Risks And Side Effects Of Hormone Therapy For Prostate Cancer
Hormone therapy may be used as adjuvant hormone therapy, which has been proven effective in increasing life span, as neoadjuvant hormone therapy, which is administered before other treatments in early-stage prostate cancer patients who have an intermediate or high risk of recurrence, or alone as palliative care. The length of the treatment depends on each patients risk of recurrence, defined according to the amount or spread of cancer in the body, Gleason score, and PSA level. Patients with intermediate-risk prostate cancer usually need four to six months of hormone therapy, while patients with high-risk disease generally need it for two to three years.
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 will be 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, adds the American Cancer Society.
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.
How Many Times Can You Have Hormone Treatment For Prostate Cancer
ADT is usually the first type of hormone therapy people will receive for prostate cancer.
If ADT stops working, people may receive further hormone therapy with different types of treatment, such as androgen receptor blockers or androgen synthesis inhibitors.
People may have hormone therapy in combination with other treatments, such as chemotherapy. Doctors will monitor how they respond to treatment and decide whether to continue hormone therapy or try a different treatment.
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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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Controversies In Hormone Therapy
The use of hormone therapy requires as much art as science. Physicians do not always agree about when it is best to start treatment, whether it needs to be continuous or can be stopped and started up again periodically, and whether monotherapy or combination therapy is best. Here are the salient issues, what the studies say and what I believe and follow in my own practice.
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What Will I Learn By Reading This
You and your doctor may be talking about using hormone therapy to control your prostate cancer. It is important for you to learn about hormone therapy so that you will know what to expect and how best to take care of yourself before, during, and after treatment. You will learn:
It is important to think about how you will work these things into your everyday life if you and your doctor decide that hormone therapy is the best way for you to control your prostate cancer..
Good Prostate Cancer Care
Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.
You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.
You should also be told about any clinical trials you may be eligible for.
If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.
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How Often And For How Long Will I Need Hormone Therapy
How often you have hormone therapy will depend on the type of drug you are receiving and the type of cancer treated. Some medications need to be administered monthly, while others dont have to be administered quite as frequently.
In regards to how long hormone therapy will last, this will vary based upon the type of cancer you have and how well you are responding to treatment. For some people, it could continue for a few months. However, it is normal to need to continue with hormone therapy for several years. A common example is women undergoing hormone therapy for breast cancer it is normal to continue with treatment for five to seven years.
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Hormonal Therapy For Aggressive Prostate Cancer: How Long Is Enough
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Men weighing treatment options for intermediate- or high-risk cancer that is still localized to the prostate can face a tricky question. A standard approach in these cases is to give radiation to the prostate along with drugs that block testosterone, a hormone that makes the cancer cells grow faster. For how long should this hormone therapy last? Thats not entirely clear. The drugs have side effects, such as fatigue, impotence, and a loss of muscle mass. But radiation doesnt control prostate cancer effectively without them. Doctors therefore aim to give hormone therapy only for as long as it takes to help their patients, without causing any undue harm.
Now, newly published results from a phase 3 clinical trial are providing some needed guidance.
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Hormone Treatment Side Effects
While hormone therapy is among the most effective forms of systemic therapy for prostate cancer, any man considering hormone therapy should weigh the risks and benefits of the treatment, including possible side effects.
Most hormone therapies cause similar side effects due to changes in the levels of hormones . The side effects of medicine-based hormone therapy and the time it takes to get over some of them depend on the type of medicine, the dose, the length of time itâs given and your overall health.
Similar side effects can occur with surgical removal of the testicles . Though orchiectomy is a simple outpatient procedure, it also has the typical side effects and risks associated with surgery, including risks for bleeding and infection.
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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What Is Hormone Therapy For Cancer
Also referred to as hormonal or endocrine therapy, this cancer treatment is different from menopausal hormone replacement therapy , which refers to the prescription of supplemental hormones to help relieve the symptoms of menopause.
Certain cancers rely on hormones to grow. In these cases, hormone therapy may slow or stop their spread by blocking the bodys ability to produce these particular hormones or changing how hormone receptors behave in the body.
Breast and prostate cancers are the two types most commonly treated with hormone therapy. Most breast cancers have either estrogen or progesterone receptors, or both, which means they need these hormones to grow and spread. By contrast, prostate cancer needs testosterone and other male sex hormones, such as dihydrotestosterone , to grow and spread. Hormone therapy may help make these hormones less available to growing cancer cells.
Hormone therapy is available via pills, injection or surgery that removes hormone-producing organs, namely the ovaries in women and the testicles in men. Its typically recommended along with other cancer treatments.
If hormone therapy is part of your treatment plan, discuss potential risks or side effects with your care team so that you know what to expect and can take steps to reduce them. Let doctors know about all your other medications to avoid interactions.
