Hormonal Therapy With Radiotherapy For Early And Locally Advanced Prostate Cancer
Doctors often advise having hormonal therapy along with radiotherapy , to make treatment more effective. This is usually if you have intermediate-risk or high-risk;early prostate cancer. You may also have hormonal therapy before treatment with HIFU.
You may have hormonal therapy during radiotherapy and either:
- a few months before radiotherapy, to shrink the cancer and make treatment more effective
- after radiotherapy, to reduce the chance of the cancer coming back .
Your doctor will advise when and how long you should have the hormonal therapy for.
If you have intermediate-risk early prostate cancer, you may have hormonal therapy for up to a few months after treatment finishes.
If you have high-risk early or locally advanced prostate cancer, you may be advised to have hormonal therapy for 2 to 3 years after radiotherapy finishes.
How Long Does Hormone Therapy Work To Stop Cancer Progression
On average, hormone therapy can stop cancer progression for 1-2 years before the prostate cancer becomes resistant. Hormone therapy can stop working over time as the prostate cancer begins to grow again .;
When this occurs, doctors may offer other therapies. Since they cant predict how long hormone therapy will work, they may perform regular blood tests to check PSA and testosterone levels. If PSA levels start to increase and testosterone levels are low, these may be signs that the cancer has started to grow again.
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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What To Expect During Hormone Therapy
As you go through hormone deprivation therapy, youâll have follow-up visits with your cancer doctor. Theyâll ask about side effects and check your PSA levels.
Doctors donât know how long hormone therapy works to keep prostate cancer in check. So, while you take it, your doctor will regularly draw blood to check your PSA levels. Undetectable or low PSA levels usually mean that the treatment is working. If your PSA levels go up, itâs a sign that the cancer has started growing again. If this happens, your cancer is considered castrate-resistant, and hormone deprivation therapy is no longer an effective treatment.
Youâll also get other blood tests to see if the cancer is affecting other parts of your body like your liver, kidneys, or bones. Scans will show how well your cancer is responding to hormone therapy.
To lessen the side effects of hormone therapy drugs, researchers suggest that you take them for just a set amount of time or until your PSA drops to a low level. If the cancer comes back or gets worse, you may need to start treatment again.
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Newer Hormonal Therapy Drugs For Advanced Prostate Cancer
These drugs are usually used when other hormonal therapies are no longer helping to control the cancer. This is when the prostate cancer cells need much lower levels of testosterone to grow. Sometimes you may have these drugs earlier on, when you are first diagnosed.
Newer hormonal therapy drugs include:
These newer hormonal therapy drugs may be given before you need chemotherapy. This is if you have no symptoms or mild symptoms, or if chemotherapy is no longer helping to control the cancer.
Or they may sometimes be given as the first hormonal therapy you have. This may be with hormonal injections or implants, or on their own.
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Hormone Therapy Helps Some Prostate Cancer Survivors Live Longer
A study published in the New England Journal of Medicine in January 2017 indicates that men whose prostates are removed to treat prostate cancer are likely to survive longer if they take drugs to block the male hormone testosterone in addition to undergoing radiation therapy.
Unfortunately, its not that simple.
Hormonal Therapy Treatment For Prostate Cancer
The following article contains a good deal of technical information, but we feel the information is helpful and would be of interest to many of our QUEST readers.
Hormonal therapy is most often used after both a radical prostatectomy and radiation have failed. Sometimes, however, it is used as a primary therapy in older patients who would not tolerate surgery or radiation.
Hormonal therapy can be divided into two phases, primary and secondary.
Primary
Most prostate cancer cells either die or go into a dormant phase when the male, blood hormonal level level is dramatically lowered. This phase of so-called androgen-dependent prostate cancer can be quite variable, lasting from only a few months to as long as 18 years. Male hormone levels can be lowered or rendered less effective in various ways.
One method of lowering the testosterone level is by removal of the testicles . Another is by injections called Lupron or Zoladex . A third alternative is antiandrogen pills such as Megace , Eulexin , Casodex , Nilandron .
