Thursday, February 2, 2023

How Long Can You Have Hormone Injections For Prostate Cancer

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What To Expect During Treatment

PSA & Hormone Therapy for Prostate Cancer | Ask A Prostate Expert, Mark Scholz, MD

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

Hormone Therapies For Breast Cancer Treatment

Several treatment options are available for treating hormone-sensitive breast cancers. Some drugs block the effects of estrogen on the cancer cells in the breast, while others prevent estrogen production altogether.

Common hormone therapy drugs include Tamoxifen , Arimidex® , and Femara® , along with Faslodex® for recurrent breast cancer.

Breast cancer in males may also be treated with tamoxifen. Tamoxifen is currently being studied as hormone therapy for the treatment of other types of cancer.

When Hormone Therapy Is Indicated

HT can be administered before, during or after a localized treatment, such as radical prostatectomy, radiation, high-intensity focused ultrasound or cryotherapy. When given before a localized treatment, it is called neoadjuvant therapy. When given after localized treatment without evidence of prostate cancer recurrence, it is called adjuvant therapy. When HT is prescribed after localized treatment for a prostate cancer recurrence, it is called salvage therapy. If a patient’s PSA starts rising after a radical prostatectomy, HT is typically given in combination with radiation therapy. Treatment recommendations are based on each patient’s specific circumstances.

Sometimes we give neoadjuvant HT while the patient is deciding on his primary treatment or to reduce the tumor’s size before starting primary treatment. Neoadjuvant HT will usually slow or stop cancer growth for a period of time.

Many radiation oncologists use HT along with radiation treatment in the belief that HT weakens cancer cells so that they’re more susceptible to destruction by the radiation. Clinical studies have suggested a synergy between radiation therapy and hormone therapy meaning they work better together. Clinical trials have shown improved outcomes for patients who receive combined therapy.

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When Is Hormone Therapy Used 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:

  • The grade of your prostate cancer
  • Your Gleason score
  • The stage of your prostate cancer
  • Your general health

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:

  • The grade tells you what your prostate cancer cells look like.
  • The Gleason score. The Gleason score tells you what your prostate cancer cells look like compared to healthy cells and gives you an idea of how quickly your cancer is growing. Your Gleason score will range from 2 to 10.
  • The stage tells how much prostate cancer you have and where your cancer is located.

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

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Your Cancer Care Team

How Long Can You Live With Recurrent Prostate Cancer

People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.

The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.

Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.

When deciding what treatment is best for you, your doctors will consider:

  • the type and size of the cancer
  • what grade it is
  • whether the cancer has spread to other parts of your body

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Why Is This Medication Prescribed

Degarelix injection is used to treat advanced prostate cancer . Degarelix injection is in a class of medications called gonadotropin-releasing hormone receptor antagonists. It works by decreasing the amount of testosterone produced by the body. This may slow or stop the spread of prostate cancer cells that need testosterone to grow.

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What Are The Advantages And Disadvantages Of Hormone Therapy

What may be important to one person might be less important to someone else. So speak to your doctor or nurse about your own situation.

Advantages

  • Its an effective way to control prostate cancer, even if it has spread to other parts of your body.
  • It can be used alongside other treatments to make them more effective.
  • It can help to reduce some of the symptoms of advanced prostate cancer, such as urinary symptoms and bone pain.

Disadvantages

  • It can cause side effects that might have a big impact on your daily life.
  • It cant cure your cancer when its used by itself, but it can help to keep the cancer under control, sometimes for many years.

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Reasons For Choosing Hormone Therapy

Hormone therapy can slow prostate cancer growth but cannot cure it. For advanced cancer cases, it is an excellent way to manage pain.

However, the duration and effectiveness of this treatment varies depending on the patient. 7085% of men who receive this treatment respond for a certain amount of time. For some men, this respite may last more than 10 years while for others it will last less than a year.

Evidence About Hormone Therapy And Prostatectomy

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

Gleave ME, La Bianca S, Goldenberg SL. Neoadjuvant Hormonal Therapy Prior to Radical Prostatectomy: Promises and Pitfalls. Prostate Cancer and Prostatic Diseases 2000 3:13644. PMID: 12497089.

