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.
When Is Brachytherapy Alone The Right Choice
For a patient with disease that is confined to the prostate and not too aggressive, brachytherapy alone is a good option. With the use of sophisticated real-time computer-based planning, we can use brachytherapy to deliver radiation in an extraordinarily precise way, with minimal exposure to the surrounding normal tissues. It is also convenient for the patient as it is done in an outpatient setting and most people are able to get back to work the next day.
But brachytherapy is not right for everyone. For some patients with less-aggressive disease, a watch-and-wait approach would also be very reasonable. At MSK, our philosophy is that when the disease is caught very early meaning a low PSA level, or nonaggressive disease as reflected by a Gleason score of 6 with evidence of cancer in only a few of the biopsy samples and no evidence from the MRI of a significant amount of disease then it would be very appropriate to do active surveillance and hold off on treatment.
Risk Factors In Aggressive Vs Slow
In the past few years, weve learned that prostate cancer really is several diseases with different causes. More aggressive and fatal cancers likely have different underlying causes than slow-growing tumors.
For example, while smoking has not been thought to be a risk factor for low-risk prostate cancer, it may be a risk factor for aggressive prostate cancer. Likewise, lack of vegetables in the diet is linked to a higher risk of aggressive prostate cancer, but not to low-risk prostate cancer.
Body mass index, a measure of obesity, is not linked to being diagnosed with prostate cancer overall. In fact, obese men may have a relatively lower PSA levels than non-obese men due to dilution of the PSA in a larger blood volume. However, obese men are more likely to have aggressive disease.
Other risk factors for aggressive prostate cancer include:
- Tall height
- Agent Orange exposure
Research in the past few years has shown that diet modification might decrease the chances of developing prostate cancer, reduce the likelihood of having a prostate cancer recurrence, or help slow the progression of the disease. You can learn more about how dietary and lifestyle changes can affect the risk of prostate cancer development and progression in PCFs Health and Wellness: Living with Prostate Cancer guide.
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How To Do Active Surveillance Right
After a diagnosis of low-risk prostate cancer, you may be presented with a range of treatment options. Considering the slow progress of most prostate cancer, active surveillance is a reasonable choice for many men. Even if you live a long time after your diagnosis, your cancer may neverbecome aggressive and cause harm. Often, low-risk prostate cancer hardly progresses at all, even over decades.
If you choose to go the active surveillance route, do it the smart way. Dr. Hu recommends that for the first two years after your diagnosis
- Get a PSA test every six months.
- Have an office visit that includes a digital exam every six months.
- Within the first two years after diagnosis, get at least one follow-up biopsy as well as magnetic resonance imaging and precision medicine tests to reduce the risk of missing more aggressive cancer.
What happens next depends on those first two years. If it looks like your cancer is stable and not progressing, your doctor may suggest less frequent follow-ups. But if there is evidence that the cancer is becoming more aggressive, then you can decide at that time whether radiation, surgery, hormone therapy or some combination of these treatments is right for you. You may never need treatment, but if you do, youll get it when its still highly effective.
The Psa Test For Prostate Cancer Is Less Than Perfect
Your doctor will tell you to get a PSA test and a digital rectal exam every year. But this autopsy study suggests thats not nearly enough. All of the men in the study had a normal result on both of these tests. In fact, another study says these tests are not very accurate at all.
In 2004, the New England Journal of Medicine published a study that reveals just how inaccurate a normal PSA reading can be.
The authors of the study wondered how often men with both a normal PSA and a normal rectal examination actually had prostate cancer.
These researchers must have done some fast talking. Somehow, they managed to talk 2,950 men into having their prostates biopsied simply as part of their research. None of the men had any indication at all that they were any more likely to have prostate cancer than the average man with normal tests.
What they found was startling. Of these nearly 3,000 men, 449 men actually had cancer despite their normal test scores. Thats one in seven.
That means that for every seven men who have normal findings, one of them has cancer. And the doctors missed it. Whats more, the actual number of the PSA score doesnt offer much help either.
- 6.6 percent of the 449 had an extremely low PSA that was less than 0.5.
- 10.1 percent had PSAs between 0.6 and 1.0.
- 17.0 percent had PSAs between 1.1 to 2.0.