Other methods are by estrogens ; by inhibitors of androgen synthesis, such as ketoconazole; by antiestrogens, such as tamoxifen; by herbal estrogen compounds, such as PC spes; or by glucocorticoids .
Secondary
The principle behind secondary hormonal therapy is that while the patient is taking a hormone that blocks the growth of the cancer, the cancer cells can mutate or change in a way that makes the Eulexin stimulate their growth.
Hormone-Resistant
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What Side Effects May I Have After I Start Hormone Therapy
The side effects that you may have after you start hormone therapy include: erectile dysfunction or impotence , lower sexual desire , hot flashes, fatigue , weight gain, breast enlargement, osteoporosis, anemia, memory loss, and cardiovascular problems. The following side effects can happen as soon as you start your treatment.
Erection problems
Difficulty getting or keeping an erection is a common side effect of hormone therapy for prostate cancer. This is also called impotence. Hormone therapy lowers the amount of testosterone in your body or stops your body from making testosterone.
Lower sex drive
Hot flashes and sweating
Breast tenderness or growth
Some men may find that their chest becomes sore and that their breasts get a little bit swollen. This is called gynecomastia . There are medicines and treatments that you doctor or health care team can give you to help with this side effect.
Fatigue
The drop in your testosterone level may make you feel very tired. You may feel tired all the time or you may get tired more easily when you do your daily activities. This is known as fatigue or tiredness. There are things you can do to help deal with this treatment side effect.
Tumor flare pain
The following side effects may happen if you take hormone treatment for a long period of time. These are:
Weight gain
Memory problems
Anemia
Bone thinning
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Cardiovascular problems
Role Of Hormonal Therapy For High
Patients with high-risk or locally advanced prostate cancer with high Gleason score, elevated PSA level and advanced clinical stage have a high probability of treatment failure after initial management by single-treatment modalities, such as hormonal therapy, radical prostatectomy, external beam radiation therapy or brachytherapy., Therefore, it is extremely important to establish the most effective treatment strategy for patients with high-risk prostate cancer. As high-risk patients may have locally advanced disease with direct extension and/or micrometastases, various combinations of treatments have been developed to augment cancer-specific survival. Neoadjuvant and/or adjuvant hormonal therapy offer synergistic enhancement of radiation therapy or radical prostatectomy due to induction of apoptosis. Moreover, hormonal therapy may play a role in elimination of occult systemic disease., Whereas many studies have demonstrated benefits of hormonal therapy used in conjunction with EBRT to treat locally advanced prostate cancer,, , , , questions and criticisms remain, including the details of the duration, timing and contents of hormonal therapy. The results of radiation oncology group trial 9202 regarding effectiveness and adverse effects of hormone therapy are very informative. These results suggest that cause-specific benefits of hormone therapy may have been offset by deaths from other causes induced by hormone therapy.
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Radiation Treatment For Prostate Cancer
The cure rate for prostate cancer using radiation is excellent, and there is a proven safety track record.
While there are several types of radiation treatments available to prostate cancer patients, the experts at the CyberKnife Center of Miami say that Stereotactic Body Radiation Therapy the kind of radiation used by CyberKnife, has some distinct advantages.
Do not let the name fool you: Despite being called CyberKnife, this treatment is not a knife, it is cutting-edge technology that destroys tumors with pinpoint precision and accuracy and leaves the healthy surrounding tissue virtually unaffected.
In fact, according to a 12-year study presented at the American Society for Radiation Oncology meeting last year, SBRT has high rates of long-term cancer control with mild toxicity.
What Kinds Of Medicines Can Be Used To Lower My Testosterone
There are several types of medicines you can take to lower the amount of testosterone in your body. These are temporary ways to lower the amount of testosterone. When you stop taking these medicines, your testosterone level will begin to go up.
LHRH agonist
LHRH is a normal human hormone that tells your body to make testosterone. An LHRH agonist is a man-made hormone similar to the one made naturally in your body. LHRH agonists work like a light switch to shut off the production of testosterone in your body. When you are given this medicine, your body will stop making the LHRH hormone and your testicles will stop making testosterone. When you are first given this medicine, your body will continue to make testosterone for a couple of weeks. This means that your testosterone level may go up for a week or two and then begin to drop. This type of medicine works as well as having an orchiectomy . These medicines are given either monthly or every three months in a shot . The medicine may also be placed as small implants under your skin. The implant gives you a steady dose of medicine. Depending on the type of implant the medicine may last from one to 12 months.
