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Endocrine Therapy For Prostate Cancer

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Good Prostate Cancer Care

Hormone Therapy & Advanced Therapies for Prostate Cancer, Celestia Higano, MD | 2021 Mid-Year Update

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.

by University Hospitals Cleveland Medical Center

Prostate cancer is the leading cause of cancer in men worldwide, and radiotherapy is one of the common forms of treatment. In a first-of-its kind meta-analysis, published today in The Lancet Oncology, researchers from University Hospitals and Case Western Reserve University show that there is consistent improvement in overall survival in men with intermediate- and high-risk prostate cancer with the addition of hormone therapy to radiotherapy treatments.

Throughout the past 40 years, randomized trials have been conducted on the impact of adding hormone therapy to prostate cancer treatments. While these trials individually show the benefit of hormone therapy, there are inconsistencies in timing and duration of treatment recommendations.

In this analysis, the team made three key discoveries:

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Is Adt A Standalone Treatment

For the most part, ADT is utilized in conjunction with other, generally localized forms of cancer treatment, such as radiation or surgical interventions. There aren’t a lot of circumstances in which ADT is implemented in a standalone capacity, though such cases do exist.

“If you have someone of advanced age and they have other medical problems and they have aggressive, advanced disease, in some cases, you may give hormone therapy alone because they may not be a good surgical candidate. For some reason, they may not be able to get radiation,” McNeil explained.

Both McNeil and Krane said treatment options can be different for each individual. They depend on the advancement of the cancer itself and life factors unique to the patient.

Mental And Emotional Health

A cancer diagnosis and cancer treatment may affect how you feel mentally and emotionally. Hormone therapy can cause:

  • A drop in mental sharpness

If you have any of these side effects, your doctor may recommend medication, counseling, or both.

Research shows that hormone therapy for prostate cancer may lead to problems with short-term memory, language, thinking, and concentration. But these problems are usually mild. Researchers are still studying the effect of hormone therapy on the brain.

When you stop taking hormone therapy, emotional and mental side effects usually disappear. But if youâve taken the drugs for many years, they may not fully go away.

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When Hormone Therapy Is Recommended

Hormone therapy is typically given to patients with intermediate- or high-risk prostate cancer. It may be used in the following ways:

  • In combination with radiation, mostly for patients with high Gleason scores or other high-risk factors.
  • After radiation or surgery when PSA rises, indicating a recurrence.
  • As therapy for patients unsuitable for radiation or surgery.
  • As therapy for metastatic prostate cancer . It may be given instead of or in combination with chemotherapy.

HT is usually not prescribed for:

  • Patients choosing a localized treatment for low-risk prostate cancer
  • Low-risk patients preferring to monitor their cancer on an active surveillance program

HT may be an option for patients who are not candidates for surgery, radiation or other localized treatment because of age, pre-existing health conditions or concerns about potential side effects of localized treatments.

Hope For Advanced Cancer

Figure 1

Your doctor will continue to monitor your PSA levels and may perform other tests after treatment for prostate cancer. If it recurs or spreads to other parts of the body, additional treatment may be recommended. Lifestyle choices may matter, too. One study found that prostate cancer survivors who exercised regularly had a lower risk of dying, for example.

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Risk Factors You Can’t Control

Growing older is the greatest risk factor for prostate cancer, particularly after age 50. After age 70, studies suggest that anywhere from 31% to 83% of men have some form of prostate cancer, though there may be no outward symptoms. Family history increases a man’s risk: having a father or brother with prostate cancer more than doubles the risk. African-American men and Caribbean men of African descent are at high risk and have the highest rate of prostate cancer in the world.

How To Tell If Hormone Therapy Is Working

If you are taking hormone therapy for prostate cancer, you will have regular PSA tests. If hormone therapy is working, your PSA levels will stay the same or may even go down. But, if your PSA levels go up, this may be a sign that the treatment is no longer working. If this happens, your doctor will discuss treatment options with you.

If you are taking hormone therapy for breast cancer, you will have regular check-ups. Checkups usually include an exam of the neck, underarm, chest, and breast areas. You will have regular mammograms, though you probably wont need a mammogram of a reconstructed breast. Your doctor may also order otherimaging procedures or lab tests.