- 23.9 percent had values of 2.1 to 3.0.
- And 26.9 percent had levels between 3.1 to 4.0.
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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.
How Do Men Feel About The Rectal Exam
I think most men are willing to do it, but some men are exceptionally opposed to it. They might be happy to hear that there are studies ongoing in the United Kingdom looking at using magnetic resonance imaging as a screening tool to be able to avoid doing a digital rectal exam in the future. There is a large African immigrant population in London with a higher incidence of prostate cancerthey didnt want to have the prostate exam because they had a lot of opposition to it. They were uncomfortable with it.
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Why Does Prostate Cancer Happen
The causes of prostate cancer are largely unknown. But 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 aged 50 or older.
For reasons not yet understood, prostate cancer is more common in men of African-Caribbean or African descent, and less common in Asian men.
Men whose father or brother were affected by prostate cancer are at slightly increased risk themselves.
Recent research also suggests that obesity increases the risk of prostate cancer.
What Kind Of Treatment Will I Need
There are many ways to treat prostate cancer. The main kinds of treatment are observation, active surveillance, surgery, radiation, hormone therapy, and chemo. Sometimes more than one kind of treatment is used.
The treatment thats best for you will depend on:
- Your age
- Any other health problems you might have
- The stage and grade of the cancer
- Your feelings about the need to treat the cancer
- The chance that treatment will cure the cancer or help in some way
- Your feelings about the side effects that might come with treatment
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Do We Know Which Treatment Is Better For Prostate Cancer Brachytherapy Or External Beam Radiation
Its not a question of which therapy is better but rather which therapy is the most tailored, pinpointed radiation for the patients specific disease.
When it comes to early stages of disease, patients very frequently do well with either brachytherapy or external beam radiation. Success rates of around 90% or higher can be achieved with either approach. When the disease is somewhat more advanced based on the PSA level or the Gleason score or visible evidence of disease on an MRI we have learned over the years that higher doses of radiation are critical to achieving better results. Some evidence suggests that for patients with intermediate- or high-risk prostate cancer, a combined approach using brachytherapy along with external beam radiation may be best.
Data that we have published recently show that for patients with intermediate-risk disease, the combination of external beam radiation with brachytherapy not only provides better biochemical control, in terms of PSA level, but also reduces the risk of distant metastases, or spread of the disease. Another recent study from Canada, which compared outcomes in patients who were treated with external beam radiation or a combination approach, found superior results when the combined approach was used. These studies provide strong evidence that higher doses of radiation provide an important benefit to patients with intermediate-risk and high-risk prostate cancers.
How Is More Advanced Prostate Cancer Treated
Cancer that has spread beyond the prostate gland, but has not spread to distant sites, is often treated with a combination of surgery or radiation, chemotherapy, hormonal therapy and newer precision medicines. Once cancer has spread to distant sites, chemotherapy and hormonal therapy, a treatment designed to markedly lower the level of testosterone in the blood, are the mainstay of treatment. Currently, chemotherapy is also used when hormonal therapy is no longer working and is also being evaluated for use in earlier stage disease. While neither chemotherapy nor hormonal therapy can cure advanced prostate cancer, both can keep the disease at bay, protect quality of life, and extend survival.
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Origins Of African Caribbeans In Western Countries
The majority of Black men currently living in Western countries are descendants of those who originated from the transatlantic slave trade between 1450 and 1900 where African slaves were exported mainly to the Americas, Europe, and the Caribbean . Odedina et al comment that the burden of CaP amongst black men originating from West Africa clearly follows the path of the TAST .
ACs have settled in the UK for at least 300 years however, the Windrush generation is responsible for the mass introduction of immigrants from the British Empire who remain in the UK today. The AC population represents a diverse group of individuals who are mostly indigenous to Africa, yet also comprise Europeans and Asian-Indians, representing the heterogeneity of the gene pool due to generations of interbreeding.
Strong cultural habits and traditions remain in migrant communities, which has an unknown impact on health-seeking behaviours therefore, caution should be used while interpreting data between ethnic groups, as possible reasons for disparities are likely multifactorial.
