different kinds of CVCs are available. The most common types are the port and the PICC line.
Doctors give chemo in cycles, with each period of treatment followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 2 or 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.
The length of treatment for advanced prostate cancer is based on how well it is working and what side effects you have.
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Side Effects Of Hormonal Therapy
Side effects can happen with any type of treatment for cancer, but everyones experience is different. Some people have many side effects. Other people have few or none at all.
If you develop side effects, they can happen any time during, immediately after or a few days or weeks after hormonal therapy. Sometimes late side effects develop months or years after hormonal therapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.
Side effects of hormonal therapy will depend mainly on the type of hormonal therapy, the dose of a drug or combination of drugs and your overall health.
It is important to report side effects and your concerns about side effects to the healthcare team. Doctors may measure how severe certain side effects are. Sometimes hormonal drug therapy may need to be adjusted if side effects are severe.
The following are the most common side effects that people tend to experience with hormonal therapy.
How Long Does It Take To Work
Nubeqa begins to work right away, but you may not notice any changes in your condition that quickly. Your doctor will order prostate-specific antigen tests for you. PSA tests can check how well Nubeqa is treating your prostate cancer. A lower PSA level in the blood is a sign that the drug is working. To learn more about your PSA level, talk with your doctor.
There arent any known interactions between Nubeqa and alcohol. However, drinking too much alcohol can cause some of the same side effects of Nubeqa.
Drinking alcohol with Nubeqa may raise your risk for certain side effects, such as:
Also, over time, drinking too much alcohol can affect how well your liver works. Your liver is responsible for metabolizing medications and has many other important functions. If you have liver damage, it may not be safe for you to take Nubeqa. .
If you drink alcohol, talk with your doctor about how much is safe for you to consume while you take Nubeqa.
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Chemo Drugs Used To Treat Prostate Cancer
For prostate cancer, chemo drugs are typically used one at a time. Some of the chemo drugs used to treat prostate cancer include:
In most cases, the first chemo drug given is docetaxel, combined with the steroid drug prednisone. If this does not work , cabazitaxel is often the next chemo drug tried .
Docetaxel and cabazitaxel have been shown to help men live longer, on average, than older chemo drugs. They may slow the cancers growth and also reduce symptoms, resulting in a better quality of life. Still, chemo is very unlikely to cure prostate cancer.
Other chemo drugs being studied for use in prostate cancer include carboplatin, oxaliplatin, and cisplatin.
What Can Be Done To Treat Or Reduce Side Effects
Once chemotherapy treatment is complete, its side effects will typically cease. However, steps can be taken to combat any side effects as they occur. For instance, medications can help prevent nausea and vomiting, laxatives or stool-binding medications can manage constipation or diarrhea, respectively, and numbing gel can soothe mouth sores. Additionally, chemotherapy dosages can be changed or alternative chemo drugs can be considered, if appropriate.
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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.
What Causes Prostate Cancer
Experts arent sure why some cells in the prostate gland become cancerous . Genetics appear to play a role. For example:
- Youre two to three times more likely to get prostate cancer if your father, brother or son has the disease.
- Inherited mutated breast cancer genes and other gene mutations contribute to a small number of prostate cancers.
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Can I Take Nubeqa If I Have Liver Or Kidney Problems
Your kidneys and liver help remove Nubeqa from your system. So if you have certain kidney or liver problems, your body may not be able to remove the drug as well as usual. Examples of these problems include chronic kidney disease and hepatitis.
Before you start taking Nubeqa, tell your doctor if you have any kidney or liver problems. Your doctor may order a blood test. This will check the function of your kidneys and liver to see whether its safe for you to take Nubeqa.
For more information, see the Nubeqa precautions section below. If you have other questions about whether Nubeqa is right for you, talk with your doctor.
Possible Side Effects Of Chemotherapy
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow , the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells can also be affected by chemo, which can lead to side effects.
The side effects of chemo depend on the type and dose of drugs given and how long they are taken. Some common side effects can include:
These side effects usually go away once treatment is finished. There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting.
Along with the risks above, some side effects are seen more often with certain chemo drugs. For example:
- Docetaxel and cabazitaxel sometimes cause severe allergic reactions. Medicines are given before each treatment to help prevent this. These drugs can also damage nerves , which can cause numbness, tingling, or burning sensations in the hands or feet.
- Mitoxantrone can, very rarely, cause leukemia several years later.
- Estramustine carries an increased risk of blood clots.
If you notice any side effects while getting chemo report them to your cancer care team so that they can be treated promptly. In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to prevent the effects from getting worse.
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Talk With Your Doctor
Its important to discuss prostate cancer treatment options with your doctor. They can help you understand the pros and cons of chemotherapy and answer any specific questions you have about your treatment.
An oncologist, a doctor specializing in cancer, can help you develop strategies to lower your chances of developing side effects.
An oncologist can also put you in touch with support groups in your area. Many people find it helpful to talk with other people who have gone through the same treatment.
Drugs That Stop Androgens From Working
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 to 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 they are not sure why it happens.
Enzalutamide , apalutamide and darolutamide are newer types of anti-androgens.
These drugs are taken as pills each day.
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When Is Hormone Therapy Used
Hormone therapy may be used:
- If the cancer has spread too far to be cured by surgery or radiation, or if you cant have these treatments for some other reason
- If the cancer remains or comes back after treatment with surgery or radiation therapy
- Along with radiation therapy as the initial treatment, if you are at higher risk of the cancer coming back after treatment
- Before radiation to try to shrink the cancer to make treatment more effective