Thursday, February 9, 2023

Hormone Replacement Therapy For Prostate Cancer

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Mental And Emotional Health

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

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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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.

Treating Prostate Cancer With Combined Hormonal

Androgens, the family of male sex hormones that includes testosterone, function as a fuel for growth in normal development. However, in some men they can also drive the progression of prostate cancer. Hormonal therapy treats prostate cancer by dramatically reducing levels of testosterone and other androgens.

Hormonal therapy is sometimes given in conjunction with external beam radiation to boost the effectiveness of treatment. Hormonal therapy may also be used to shrink the size of large prostate glands before brachytherapy takes place, to enable proper placement of the radioactive seeds.

Combination hormonal/radiation therapy is now a standard option for men with cancer that has extended beyond the prostate or whose cancer is considered high-risk based on other clinical findings, with studies showing that it reduces the risk of dying from prostate cancer and other causes more than with either treatment given alone..

Combination therapy can also be considered for men with localized prostate cancer in the intermediate-risk category. Whether men with low-risk prostate cancer would benefit from a hormonal therapyradiation combination is uncertain.

Image: sturti/Getty Images

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Is Prostate Cancer Fatal

Fortunately, with advances in the field of oncology , prostate cancer is no longer a death sentence for most men. In fact, the long-term survival rate among American patients when the cancer is caught early is almost 100%, rendering it of one the most non-lethal cancers of the modern era.

Modern oncological medicine is remarkably adept at catching and treating prostate cancer before it poses a lethal threat. The chart above indicates that, although prostate cancer is overwhelmingly common in the US, the mortality rate of American men diagnosed with prostate cancer is relatively low compared to other regions.

How Hormone Therapy Is Used Against Cancer

Pin on Prostate cancer

Hormone therapy is used for two main reasons.

  • Treat cancer. Hormone therapy can stop or slow cancer’s growth and reduce the chance it will return.
  • Ease cancer symptoms. Hormone therapy may be used to reduce or prevent symptoms in men with prostate cancer who are not able to have surgery or radiation therapy.

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> > > This Simple Morning Test Will Fix Your Prostate

Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. This condition causes pain in the lower back and groin area, and may cause urinary retention. Symptoms include leaking and discomfort. In severe cases, a catheter may be required to relieve the symptoms. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. If these do not work, your symptoms could progress and become chronic.

An acute bacterial infection can cause a burning sensation. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. The symptoms of acute bacterial prostatitis are similar to those of CPPS. Patients may experience a fever or chills as a result of the infection.

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What Have I Learned By Reading This

You learned about:

  • Ways to get hormone therapy
  • What to expect when you have hormone therapy
  • What side effects you may have from hormone therapy

If you have any questions, please talk to your doctor or healthcare team. It is important that you understand what is going on with your treatment. This knowledge will help you take better care of yourself and feel more in control so that you can get the most from your treatment..

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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.

The Future Of Hormone Therapy For Prostate Cancer

Reducing Side Effects of Hormone Therapy for Prostate Cancer | Prostate Cancer Staging Guide

Some experts arent sure how much further we can improve hormone therapy for prostate cancer.

Im not saying that weve reached the end of what we can do with hormonal therapy, Thrasher tells WebMD, but there are only so many ways to shut down the hormonal effects. The cancer will still eventually escape.

Brooks argues that, overall, prostate cancer is only moderately affected by hormones. You can only do so much manipulating the levels of hormones, says Brooks. We have to find better ways to fight the basis of the cancer cells.

Thrasher and Brooks have more hope that the next breakthroughs will come with different approaches, like chemotherapy or vaccines.

But Holden remains optimistic about the future of hormone therapy for prostate cancer.

Cancer cells eventually figure out how to survive, how to overcome a specific hormone therapy, he says. But if we have enough types of drugs and can keep changing the hormone therapy, we might be able to keep the cancer cells in a state of confusion. We could change therapies before they have a chance to adapt.

Its like an endless chess game, he says. You may not ever win, but you might be able to prolong the game indefinitely. I think that hormone therapy still has a lot of promise. We just need to develop better anti-androgens, and more varieties of them.