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Inhibition Of Extragonadal Precursor Steroids: Abiraterone

Abiraterone acetate is an oral prodrug that is deacetylated to its active metabolite abiraterone which inhibits the steroidogenic CYP17A1 enzyme, a member of the cytochrome P450 family. Abiraterone is currently indicated in the United States for treatment of mCRPC and mCSPC in combination with prednisone. CYP17A1 acts primarily in the adrenal gland to catalyze 2 steps that convert precursor steroids to testosterone, DHT, and DHEA . Early phase 1 studies of abiraterone showed increased levels of ACTH and thus led to mineralocorticoid excess in treated patients this can lead to adverse events such as fluid retention, hypertension, and hypokalemia . Patients in subsequent trials received glucocorticoids in combination with abiraterone to mitigate risk of such adverse events. Notably, abiraterone is a steroidal drug that shares structural similarity with DHEA and, as a result, is metabolized by various enzymes of the steroidogenic machinery such as 3HSD1 and SRD5A. This process leads to downstream production of various metabolites that can act as both AR antagonists and partial AR agonists . The missense-encoding HSD3B1 variant has been shown to modulate production of 3-keto-5-abiraterone, with metabolite concentration increasing with increasing number of HSD3B1 alleles inherited .

Treatment Options For Localized Prostate Cancer

Hormone Therapy for Prostate Cancer

If you are diagnosed with low-risk prostate cancer, you may be presented with a number of different treatment options. The most common include:

  • Active Surveillance: Your doctor may want to monitor your disease to see if treatment is necessary. With active surveillance, you will have regular check-ups with your doctors, and he or she may perform biopsies regularly. If your test results change, your doctor will discuss your options for starting treatment.
  • Watchful Waiting: While some doctors use the terms active surveillance and watchful waiting interchangeably, watchful waiting usually means that fewer tests are done. You will still visit your doctor regularly, but your doctor will discuss changes in your health as they relate to managing your symptoms, not curing your disease.
  • Prostatectomy: Removal of the prostate, called prostatectomy, is an option that has a strong likelihood of removing your cancer since you are removing the gland where it is located. However, this is an invasive procedure that can lead to other issues, which will be covered later.
  • Radiation: Your doctor may suggest radiation as a means of therapy that targets tumors with radiation, usually through daily treatments in a hospital or clinic over multiple weeks.

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How Can I Lower My Testosterone With Surgery

The majority of the testosterone in your body is made by your testicles. You can lower your testosterone with an operation called an orchiectomy. An orchiectomy is a simple and effective way to lower the amount of testosterone in your body. However, it is a permanent form of hormone therapy.

Your surgery

Some men are concerned about how their body will look after their testicles are removed. There are testicular prostheses , or artificial testicles, that can be placed in your scrotum to replace the testicles removed during your surgery. The prostheses make your scrotum look like it did before surgery. If youare concerned about how your body will look, speak with your doctor or health care team about artificial testicles.

After surgery

Your scrotum may feel a little bit sore and may be swollen. You will be given medicines to relieve the soreness. You may use ice packs for the first day or two after your orchiectomy to help with the swelling. Remember, do not put the ice pack directly on your scrotum. Put a towel or piece of clothing over your scrotum, then place the ice pack on top of it. You will need to keep your incision clean and dry. Your doctor and health care team will tell you how to clean your incision. You will need to avoid heavy lifting or hard activity for one to two weeks following your surgery.

Follow-up tests

Possible side effects

More hormone treatment

Why Does Hormone Therapy Cause Side Effects

If testosterone is taken away or blocked by hormone therapy, prostate cancer cells will usually shrink, wherever they are in the body. But reducing or blocking testosterone can cause other things to change in your body too.

Testosterone controls the development and growth of the sexual organs, including the prostate, and affects the way you think and feel. It also controls other male characteristics, such as erections and muscle strength. So when testosterone is reduced, or taken away by hormone therapy, all of these things can change.

The diagram below shows how testosterone affects a mans body. Knowing this can help you understand what side effects you might get when youre having hormone therapy.

The side effects of hormone therapy are caused by lowered testosterone levels. Side effects will usually last for as long as you are on hormone therapy. If you stop your hormone therapy, your testosterone levels will gradually rise again and some side effects will reduce. Your side effects wont stop as soon as you finish hormone therapy it may take several months.

Surgery to remove the testicles cant be reversed, so the side effects are permanent. But there are treatments that can help reduce or manage some of the side effects.

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What Are Prostate Cancer Survival Rates By Stage

Staging evaluation is essential for the planning of treatment for prostate cancer.

  • A basic staging evaluation includes the patient examination, blood tests, and the prostate biopsy including ultrasound images of the prostate.
  • Further testing and calculations may be performed to best estimate a patientâs prognosis and help the doctor and patient decide upon treatment options.

Prognosis refers to the likelihood that cancer can be cured by treatment, and what the patientâs life expectancy is likely to be as a consequence of having had a prostate cancer diagnosis.

If cancer is cured, your life expectancy is what it would have been had you never been diagnosed with prostate cancer. If cancer cannot be cured due to it recurring in distant locations as metastases, or recurs either locally or in an area no longer able to be treated in a curative manner, then estimates can be made of what is likely to be your survival-based again on group statistics for people who have been in the same situation.

Nomograms are charts or computer-based tools that use complex math from the analysis of many patientsâ treatment results.

