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What Are The Advantages Of Orchiectomy

Changing the Treatment Story With Hormonal Therapy in Prostate Cancer

First, it is a single, simple, surgical procedure with a very low risk of problems and 100 percent efficacy.

Second, it can be carried out in ways which are not physically evident. In other words, it is possible to carry out what is known as a subcapsular orchiectomy, in which the cores of the two testes are removed while the capsules remain in the scrotum. This means that the man still appears to be an intact male.

A Genetic Biomarker Test For Newly Diagnosed Prostate Cancer

Results from a study of a different genetic biomarker test suggest that it could one day help inform treatment decisions for men newly diagnosed with localized prostate cancer.

According to findings published February 24 in JCO Precision Oncology, a biomarker test called the Oncotype DX Genomic Prostate Score accurately predicted the long-term risk of metastasis and death from prostate cancer in men with localized disease. The test needs to be validated in larger forward-looking studies before it can be used to guide treatment, the study researchers noted.

Presentation On Theme: Hormonal Treatment In Prostate Cancer Presentation Transcript:

1 Hormonal Treatment in Prostate CancerSunaryo HardjowijotoDepartment UrologyAirlangga School of Medicine-Soetomo HospitalSurabayaUroFiesta 2015UROFIESTA 2015

2 EPIDEMIOLOGY : USA 2012: About 241.740 new casesAbout will die2/3 of pts diagnozed in > 65 y oldRare before 40About 1 man in 6 has PCa during lifetime2nd leading cause of cancer deathAbout 1 man in 36 will die of PCaUroFiesta 2015

3 Epidemiology of Prostate Cancer in IndonesiaProstate cancer is the third most common cancer in male in IndonesiaRef :Globocan 2012 UroFiesta 2015

4 Incidence and Mortality rate of prostate cancer in IndonesiaRef :Globocan 2012 UroFiesta 2015

5 Clinical Staging of Prostate CancerNCCN Guideline Prostate Cancer versionUroFiesta 2015

7 HORMONAL THERAPHY OF Ca P1788 :John Hunter The Father of Surgery Prostate Growth Depended on Testicular Function.1941 :Huggins and Hodges Proved the favourable Responsiveness of MCaP to ADT.UroFiesta 2015

9 Role of Androgen Deprivation Therapy in Prostate CancerEAU Guidelines Prostate Cancer 2014UroFiesta 2015

10 MECHANISM of ANDROGEN DEPRIVATION :Suppressing the secretion of testicular androgen SurgicalMedicalInhibiting the action of circulating Androgen by anti AndrogenUroFiesta 2015

11 HORMONAL TREATMENT of Ca P:INDICATIONS :Early Ca P unfit for Radical SurgeryRefuse EBRTSymptomatic advance Ca P T3-4M PSA > 25 ng/mLAdjuvant/Neoadjuvant for curative therapyUroFiesta 2015

17 Efficacy of ZOLADEX in Prostate CancerUroFiesta 2015

18 UroFiesta 2015

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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.

Hormone Therapy With Radiotherapy

Androgen Deprivation Therapy for Prostate Cancer

You have this if:

  • your cancer hasnt spread to other parts of the body but is at a high risk of coming back, eg the cancer has grown through the covering of your prostate
  • you have a very high prostatic specific antigen level
  • you have a high Gleason score

You might have hormone therapy before, during and after radiotherapy. Doctors usually recommend that you have the treatment for between 3 months and 3 years. How long depends on the risk of your cancer coming back and how many side effects you get.

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Hormonal Therapy With Radiotherapy

Hormonal therapy is often used to treat early and locally advanced prostate cancer. If you have low-risk early prostate cancer you do not usually need hormonal therapy.

Doctors often advise having hormonal therapy with radiotherapy , to make your treatment more effective. You may have hormonal therapy before, during and after radiotherapy. It can be given:

  • a few months before radiotherapy, to shrink the cancer
  • after radiotherapy, to reduce the chance of the cancer coming back .

Your doctor will talk to you about how long you take hormonal therapy for. They will also explain the possible side effects.

Dealing With Common Side Effects

Your treatment team can tell you about the side effects that are most common with your specific treatment and may be able to give you medicines to prevent or relieve side effects or suggest other ways to manage side effects. For general advice, see the see the symptom management section.