Anti-androgens
Anti-androgens act like a brick wall. They block the small amount of testosterone made in your adrenal glands from reaching your prostate cancer cells. This keeps your prostate cancer cells from growing. These medicines are pills that are taken orally one to three times a day.
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Questions To Ask Your Doctor
These questions may be useful to you when you talk to your doctor about your hormone therapy:
About hormone therapy
- Why are you suggesting hormone therapy for me?
- What type of hormone therapy will be used?
About your treatment
- How often will I need this medicine?
- How long will I be on hormone therapy?
- Are there other choices of treatment in my case?
- Will I need regular blood tests while I am on hormone therapy?
- What will these tests tell us?
- Do I need to eat a special diet?
- Should I exercise?
About Side Effects
- Will I lose my sex drive and become impotent? Will this be temporary or will it last forever?
- What other side effects might I have?
- How long will these side effects last?
- When will these side effects happen?
- Are there any side effects I should tell you about right away?
- What can I do to manage my side effects?
About Contacting Your Doctor
- How do I get in touch with you or my health care team after your office is closed?
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 .
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What Kinds Of Medical Information Should I Keep
It is important for you to keep a copy of your prostate cancer treatment records. You may not always see the same doctor for your follow-up care, so having this information to share with another doctor can be very helpful. The following is a list of medical information you may want to keep.
- The results of any tests you have taken such as your Prostate-Specific Antigen test.
- When you found out you had prostate cancer.
- Information on the kinds of treatment you have had for your prostate cancer including:
- The places and dates where you had your treatment.
- What type of treatment you had. And,
- Any medicines you took before, during, and after your prostate cancer treatment.
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.
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Whats The Typical Dosage
Hormone therapy can be used alone or in combination with other therapies. It may also be used before or after other therapies.
Lupron is administered by injection. The dosage will vary according to your particular situation. Here are some typical dosage options your doctor may prescribe:
- 1 mg once per day, varying the injection site
- 7.5 mg every 4 weeks
- 22.5 mg every 12 weeks
- 30 mg every 16 weeks
- 45 mg every 24 weeks
If you stop taking Lupron, youll start producing testosterone again.
You will experience some changes when your hormone levels fluctuate or have a substantial drop. Its a good idea to talk about this in advance so youre not caught off guard.
Consider asking some of these questions when you consult with your doctor:
- Why do you recommend treatment with Lupron?
- How often will I have to take the drug?
- Will I administer it myself or will I need to come in to the clinic?
- How often will we test to see if its working?
- How long will I have to take it?
- What should I do if I miss a dose or if I stop taking it?
- What are the potential side effects, and can we do anything about them?
- Are there any other medications, supplements, or foods I should avoid while taking Lupron?
- If it doesnt work, what are the next steps?
According to the American Cancer Society, the relative five-year survival rates for men with prostate cancer, compared to men without the disease, are:
Your doctor can give you an idea what to expect from your treatment with Lupron.
What Hormone Therapy Does
Hormone therapy can control or shrink the cancer and reduce symptoms. It can help you feel better and improve your quality of life for a time but it cant cure the cancer.
Most men with advanced prostate cancer have hormone therapy. If your cancer has spread when it is diagnosed, you might start hormone therapy straight away.
If you dont have symptoms, your doctor might suggest monitoring your symptoms and then starting treatment when needed. They call this watchful waiting.
Your doctor might offer you a choice of treatment. And you might have more than one type of hormone therapy at the same time.;
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Surgery To Remove The Testicles
Surgery to remove your testicles isnt a common way of lowering the amount of testosterone you produce.
You usually only have surgery to remove your testicles if you need your testosterone reduced urgently. For example if your cancer has spread to your bones and is pressing on your spinal cord, your doctors might want to reduce the amount of testosterone quickly.
Your doctors might also suggest surgery as an option if you dont want to have injections or tablets.;