The prognosis for prostate cancer varies widely and depends on many factors, including the age and health of the patient, the stage of the tumor when it was diagnosed, the aggressiveness of the tumor, and cancerâs responsiveness to treatment, among other factors.

The 5 and 10-year survival rate of prostate cancer chart

Stage and 5-Year Survival

Orchiectomy Surgical Removal Of The Testicles

Treating Locally Advanced Prostate Cancer

Once a common treatment, orchiectomy is rarely used now, thanks to the development of advanced ADT drugs. The procedure removes the testicles the source of most testosterone production. The scrotal sac is left intact, and patients can have testicular prostheses implanted for cosmetic purposes. Orchiectomy is effective in drastically reducing levels of testosterone, but it has several downsides. Removal of the testicles is permanent and irreversible. Loss of the testicles makes it challenging to have intermittent hormone therapy, an advantageous treatment. And there is a psychological effect: Many patients feel distress related to the idea of lost masculinity if they undergo this procedure.

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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

Is The Active Ingredient In Equelle Also Found In Foods

The active ingredient in Equelle is S-equol. Trace amounts of S-equol are found in animal-based foods due to the fact its produced by gut bacteria in animals. Richer food sources of S-equol include popular and traditional fermented tofu products in Taiwan known as chou-doufu. S-equol has also been added to some food bars in the US.

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How Will I Know If My Treatment Is Working

You will have regular appointments to check how well your treatment is working and monitor any side effects. These will involve regular prostate specific antigen blood tests to measure the amount of PSA in your blood.

PSA is a protein produced by cells in your prostate and also by prostate cancer cells, even if they have spread to other parts of your body. The PSA test is a good way to check how well your treatment is working.

How your treatment is monitored will depend on whether youre having hormone therapy as part of treatment that aims to cure your prostate cancer, or having life-long hormone therapy to keep advanced prostate cancer under control.

You can contact your nurse at the hospital, or our Specialist Nurses, between appointments if you have any side effects or symptoms that youd like to talk about.

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Intermittent Hormone Therapy for Prostate Cancer 101 | Ask a Prostate Expert, Mark Scholz, MD

Yes, Medicare covers chemotherapy cancer treatment for patients in a hospital setting, outpatient setting, or doctors office. If its administered during a hospital stay, you may have to pay the Part A deductible. If done at a doctors. The Data Visualizations tool makes it easy for anyone to explore and use the latest official federal government cancer data from United States Cancer Statistics. It includes the latest cancer data covering the U.S. population. See rates or numbers of new prostatecancers or prostatecancer deaths for the entire United States and individual states.

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University Of Iowa General Surgery Residency

Hormone ablation therapy for breast or prostate cancer accelerates the development of osteoporosis in both men and women by causing. Jul 14, 2022 · These results indicate that zoledronic acid not only prevents bone loss, but also increases BMD, during androgen-deprivation therapy for prostate cancer. Aug 26, 2021 · The primary systemic treatment for prostatecancer, androgen deprivation therapy , lowers testosterone and causes side effects related to low testosterone. Although most men may experience only a few of these symptoms, the list of potential effects of testosterone loss is long: hot flashes, decreased sexual desire, loss of bone density . Mar 10, 2009 · Hormonetherapy is a treatment option for men with prostatecancer in any of the following situations: when cancer has metastasized beyond the prostate. when cancer is confined to the prostate, but hormonetherapy is used to boost the effectiveness of radiation therapy or to shrink the size of a tumor before brachytherapy..

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Microscopic Findings Of Hormonal Therapy Effects On Adenocarcinoma

There is a decrease in the tumor volume and number of malignant glands in adenocarcinoma. In a small percentage of patients treated with neoadjuvant hormonal therapy before radical prostatectomy, no residual tumor is identified. A decrease in size of the adenocarcinoma glands is characteristic, with small and atrophic glands being detected. Loss or collapse of luminal spaces is typical.

A particularly insidious pattern of growth that can be difficult to recognize as malignant is the presence of widely scattered single tumor cells embedded in a wide expanse of stroma. A branching pattern and mucinous spaces and clefts may be seen. Cytologically, the carcinoma cells classically show nuclear pyknosis, hyperchromasia, inconspicuous nucleoli, cytoplasmic clearing, and cytoplasmic vacuolization. These changes can impart a histiocytoid appearance to the tumor cells. The stroma may be inflamed and edematous, fibrotic, hyalinized, and sclerotic. There is no change in highmolecular-weight cytokeratin expression in basal cells, so this marker still has diagnostic value in difficult-to-diagnose cases following hormonal therapy.

Hormonal therapy has been associated, in rare cases, with the emergence of prostatic carcinoma variants, including small cell carcinoma, sarcomatoid carcinoma, and squamous cell carcinoma. Images of hormonal therapy effects on prostate cancer are provided below.

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