Almost all men receiving hormone therapy experience hot flashes. Hot flashes may get better or even go away over time, but if hot flashes are a problem for you, ask your doctor about medications or alternative-medicine approaches to help alleviate them.

Hormone therapy lowers the level of both testosterone and estrogen, which maintains bone strength. Men who receive hormone therapy for prolonged periods may develop bone thinning, which can lead to osteoporosis and broken bones. Your doctor may follow the density of your bones using a DEXA scan during hormone therapy and, if appropriate, prescribe medications to prevent complications from osteoporosis. In addition, diet and exercise can help keep your bones strong.

Hormone therapy can decrease muscle mass and increase the percentage of body fat, increasing body weight overall. It can also increase your risk for heart attack, stroke, diabetes and high cholesterol. Talk with your doctor about how to modify your diet and what exercise is appropriate to prevent these complications or reduce your risk. Seattle Cancer Care Alliance also has nutrition services to help you optimize your nutritional health during and after treatment.

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How Prostate Cancer Is Treated

In cancer care, different types of doctorsincluding medical oncologists, surgeons, and radiation oncologistsoften work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.

The common types of treatments used for prostate cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health.

Cancer treatment can affect older adults in different ways. More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found another section of this website.

Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer:

Hormone Therapy And Radiation Therapy In Treating Patients With Prostate Cancer

Hormonal Therapy
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
First Posted : January 27, 2003Results First Posted : October 31, 2017Last Update Posted : June 15, 2022

RATIONALE: Hormones can stimulate the growth of prostate cancer cells. Hormone therapy may fight prostate cancer by reducing the production of androgens. Radiation therapy uses high-energy x-rays to damage tumor cells. It is not yet known which regimen of hormone therapy and radiation therapy is more effective for prostate cancer.

PURPOSE: Randomized phase III trial to compare the effectiveness of two different regimens of hormone therapy and radiation therapy in treating patients who have prostate cancer.

Condition or disease
Drug: CasodexDrug: EulexinDrug: LHRH agonistRadiation: radiation therapy Phase 3

OBJECTIVES:

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to prostate-specific antigen level , tumor stage , Gleason score , and prior hormonal therapy . Patients are randomized to one of two treatment arms.

Patients are followed every 3 months for 1 year, every 6 months for 4 years, and then annually thereafter.

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Therapies That Interfere With Androgen Function

Taken daily as pills, antiandrogens bind to the androgen receptor proteins in the prostate cells, preventing the androgens from functioning. In addition to preventing a flare reaction, antiandrogens may be added to your treatment plan if an orchiectomy, LHRH agonist or LHRH antagonist is no longer working by itself. Commonly prescribed antiandrogens include flutamide and bicalutamide .

Enzalutamide is a newer type of antiandrogen that blocks the signal that the receptor normally sends to the cells control center to trigger growth and division. This antiandrogen may be used to treat castration-resistant prostate cancer.

Hormone Therapy With Radiation

Hormone therapy is often given together with radiation therapy for localized disease .

Hormone therapy usually consists of a shot that lowers your testosterone, given every 1 to 6 months, depending on the formulation. Sometimes, it is prescribed as a daily pill that blocks testosterone from reaching the cancer cells. Clinical trials show a benefit in patients who receive hormonal treatment in combination with external beam radiation. Hormone therapy has been shown to improve cure rates of prostate cancer for men receiving radiation therapy and is part of the standard of care for men with certain types of intermediate-risk prostate cancer and nearly all high-risk prostate cancer. It is often given for intermediate-risk cancer for 4 to 6 months , and for 2 to 3 years in men with high-risk localized prostate cancer, although some doctors may recommend as little as 18 months of hormone therapy.

Hormone therapy should not be given to men with low-risk prostate cancer and is not a standalone treatment for localized prostate cancer in any risk category.

Want more information about a prostate cancer diagnosis and treatment options? Download or order a print copy of the Prostate Cancer Patient Guide.

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What Is Hormonal Therapy For Prostate Cancer

Hormonal therapy for prostate cancer is a treatment to lower the levels of the hormone testosterone in the body. Prostate cancer needs testosterone to grow. Testosterone is mainly made by the testicles. Hormonal therapies reduce the amount of testosterone in the body, or stop it reaching the prostate cancer cells.