Hurtado-Coll A, Goldenberg SL, Klotz L, Gleave ME. Preoperative Neoadjuvant Androgen Withdrawal Therapy in Prostate Cancer: The Canadian Experience. Urology 2002 60:4551. PMID: 12231047.

Kumar S, Shelley M, Harrison C, et al. Neo-adjuvant and Adjuvant Hormone Therapy for Localized and Locally Advanced Prostate Cancer. Cochrane Database of Systematic Reviews 2006 CD006019. PMID: 17054269.

Soloway MS, Sharifi R, Wajsman Z, et al. Randomized Prospective Study Comparing Radical Prostatectomy Alone Versus Radical Prostatectomy Preceded by Androgen Blockade in Clinical Stage B2 Prostate Cancer. The Lupron Depot Neoadjuvant Prostate Cancer Study. Journal of Urology 1995 154:4248. PMID: 7541859.

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Cancers Treated With Hormone Therapy

Hormone therapy is used to treat prostate and breast cancers that use hormones to grow. Hormone therapy is most often used along with other cancer treatments. The types of treatment that you need depend on the type of cancer, if it has spread and how far, if it uses hormones to grow, and if you have other health problems.

Table : Boosting The Effectiveness Of Radiation Therapy

A randomized controlled study involving 206 men with early-stage prostate cancer evaluated whether adding six months of hormone therapy to external-beam radiation treatment would boost both overall survival and disease-free survival . The results are given below. The same research group found, in an earlier study, that the addition of hormone therapy was of most benefit to men who were considered at moderate or high risk, based on their clinical profile.

Five-year follow-up 82% Source: Journal of the American Medical Association, 2004 292:8217. PMID: 15315996.

Combined with radiation therapy. A number of studies have shown that men with early-stage prostate cancer are more likely to be cured when hormone therapy is given in conjunction with radiation therapy . Even when the disease is regionally advanced, meaning that it has progressed to tissues immediately surrounding the prostate gland, neoadjuvant hormone therapy reduces risk of progression and relapse .

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What Types Of Hormone Therapy Are There

There are two basic kinds of hormone therapy for prostate cancer. One class of drugs stops the body from making certain hormones. The other allows the body to make these hormones, but prevents them from attaching to the cancer cells. Some doctors start treatment with both drugs in an effort to achieve a total androgen block. This approach goes by several names: combined androgen blockade, complete androgen blockade, or total androgen blockade.

Here’s a rundown of the techniques.

Hormone therapy for prostate cancer can cause bone thinning osteoporosis, which can lead to broken bones. However, treatment with bisphosphonates — like Aredia, Fosamax, and Zometa — may help prevent this condition from developing, says Holden.

Surgery To Remove The Testicles

How Long Can You Live With Recurrent Prostate Cancer

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 don’t want to have injections or tablets.

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Checking Your Hormone Therapy Is Working

You 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 you have had the 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 starts to grow and develop, the level of PSA may go up. This is hormone resistant prostate cancer or castrate resistant prostate cancer. Then your doctor may need to change your treatment. They will discuss this with you

Who Can And Can’t Have Prostap Injections

Most people can have Prostap injections, however they are not suitable for:

  • Women who are pregnant. If you could get pregnant you’ll need to use a non-hormonal method of contraception, eg condoms or diaphragm, while you’re having Prostap injections and for a few months after your last injection. Ask your doctor for further advice.
  • Women who are breastfeeding.
  • Women with vaginal bleeding where the cause is not known.

Your doctor will need to weigh up the risks and benefits of having Prostap injections and may need to do some extra monitoring if you have:

  • osteoporosis or a risk of developing it, for example due to a family history, anorexia or bulimia, smoking, excessive alcohol consumption, low body mass index , or long-term treatment with corticosteroid or anticonvulsant medicines
  • liver problems.

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How Is Prostate Cancer Treated

Lorenzo asked his doctors about survival and side effects and talked to friends and family members before deciding on treatment. He shares his story in this blog post.

