I Am Getting Hot Flushes From The Hormone Therapy These Can Be Quite Severe Is There Any Treatment That May Help
Unfortunately hot flushes are the most common side effect of hormonal therapy and can be very bothersome. There are some lifestyle changes that men can make which may help reduce them:
- Avoid too many hot spices from foods etc
- Avoid smoking, caffeine and excessive alcohol.
- Try and wear cotton/ natural fabric clothing and bed sheets rather than using man made fabrics
- Take luke warm baths or showers
- Use a fan to help cool a room and try and obtain a mini portable fan for personal use or an atomizer that can be used to spray water when out and about.
What The Researchers Did
Dr. Crawfords team reviewed clinical data from nearly 23,000 men who were given ADT injections between 2007 and 2016. Each mans treatment varied by how their ADT was formulated. Some types of ADT are given once a month, and others are given at three-, four-, or six-month intervals. The researchers wanted to know how many men were late on their ADT treatments, and how that would affect the amounts of testosterone in their blood.
During this research, the investigators defined month in two ways: either as one lasting 28 days, which is how months were defined during the clinical trials that set dosing schedules for ADT, or as a calendar month lasting 31 days. ADT was deemed late if it was given after day 28 by the first definition or after day 32 by the second definition.
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Treating Advanced Prostate Cancer
If the cancer has reached an advanced stage, it’s no longer possible to cure it. But it may be possible to slow its progression, prolong your life and relieve symptoms.
Treatment options include:
- hormone treatment
If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.
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Neoadjuvant And Adjuvant Hormone Therapy For Early
Hormone therapy is sometimes given in conjunction with a definitive prostate cancer treatment, such as radiation therapy, in order to improve health outcomes. When hormone therapy is given in advance of a primary treatment, its known as neoadjuvant therapy when its given during or after a primary treatment, its known as adjuvant therapy.
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:
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Questions About Fatigue To Ask Your Doctor Or Nurse
You may find it helpful to keep a note of any questions you have to take to your next appointment.
- Is my prostate cancer treatment likely to cause fatigue?
- How long might my fatigue last?
- What can I do to improve or manage my fatigue?
- What physical activity is suitable for me?
- Is there a local support group for men with prostate cancer-related fatigue?
- How can I access a local exercise programme?
- What other support is available to me?
- Who can I speak to for advice about work?
How Can I Manage Fatigue
Lots of things can cause fatigue, so theres no one treatment that can get rid of it completely. But there are lots of things you can do to improve or manage your fatigue. Read the information below to find out how small changes to your life can make a big difference.
You can also visit our How to manage fatigue guide or speak to our Specialist Nurses.
Talk to your doctor or nurse
Its important to talk to your healthcare team if you think you have fatigue. They can help you understand what might be making your fatigue worse and help you find ways to manage your fatigue. They can also check for any other health problems that might be causing your fatigue or making it worse.
Keep active
Physical activity can help to improve fatigue. Read more about physical activity to improve fatigue.
Plan ahead and take things slowly
You might not have enough energy to do everything you used to do. But if you plan ahead, you can try to do the things that are most important to you.
Keeping a diary can help you plan your activities. .
The five Ps
Some men find thinking about the five Ps helpful when planning their time.
Get help with emotional problems
Ask for help
It can be difficult to ask for help when youre used to being independent. But partners, family members and friends will usually want to help. Think about which activities you want to do for yourself, and which ones someone else could do for you.
Make time to relax
Eat and drink well
Improve your sleep
During the day
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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 .
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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Exercise And Hormone Therapy Side
Taking some exercise is a great way to feel better if you are having hormone therapy.
It can:
- Keep your bones healthy
- Reduce the risk of the cancer coming back after treatment.
Always talk to your doctor before starting to exercise so that they can give you advice about the best type of exercise for you. There may be special exercise programmes you can do, such as Exwell or the Irish Cancer Societys Strides for Life walking groups. Call our Support Line, visit a Daffodil Centre or go to your local cancer support centre to find out whats available in your area.
Hormone therapy can have a big impact on your sex life. Because hormone therapy reduces the male sex hormone testosterone, it can affect your interest in sex and your ability to get an erection.
Libido may come back once you stop taking hormone therapy, although it can take many months. Read more about sex and prostate cancer.
Surgically Removing The Prostate Gland
A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.
Like any operation, this surgery carries some risks, such as urinary incontinence and erectile dysfunction.
In extremely rare cases, problems arising after surgery can be fatal.
It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.
Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.
You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation .
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Who Can Have Abiraterone
Abiraterone is a treatment for advanced prostate cancer. It is most commonly offered to men whose cancer has stopped responding to other types of hormone therapy. You may hear this called hormone-relapsed or castrate-resistant prostate cancer.
Abiraterone may be suitable if you have no symptoms or mild symptoms. Your hospital doctor may offer you abiraterone if you cant have chemotherapy, or you dont want to have it yet. Or you may be offered abiraterone if youve had a chemotherapy drug called docetaxel and your cancer has stopped responding to it.