Testosterone is important for:

  • muscle development and bone strength.

Hormonal therapies are drugs that can be given as injections or as tablets.

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How Often And For How Long Will I Need Hormone Therapy

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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.

Read Also: How To Reduce Androgen Hormones In Females

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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.

Hormone Therapy Side Effects

Testosterone is the primary male hormone, and plays an important role in establishing and maintaining typical male characteristics, such as body hair growth, muscle mass, sexual desire, and erectile function, and contributes to a host of other normal physiologic processes in the body. The primary systemic

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Staging Of Prostate Cancer

Doctors will use the results of your prostate examination, biopsy and scans to identify the stage of your prostate cancer .

The stage of the cancer will determine which types of treatments will be necessary.

If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.

Different Approaches To Starting Hormone Therapy

Hormone Therapy Side Effect Solutions: Exercise, Acupuncture, and More | Mark Moyad, MD | PCRI

Experts debate how early treatment with hormone therapy should be started. Some argue that the benefits of hormone therapy for prostate cancer should be offered to men earlier in the course of the disease. Others assert that there’s little evidence that getting treatment early is better than getting it later.

“Unfortunately, there are still some doctors who are offering hormonal therapy earlier in the course of the disease than is commonly recommended,” Brooks says. Given that the side effects can be serious, Brooks argues that starting treatment with hormone therapy so early may not be a good idea.

However, Holden argues that early treatment may be helpful. “I think one of the reasons that the death rate from prostate cancer is going down is that we’re using hormone therapy early,” he tells WebMD. “We haven’t proved that early treatment improves overall survival yet, but I think we will.”

Researchers are also looking at “intermittent therapy,” starting and stopping hormone treatment for months at a time. The big advantage is that men could go off therapy temporarily and thus be free of the side effects. Early study results have been promising.

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What Is Intermittent Adt

Researchers have investigated whether a technique called intermittent androgen deprivation can delay the development of hormone resistance. With intermittent androgen deprivation, hormone therapy is given in cycles with breaks between drug administrations, rather than continuously. An additional potential benefit of this approach is that the temporary break from the side effects of hormone therapy may improve a mans quality of life.

Randomized clinical trials have shown similar overall survival with continuous ADT or intermittent ADT among men with metastatic or recurrent prostate cancer, with a reduction in some side effects for intermittent ADT .

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 some 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.

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Microscopic Findings Of Hormonal Therapy Effects On Adenocarcinoma Gleason Grade

It has been established that Gleason grading should not be performed after androgen-deprivation therapy. This is because androgen-deprivation therapy effects induce histomorphologic changes that simulate higher-grade disease, such as luminal space loss and single-cell infiltrates . It should be noted, however, that finasteride has little, if any, effect on the Gleason grade of adenocarcinoma.

Treatment To Lower Androgen Levels From Other Parts Of The Body

Cardiovascular Effects of Androgen Deprivation Therapy in Prostate ...

LHRH agonists and antagonists can stop the testicles from making androgens, but cells in other parts of the body, such as the adrenal glands, and prostate cancer cells themselves, can still make male hormones, which can fuel cancer growth. Some drugs can block the formation of androgens made by these cells.

Abiraterone blocks an enzyme called CYP17, which helps stop these cells from making androgens.

Abiraterone can be used in men with advanced prostate cancer that is either:

  • Castration-resistant

This drug is taken as pills every day. It doesnt stop the testicles from making testosterone, so men who havent had an orchiectomy need to continue treatment with an LHRH agonist or antagonist. Because abiraterone also lowers the level of some other hormones in the body, prednisone needs to be taken during treatment as well to avoid certain side effects.

Ketoconazole , first used for treating fungal infections, also blocks production of androgens made in the adrenal glands, much like abiraterone. It’s most often used to treat men just diagnosed with advanced prostate cancer who have a lot of cancer in the body, as it offers a quick way to lower testosterone levels. It can also be tried if other forms of hormone therapy are no longer working.

Ketoconazole also can block the production of cortisol, an important steroid hormone in the body, so men treated with this drug often need to take a corticosteroid .

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