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What Are Prostate Cancer Treatment Side Effects
Some prostate cancer treatments can affect the bladder, erectile nerves and sphincter muscle, which controls urination. Potential problems include:
- Incontinence: Some men experience urinary incontinence. You may leak urine when you cough or laugh, or you may feel an urgent need to use the bathroom even when your bladder isnt full. This problem can improve over the first six to 12 months without treatment.
- Erectile dysfunction : Surgery, radiation and other treatments can damage the erectile nerves and affect your ability to get or maintain an erection. Some men regain erectile function within a year or two . In the meantime, medications like sildenafil or tadalafil can help by increasing blood flow to the penis.
- Infertility: Treatments can affect your ability to produce or ejaculate sperm, resulting in male infertility. If you think you might want children in the future, you can preserve sperm in a sperm bank before you start treatments. After treatments, you may undergo sperm extraction. This procedure involves removing sperm directly from testicular tissue and implanting it into a womans uterus.
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What Are The Symptoms Of Prostate Cancer
Early-stage prostate cancer rarely causes symptoms. These problems may occur as the disease progresses:
- Frequent, sometimes urgent, need to urinate, especially at night.
- Weak urine flow or flow that starts and stops.
- Painful urination .
- Painful ejaculation and erectile dysfunction .
- Blood in semen or urine.
- Lower back pain, hip pain and chest pain.
- Leg or feet numbness.
How Does The Doctor Know I Have Prostate Cancer
Prostate cancer tends to grow slowly over many years. Most men with early prostate cancer dont have changes that they notice. Signs of prostate cancer most often show up later, as the cancer grows.
Some signs of prostate cancer are trouble peeing, blood in the pee , trouble getting an erection, and pain in the back, hips, ribs, or other bones.
If signs are pointing to prostate cancer, tests will be done. Most men will not need all of them, but here are some of the tests you may need:
PSA blood test: PSA is a protein thats made by the prostate gland and can be found in the blood. Prostate cancer can make PSA levels go up. Blood tests will be done to see what your PSA level is and how it changes over time.
Transrectal ultrasound : For this test, a small wand is put into your rectum. It gives off sound waves and picks up the echoes as they bounce off the prostate gland. The echoes are made into a picture on a computer screen.
MRI: This test uses radio waves and strong magnets to make detailed pictures of the body. MRI scans can be used to look at the prostate and can show if the cancer has spread outside the prostate to nearby organs.
Prostate biopsy: For a prostate biopsy, the doctor uses a long, hollow needle to take out small pieces of the prostate where the cancer might be. This is often done while using TRUS or MRI to look at the prostate. The prostate pieces are then checked for cancer cells. Ask the doctor what kind of biopsy you need and how its done.
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About Dr Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
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Can Prostate Cancer Treatment Affect Your Quality Of Life
Your age and overall health will make a difference in how treatment may affect your quality of life. Any health problems you have before youre treated, especially urinary, bowel or sexual function problems, will affect how you recover. Both surgery and radiation can cause urinary incontinence or impotence .
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Drugs To Treat Cancer Spread To Bone
If prostate cancer spreads to other parts of the body, it almost always goes to the bones first. These areas of cancer spread can cause pain and weak bones that might break. Medicines that can help strengthen the bones and lower the chance of fracture are bisphosphonates and denosumab. Sometimes, radiation, radiopharmaceuticals, or pain medicines are given for pain control.
Side effects of bone medicines
A serious side effect of bisphosphonates and denosumab is damage to the jaw, also called osteonecrosis of the jaw . Most people will need to get approval from their dentist before starting one of these drugs.
What Will Happen After Treatment
Youll be glad when treatment is over. But its hard not to worry about cancer coming back. When cancer comes back it is called a recurrence. Even when cancer never comes back, people still worry about it. For years after treatment ends, you will see your cancer doctor. At first, your visits may be every few months. Then, the longer youre cancer-free, the less often the visits are needed.
Be sure to go to all follow-up visits. Your doctors will ask about your symptoms, examine you, and might order blood tests and maybe other tests to see if the cancer has come back.
Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us at 1-800-227-2345 or talk to your doctor to find out what you can do to feel better.
You cant change the fact that you have cancer. What you can change is how you live the rest of your life, making healthy choices and feeling as good as you can.