Different types of treatment are available for prostate cancer. You and your doctor will decide which treatment is right for you. Some common treatments are

  • Expectant management. If your doctor thinks your prostate cancer is unlikely to grow quickly, he or she may recommend that you dont treat the cancer right away. Instead, you can choose to wait and see if you get symptoms in one of two ways:
  • Active surveillance. Closely monitoring the prostate cancer by performing prostate specific antigen tests and prostate biopsies regularly, and treating the cancer only if it grows or causes symptoms.
  • Watchful waiting. No tests are done. Your doctor treats any symptoms when they develop. This is usually recommended for men who are expected to live for 10 more years or less.
  • Surgery. A prostatectomy is an operation where doctors remove the prostate. Radical prostatectomy removes the prostate as well as the surrounding tissue.
  • Radiation therapy. Using high-energy rays to kill the cancer. There are two types of radiation therapy
  • External radiation therapy. A machine outside the body directs radiation at the cancer cells.
  • Internal radiation therapy . Radioactive seeds or pellets are surgically placed into or near the cancer to destroy the cancer cells.
  • Hormone Therapy Side Effects

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

    Hormone therapy either blocks your bodys ability to produce hormones or interferes with how hormones behave. This means that it can also cause some side effects. The side effects of hormone therapy will depend on the type of treatment you receive and how your body responds to it. These side effects are similar to what women may experience at menopause.

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    How Hormone Therapy Is Used Against 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.

    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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    Hormonal Treatments For Prostate Cancer Are Often Given Late

    • By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

    Men with advanced prostate cancer are typically treated with drugs that cause testosterone levels to plummet. Testosterone is a hormone that fuels growing prostate tumors, so ideally this type of treatment, which is called androgen deprivation therapy , or hormonal therapy, will stall the disease in its tracks.

    For that to happen, ADT has to be administered correctly. But according to a new study, men frequently dont get ADT at the proper dosing intervals. Too many of them get the treatments later then they should, causing testosterone levels to rise unacceptably. Rapid increases in testosterone following delays in dosing could have implications for cancer progression, cautions Dr. David Crawford, a urologist at the University of California San Diego, who led the study.

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    How Does Hormone Therapy Work

    Hormone Therapy For Prostate Cancer Before Radiotherapy ...

    Hormone therapy for prostate cancer works by either preventing the body from making these androgens or by blocking their effects. Either way, the hormone levels drop, and the cancers growth slows.

    Testosterone and other hormones are like fertilizer for cancer cells, Holden tells WebMD. If you take them away, the cancer goes into shock, and some of the cells die.

    In 85% to 90% of cases of advanced prostate cancer, hormone therapy can shrink the tumor.

    However, hormone therapy for prostate cancer doesnt work forever. The problem is that not all cancer cells need hormones to grow. Over time, these cells that arent reliant on hormones will spread. If this happens, hormone therapy wont help anymore, and your doctor will need to shift to a different treatment approach.

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    Drugs That Stop Androgens From Working

    Anti-androgens

    For most prostate cancer cells to grow, androgens have to attach to a protein in the prostate cancer cell called an androgen receptor. Anti-androgens are drugs that also connect to these receptors, keeping the androgens from causing tumor growth. Anti-androgens are also sometimes called androgen receptor antagonists.

    Drugs of this type include:

    They are taken daily as pills.

    In the United States, anti-androgens are not often used by themselves:

    • An anti-androgen may be added to treatment if orchiectomy or an LHRH agonist or antagonist is no longer working by itself.
    • An anti-androgen is also sometimes given for a few weeks when an LHRH agonist is first started. This can help prevent a tumor flare.
    • An anti-androgen can also be combined with orchiectomy or an LHRH agonist as first-line hormone therapy. This is called combined androgen blockade . There is still some debate as to whether CAB is more effective in this setting than using orchiectomy or an LHRH agonist alone. If there is a benefit, it appears to be small.
    • In some men, if an anti-androgen is no longer working, simply stopping the anti-androgen can cause the cancer to stop growing for a short time. This is called the anti-androgen withdrawal effect, although it is not clear why it happens.

    Newer anti-androgens

    Enzalutamide , apalutamide and darolutamide are newer types of anti-androgens. They can sometimes be helpful even when older anti-androgens are not.

    These drugs are taken as pills each day.

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