If youve already had a type of hormone therapy called enzalutamide, abiraterone probably wont be an option. This is because research suggests that men who have already had one of these drugs dont respond so well to the other drug. However, if you get severe side effects from enzalutamide, you may be able to try abiraterone.
If you’re having trouble getting abiraterone, even though your doctor thinks it is suitable for you, please let us know.
Earlier abiraterone
There is evidence that some men may benefit from having abiraterone at an earlier stage, when they are first diagnosed with advanced prostate cancer. You may hear this called hormone-sensitive prostate cancer, as the cancer is likely to respond to standard hormone therapy.
Abiraterone or enzalutamide?
Abiraterone and enzalutamide are both types of hormone therapy that treat advanced prostate cancer, but they work in slightly different ways.
How Does Hormone Therapy Work
Hormone therapy can work in two ways – either by stopping your body from making testosterone, or by stopping testosterone from reaching cancer cells. Prostate cancer cells usually need testosterone to grow. So if testosterone is taken away or blocked, the cancer will usually shrink, wherever in the body.
Hormone therapy on its own won’t cure your prostate cancer. If you have hormone therapy on its own, the treatment will aim to control your cancer and delay or manage any symptoms.
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Living On Hormones Managing Side Effects With Exercise
Whilst you are on Hormone Deprivation Therapy you can feel fatigued, notice a low mood, gain weight around your tummy , have hot flushes and experience a loss of libido. You may also experience breast tenderness or swelling, strength and muscle loss, loss of body hair and bone thinning. Daily exercise can help delay the onset of some of these side effects, as well as help manage some of them, should they develop.
Active Surveillance And Watchful Waiting
If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.
Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.
ASCO encourages the following testing schedule for active surveillance:
-
A PSA test every 3 to 6 months
-
A DRE at least once every year
-
Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years
Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.
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Hormone Therapy: Stopping Resistance In Its Tracks
Hormone therapy is the main form of prostate cancer treatment
Hormone therapy will stop working for nearly all patients
Hormone therapy stops the androgen receptor from telling cancer cells to grow
The outside of the AR acts as a switch. When the switch is on, the AR tells cancer to grow
The switch is turned on by male hormones and turned off by hormone therapy
This project will explore how AR variants are made and how to stop this process
ARVs dont have a switch so they are always on. Hormone therapy doesnt work on ARVs
Preventing ARV production could keep hormone therapy working for longer
About the Researchers
Centre for Cancer, Newcastle University
Dr Luke Gaughan
Principal Investigator
Dr Luke Gaughan is a senior lecturer at Newcastle University. He has worked on several exciting projects studying the mechanisms of androgen receptor regulation in prostate cancer.
Dr Dominic Jones
Research Associate
Dominic is a research associate at Newcastle University. He will be using cutting edge technology to identify the key proteins involved in the production of androgen receptor variants and the growth and spread of prostate cancer.
Project Updates
What Does Current Guidance Say On This Issue
NICE prostate cancer guidelines give recommendations for locally-advanced and metastatic prostate cancer, which fall under the advanced definition used in this review.
Radical radiotherapy plus androgen suppression therapy is recommended for high-risk localised cancer. NICE advises that suppression may be given before, during or after radiotherapy, but dont state a precise timing in relation to diagnosis. Chemotherapy plus androgen suppression is recommended for newly diagnosed metastatic prostate cancer.
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Physical Emotional And Social Effects Of Cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.
Table : Survival Benefits Of Early Treatment
An analysis of 98 men with prostate cancer that had spread to the lymph nodes, who were randomly assigned to receive immediate hormone therapy or to forgo it until the disease spread further to bones or lungs, found that early treatment saved lives.
Deaths from prostate cancer 21 Source: Lancet Oncology 2006 7:4729. PMID: 16750497.
Other studies have shown that starting hormone therapy early on increases survival times, delays cancer progression, and results in better quality of life. However, in a review of four studies involving 2,167 men with metastatic prostate cancer, the Cochrane Collaboration concluded that early hormone therapy had offered only a small overall survival advantage over deferred treatment, and cautioned that more research on the issue needs to be done.
Although debate on this issue continues, in most cases I advise my patients with metastatic disease to begin hormone treatment early on. This is particularly important for someone with spine metastases, because a bone fracture or extension of the cancer into the spinal cord area could lead to impaired mobility and even paralysis. Fortunately, this is a rare event.
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What Is Hormone Therapy
Hormones occur naturally in your body. They control the growth and activity of normal cells. Testosterone is a male hormone mainly made by the testicles.
Prostate cancer usually depends on testosterone to grow. Hormone therapy blocks or lowers the amount of testosterone in the body.
Hormone therapy on its own doesn’t cure prostate cancer. But it can lower the risk of an early prostate cancer coming back when you have it with other treatments. Or it can shrink an advanced prostate cancer or slow its growth.
When You Have Goserelin
You have the injection every 4 weeks or every 12 weeks. If you have it every 12 weeks, you have a type of goserelin called Zoladex LA.
Let your doctor or nurse know if the gap between your appointments isnt 4 or 12 weeks. They will make sure you have the injection on time.
You usually have goserelin injections for a long period of time.
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