Thursday, January 26, 2023

Hormone Shots For Prostate Cancer Treatment

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What Will I Learn By Reading This

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

You and your doctor may be talking about using hormone therapy to control your prostate cancer. It is important for you to learn about hormone therapy so that you will know what to expect and how best to take care of yourself before, during, and after treatment. You will learn:

It is important to think about how you will work these things into your everyday life if you and your doctor decide that hormone therapy is the best way for you to control your prostate cancer..

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Checking Your Hormone Therapy Is Working

Youll have regular blood tests to check the level of a protein called prostate specific antigen . PSA is a protein made by both normal and cancerous prostate cells. It is in the blood in small amounts in all men, unless they have had their prostate gland completely removed.

While the hormone therapy is working, the level of PSA should stay stable or may go down. But if prostate cancer cells are starting to grow and develop, the level of PSA may go up. Then your doctor may need to change your treatment. They will discuss this with you.

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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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Why does hormone therapy worsen some prostate cancers?

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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Treatment To Lower Androgen Levels From Other Parts Of The Body

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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How Long Do You Take Hormonal Therapy For

For early prostate cancer this depends on the prostate cancer risk group. If the cancer is:

  • intermediate-risk you may have hormonal therapy for a few months after radiotherapy
  • high-risk you may be advised to have hormonal therapy for up to 2 to 3 years after radiotherapy.

For locally advanced prostate cancer you usually have hormonal therapy for 2 to 3 years after radiotherapy.

When Is Hormone Therapy Used For Prostate Cancer

Hormone Therapy 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

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The Future Of Hormone Therapy For Prostate Cancer

Some experts aren’t sure how much further we can improve hormone therapy for prostate cancer.

“I’m not saying that we’ve 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.”

“It’s 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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How Might I Feel During Hormone Therapy

Nearly all men being treated for prostate cancer say that they feel emotionally upset at different times during their hormone therapy. It’s not unusual to feel anxious, depressed, afraid, angry, frustrated, alone, or helpless. Hormone therapy may affect your emotions because it lowers the amount of testosterone in your body.

Some men find it helps to learn about their disease and treatment because it makes them less afraid of their treatment. Find out as much as you want to know. Do not be afraid to ask questions. Your emotional health is as important as your physical health.

Talking with an understanding friend, relative, minister or another patient may be helpful. Your doctors office may be able to give you a list of local prostate cancer support groups. There will be men in the support groups who have had hormone therapy. You may also contact the American Cancer Society at 1-800-227-2345 or the National Cancer Institutes Cancer Information Line at 1-800-422-6237 to find out about cancer resources in your local community.

Many people don’t understand prostate cancer or its treatment. They may stay away from you because they’re not sure what to say or how to help. Try to be open when you talk to other people about your illness, treatment, needs, and feelings. People will often be willing to lend their support. If you get tired easily, limit your activities and do only the things that mean the most to you.

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Before Receiving Degarelix Injection

  • tell your doctor and pharmacist if you are allergic to degarelix injection, any other medications, or any of the ingredients in degarelix injection. Ask your pharmacist or check the patient information for a list of the ingredients.
  • tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amiodarone , disopyramide , quinidine, procainamide, or sotalol . Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor if you have or have ever had long QT syndrome high or low levels of calcium, potassium, magnesium, or sodium in your blood or heart, liver, or kidney disease.
  • women who are or who may become pregnant should not receive degarelix injection. Degarelix injection may harm the fetus. If you receive degarelix injection while you are pregnant, call your doctor immediately. If you are breastfeeding, talk to your doctor before you receive degarelix injection.

Look For These Symptoms

Androgen Deprivation Therapy for Prostate Cancer

We encourage all our male patients, particularly those over the age of 50, to be aware of potential dysfunction of their prostate gland. Be aware of:

  • trouble urinating
  • general pain in the lower back, hips or thighs
  • pain when urinating
  • pain when ejaculating

If you should experience any of these, you should schedule an appointment with one of our practitioners immediately.

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Diabetes And Heart Disease

Hormonal therapy may increase your risk for diabetes and heart disease. Maintain a healthy lifestyle to help reduce this risk.