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Treatment To Lower Androgen Levels From The Adrenal Glands

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. Drugs are available that 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:

  • Castrate-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. Its 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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What Can Hormone Replacement Therapy Treat

Not all men experience the effects of low testosterone in the same way. Some men have many minor symptoms, while others have a few main symptoms. Hormone replacement therapy used to treat low testosterone can address many issues, including:

  • Overactive bladder
  • Muscle loss and loss of strength
  • General sense of fatigue
  • Reduction in body and facial hair
  • Dry skin and rapid skin aging
  • Increase in body cholesterol
  • Anemia and a decrease in hemoglobin
  • Muscle and joint ache

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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.

Risk Of Other Health Problems

Side Effects Of Hormone Therapy Shots For Prostate Cancer ...

Evidence suggests that having hormone therapy might increase the chance of developing heart disease, stroke and type-2 diabetes. There is also some research that suggests having hormone therapy can increase your risk of getting blood clots and anaemia. But more research is needed to help us understand the links between these conditions.

Research shows that hormone therapy can cause:

  • an increase in weight, particularly around the waist
  • an increase in cholesterol levels
  • changes in insulin.

Talk to your hospital doctor and GP about how often you should have general health checks. You may be weighed and have your blood pressure checked regularly. You may also have blood tests to check for diabetes and to measure your cholesterol levels. Your GP may suggest you have these checks about every six months. Or you can ask for them yourself at your GP surgery.

If you already have heart problems or diabetes, talk to your doctor before you start hormone therapy. They will work with you to manage these conditions.

While the risk of getting these conditions may be worrying, its important to remember that hormone therapy helps men to live longer by controlling the cancer.

What can help?

A healthy lifestyle can help reduce your risk of heart disease, stroke and type-2 diabetes. This includes:

  • eating a healthy diet

Read more about diet and physical activity.

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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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Who Is A Candidate

Most men with advanced prostate cancer are candidates for hormone therapy. Its usually considered when prostate cancer has spread beyond the prostate, and surgery to remove the tumor is no longer possible.

Prior to starting treatment, youll need to have a liver function test along with a blood test to make sure your liver can break down the medications properly.

Currently, enzalutamide is only approved for use in men with prostate cancer that has already spread to other parts of the body, and who no longer respond to medical or surgical treatments to lower testosterone levels.

In some cases, prostate cancer cells can resist hormone treatments and multiply even in the absence of male hormones. This is called hormone-resistant prostate cancer. Men with hormone-resistant prostate cancer arent candidates for further hormone therapy.

Complications Of Hormonal Therapy

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

E. David Crawford, MD, Professor of Surgery and Radiation Oncology, Head of the Section of Urologic Oncology at the University of Colorado, and Chairman of the 16th International Prostate Cancer Update, provided an excellent overview of complications of hormonal therapy and their treatment. He began this discussion by outlining not only the benefits but also the complications of androgen deprivation, the latter including osteoporosis, hot flushes, gastrointestinal side effects, anemia, gynecomastia, sarcopenia, central nervous system effects, change in body weight, sexual dysfunction, loss of bone density, and increased risk of bone fracture and hot flushes .

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Treatment To Lower Testicular Androgen Levels

Androgen deprivation therapy, also called ADT, uses surgery or medicines to lower the levels of androgens made by the testicles.

Orchiectomy

Even though this is a type of surgery, its main effect is as a form of hormone therapy. In this operation, the surgeon removes the testicles, where most of the androgens are made. This causes most prostate cancers to stop growing or shrink for a time.

This is done as an outpatient procedure. It is probably the least expensive and simplest form of hormone therapy. But unlike some of the other treatments, it is permanent, and many men have trouble accepting the removal of their testicles. Because of this, they may choose treatment with drugs that lower hormone levels instead.

Some men having this surgery are concerned about how it will look afterward. If wanted, artificial testicles that look much like normal ones can be inserted into the scrotum.

LHRH agonists

Luteinizing hormone-releasing hormone agonists are drugs that lower the amount of testosterone made by the testicles. Treatment with these drugs is sometimes called medical castration because they lower androgen levels just as well as orchiectomy.

With these drugs, the testicles stay in place, but they will shrink over time, and they may even become too small to feel.

  • Leuprolide mesylate

LHRH antagonists

Possible side effects

Many side effects of hormone therapy can be prevented or treated. For example:

Thinking About Taking Part In A Clinical Trial

Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, theyâre not right for everyone.

If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials.

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