Continuous Adt Beats Out Intermittent Adt
The late-stage international study involved men with hormone-sensitive cancers that had spread beyond the prostate. All were given androgen deprivation therapy with Zoladex and Casodex for seven months. Men who responded were divided into two groups, with one staying on continuous ADT and the other getting intermittent treatment. They were tracked for an average of more than nine years.
Results showed that “survival with intermittent hormone therapy was inferior to survival with continuous hormone therapy,” Hussain says.
Men given continuous therapy lived an average of nearly six years, compared with about five years for men getting intermittent therapy.
Men with minimal disease spread on continuous therapy lived an average of about seven years vs. five years for those treated intermittently — a striking two-year difference, Hussain says.
Among men with more extensive disease spread, the gap in survival narrowed: about four-and-a-half years for continuous therapy vs. five years for intermittent treatment.
But Hussain says that even these men should not be offered treatment breaks, as further study is needed.
Overall, the men who got the stop-and-start treatment received about half the amount of hormone therapy as men who got continual ADT, says researcher David I. Quinn, MBBS, PhD, of the University of Southern California in Los Angeles.
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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 .
When Is Hormone Therapy Used For Prostate Cancer
On its own, hormone therapy can be a good way to control the growth of your prostate cancer. It can also be used with another prostate cancer treatment to help it work better. You should keep in mind that the following things will affect when you have hormone therapy and if you have hormone therapy along with another type of prostate cancer treatment:
Your stage, grade, and Gleason score are determined by a pathologist. A pathologist is a specially trained physician who reviews biopsy results in order to find changes in your body caused by cancer. When you had your prostate biopsy, the pathologist looked at the tissue samples taken from your prostate gland and prepared your biopsy report. The report tells you and your doctor the following information:
This information is used to help your doctor chose the most effective type of hormone therapy for you. The types of hormone therapy include:
Neoadjuvant hormone therapy
If you have early stage prostate cancer, you and your doctor may decide on a course of hormone therapy prior to the start of your main prostate cancer treatment. This is called neoadjuvant or pre-therapy. This type of hormone therapy is used to help shrink your prostate cancer tumor. This helps make your main treatment more effective. This is very common with men who get radiation therapy.
Adjuvant hormone therapy
Adjuvant therapy is given to you at the same time you have your main prostate cancer treatment.
Salvage hormone therapy
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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.
How Long Do You Take Hormonal Therapy For
For early prostate cancer this depends on the prostate cancer risk group. If the cancer is:
- intermediate-risk you may have hormonal therapy for a few months after radiotherapy
- high-risk you may be advised to have hormonal therapy for up to 2 to 3 years after radiotherapy.
For locally advanced prostate cancer you usually have hormonal therapy for 2 to 3 years after radiotherapy.
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T Cell In Colorectal Cancer Therapy
The existing evidence showed that T cells have a strong anti-tumor function in vitro and in vivo. Using T cells expanded in vitro for tumor cell immunotherapy can effectively control or relieve the tumor patients with very few cells or severely defective T cell function. However, there are still many unknowns about the application of T cell therapy in the treatment of colorectal cancer. The above-mentioned study by Wu et al. fills the gap in the study of T17 cells in colorectal tumors, and also provides the possibility for tumor treatment and prognosis prediction by targeting T17 cells, which guides new strategies for future clinical transformation. If you are exploring the application of T cell therapy in colorectal cancer, Creative Biolabs will provide you with a full range of guidance and assistance.
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Options In Hormone Therapy
Testosterone levels in the body can be reduced either surgically or with drugs. The surgical option is castration, achieved by removing the testicles during a bilateral orchiectomy. Once the only option, it has since been supplanted by drugs that lower testosterone levels to amounts achieved by surgery.
For men, normal testosterone levels range from 300 to 1,000 ng/dl. The FDA requires that any new drug used in hormone therapy for prostate cancer lower testosterone levels to 50 ng/dl or less. In my practice, I usually try to lower levels even further, to 20 ng/dl.
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Systemic Therapy For Metastatic Disease
The most common use of hormone therapy today is to treat men whose prostate cancer has metastasized to other parts of the body. If prostate cancer cells escape the prostate, they migrate first to surrounding structures, such as the seminal vesicles and lymph nodes, and later to the bones or, rarely, to other soft tissues.
Hormone therapy is recommended as a palliative treatment, to relieve symptoms such as bone pain. And while hormone therapy is not a cure, in that it cant eliminate prostate cancer completely, it often extends life for many years. By reducing testosterone levels, hormone therapy can shrink a prostate tumor and its metastases and slow further progression of the cancer for so long that sometimes a man with this disease dies of something other than 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
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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