  • Dont smoke or use tobacco products. If you currently smoke, the Tobacco Treatment Program can help you quit. Your healthcare team will refer you to this program for support, or you can call for more information.
  • Maintain or achieve a healthy body weight. If youd like to meet with a clinical dietitian nutritionist, call .
  • Follow a healthy diet. Your diet should be high in fiber, low in fat, and low in concentrated sweets. For more information, read Nutrition and Prostate Cancer: Making Healthy Diet Decisions.
  • Exercise regularly. Examples include brisk walking, jogging, biking, aerobics, and yard work. We recommend you exercise 30 minutes every day in addition to your daily routine. Even if you cant exercise every day, whatever you can do will be helpful.

What To Expect During Treatment

Doctors often use hormone therapies, such as Lupron, in combination with radiation therapy or other treatments. They may also use it following surgery.

Healthcare professionals administer Lupron as a depot, which is a small implant that they inject under the persons skin. The individual can often choose an injection site that is suitable for them. Common injection sites include:

The treatment regimen for Lupron will depend on the individuals circumstances, and a person can work with their doctor to determine the best dosage. Some typical dosages include:

  • 7.5 mg one injection every 4 weeks
  • 22.5 mg one injection every 12 weeks
  • 30 mg one injection every 16 weeks
  • 45 mg one injection every 24 weeks

When a person first starts treatment with Lupron, they may have a testosterone flare. Later on, they may experience side effects due to having very low testosterone levels in their body. After treatment stops, testosterone levels begin to return to normal.

When a person first takes Lupron, their testosterone levels may rise, or flare, before dropping to very low levels. For some people, particularly those with advanced prostate cancer, a testosterone flare can temporarily cause their symptoms to worsen.

The symptoms of a testosterone flare can include:

  • blockage of the ureters, the tubes that carry urine from the kidneys to the bladder
  • spinal cord compression
  • issues with urination

Possible side effects of hormone therapies, such as Lupron, can

  • radiation therapy

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How Hormone Therapy Is Given

Hormone therapy may be given in many ways. Some common ways include:

  • Oral. Hormone therapy comes in pills that you swallow.
  • Injection. The hormone therapy is given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly.
  • Surgery. You may have surgery to remove organs that produce hormones. In women, the ovaries are removed. In men, the testicles are removed.

Intermittent Versus Continuous Hormone Therapy

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

Most prostate cancers treated with hormone therapy become resistant to this treatment over a period of months or years. Some doctors believe that constant androgen suppression might not be needed, so they advise intermittent treatment. This can allow for a break from side effects like decreased energy, sexual problems, and hot flashes.

In one form of intermittent hormone therapy, treatment is stopped once the PSA drops to a very low level. If the PSA level begins to rise, the drugs are started again. Another form of intermittent therapy uses hormone therapy for fixed periods of time for example, 6 months on followed by 6 months off.

At this time, it isnt clear how this approach compares to continuous hormone therapy. Some studies have found that continuous therapy might help men live longer, but other studies have not found such a difference.

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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.

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.

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    How Might Hormone Therapy Make Me Feel

    Hormone therapy itself can affect your mood. You may find that you feel more emotional than usual or just different to how you felt before. Some men find that they cry a lot. You may also get mood swings, such as getting tearful and then angry. Just knowing that these feelings are caused by hormone therapy can help.

    Everyones different some men are surprised by the side effects and how upsetting they find them. Others have fewer symptoms or are not as worried by them.

    Some of the other side effects of hormone therapy are hard to come to terms with. Physical changes, such as putting on weight, or changes to your sex life, might make you feel very different about yourself. Some men say they feel less masculine because of their diagnosis and treatment.

    If youre starting hormone therapy very soon after being diagnosed with prostate cancer, you might still feel upset, shocked, frightened or angry about having cancer. These feelings are normal, and its okay to feel this way.

    Things in your day-to-day life can change because of the hormone therapy. Your relationships with your partner, family and friends might change. Or you might be too tired to do some of the things you used to do.

    Some men experience low moods, anxiety or depression. This could be directly caused by the hormone therapy itself, or because youve been diagnosed with prostate cancer. It could also be due to the impact that treatment is having on you and your family.

    What can help?

    Talking about it

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