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
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 .
Hormone Therapy For Prostate Cancer
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Hormone therapy is also called androgen suppression therapy. The goal of this treatment is to reduce levels of male hormones, called androgens, in the body, or to stop them from fueling prostate cancer cell growth.
Androgens stimulate prostate cancer cells to grow. The main androgens in the body are testosterone and dihydrotestosterone . Most androgens are made by the testicles, but the adrenal glands as well as the prostate cancer cells themselves, can also make androgens.
Lowering androgen levels or stopping them from getting into prostate cancer cells often makes prostate cancers shrink or grow more slowly for a time. But hormone therapy alone does not cure prostate cancer.
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How Does Hormone Therapy Work Against Prostate Cancer
Early in their development, prostate cancers need androgens to grow. Hormone therapies, which are treatments that decrease androgen levels or block androgen action, can inhibit the growth of such prostate cancers, which are therefore called castration sensitive, androgen dependent, or androgen sensitive.
Most prostate cancers eventually stop responding to hormone therapy and become castration resistant. That is, they continue to grow even when androgen levels in the body are extremely low or undetectable. In the past, these tumors were also called hormone resistant, androgen independent, or hormone refractory however, these terms are rarely used now because the tumors are not truly independent of androgens for their growth. In fact, some newer hormone therapies have become available that can be used to treat tumors that have become castration resistant.
Hormone Treatment Fights Prostate Cancer
Hormone therapy for prostate cancer has come a long way in the past few decades. Not so long ago, the only hormonal treatment for this disease was drastic: an orchiectomy, the surgical removal of the testicles.
Now we have a number of medications — available as pills, injections, and implants — that can give men the benefits of decreasing male hormone levels without irreversible surgery.
“I think hormonal therapy has done wonders for men with prostate cancer,” Stuart Holden, MD, Medical Director of the Prostate Cancer Foundation.
Hormone therapy for prostate cancer does have limitations. Right now, it’s usually used only in men whose cancer has recurred or spread elsewhere in the body.
But even in cases where removing or killing the cancer isn’t possible, hormone therapy can help slow down cancer growth. Though it isn’t a cure, hormone therapy for prostate cancer can help men with prostate cancer feel better and add years to their lives.
On average, hormone therapy can stop the advance of cancer for two to three years. However, it varies from case to case. Some men do well on hormone therapy for much longer.
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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.
What Is The Most Commonly Used Treatment For Prostate Cancer
According to a study published online by JAMA Oncology (2015 doi: 10.1001/jamaoncol.
What foods kill prostate cancer cells?
There is no particular food or recipe that can directly kill prostate cancer cells. Some foods that may be helpful in curing prostate cancer and preventing relapse include foods containing lycopene, beans, green tea, cruciferous vegetables, and fruits like cranberries, strawberries, blueberries, and berries. pomegranates.
At what age is prostate cancer untreated?
Men between the ages of 60 and 69 were more likely to receive radiation therapy than radical prostatectomy. Men between the ages of 70 and 79 were most likely to receive no treatment, and almost all men over 80 received no treatment.
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First Line Treatment For Advanced Prostate Cancer
The established first line approach is to control the progression of the disease by reducing levels of testosterone in the body. This is because testosterone increases the speed at which prostate cancer cells reproduce.
There are two different ways to lower testosterone levels. Hormone therapy lowers the levels of testosterone in the body by taking tablets or having injections. It is sometimes referred to as medical castration. The surgical option involves removing the testicles, known as surgical castration or orchidectomy, although this is now rarely used.
Another approach is called anti-androgen treatment. Androgens have to bind to a protein in the cell called an androgen receptor to work. Anti-androgens are drugs that bind to these receptors so the androgens cant, effectively blocking them. The main side-effects are gynaecomastia breast enlargement and breast pain, although a single radiotherapy dose to the breasts can help this side-effect.
Combining anti-androgens with testosterone reduction is known as Maximum Androgen Blockade and may be used if hormone treatment alone is not working sufficiently.
Treating with chemotherapy at the same time as the start of hormone deprivation was found to increase survival by 13 months in all patients and 17 months in men with high-volume disease.
Intermittent Versus Continuous Hormone Therapy
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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How Is Hormone Therapy Used To Treat Cancer
Doctors often use hormone therapy along with other types of cancer treatment, such as radiation therapy, chemotherapy, or surgery. If a person cannot have those treatments because of other health problems, hormone therapy may be used alone.
Hormone therapy can be used in different ways at different times. These include:
Before surgery or radiation therapy to shrink a tumor. This is called neoadjuvant therapy.
After other cancer treatments to reduce the risk that cancer will come back. This is called adjuvant therapy.
For cancer that comes back after treatment, called recurrent cancer.
For cancer that has spread to other parts of the body, called metastatic cancer.
The goal of hormone therapy depends on the type of cancer and how far it has spread. Sometimes, the goal is to keep cancer from coming back after treatment. Or the goal may be to stop or slow cancer growth.
Hormone therapy may also be used to help prevent or manage cancer symptoms. Relieving side effects is an important part of cancer care and treatment. This is called palliative care or supportive care. Be sure to ask your doctor why a specific hormone therapy is being recommended for you and how the therapy will contribute to your cancer treatment plan.
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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When Does Hormone Therapy Fail For Prostate Cancer
Cancer cells are smart. When faced with a continuous stressor such as chemotherapy or hormone therapy, they eventually evolve and learn evasive maneuvers. When prostate cancer cells grow resistant or become insensitive to hormone therapy, the cancer is referred to as hormone refractory.
Hormone therapy may work to treat prostate cancer for many years. However, its only a temporary fix because eventually, the cancer becomes resistant. The risk of resistance goes up if the cancer has taken hold for a long time or if it has relapsed.
The Suitability Of Patients Over Age 70 For Hormonal Therapy
It is agreed by all that hormonal therapy is indicated for an increasing percentage of patients with increasing age, but the only entirely uncontroversial indication for it is symptomatic, metastatic prostate cancer . Irritative and obstructive urinary symptoms can also be treated hormonally .
The patients chronological age is less important than his biological age and life expectancy. In one study, the tumor-specific survival rates of patients with local prostate cancer were no different at age 60 and at age 80 if the patients were given hormonal treatment only in case of progression of their prostate cancer. In this age group, it was the Gleason scorea tumor-associated, rather than patient-associated, factorthat shortened metastasis-free 10-year survival: The figure for highly differentiated prostate cancer was 81%, while that for poorly differentiated prostate cancer was 26% .
The case studies mentioned above yielded survival figures based on the patients chronological age. One may suspect, however, that the treating physicians were also influenced by their patients comorbidities when choosing the therapy to be given to each. In a population-based study in the Netherlands, only 8% of the patients under age 69 had two or more comorbidities, as compared to 27% of patients aged 80 .
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Your Hormone Therapy Plan
The type of hormone therapy prescribed for you, the amount you take, and how often you take it depends on many factors. These include:
The type of cancer
The risk of cancer returning or how long it had been before the cancer returned
The type of cancer treatment you have already received or currently receive
Side effects that you experience
Whether or not menopause has occurred
Some people need hormone therapy for a short time. Other people will remain on hormone therapy for several years or the rest of their lives. Hormone treatment can be daily, monthly, yearly, or as needed. For example, with certain types of breast cancer, people can take daily hormone therapy for 5 to 10 years. People with prostate cancer may have intermittent hormone therapy. This means that they will receive hormone therapy at specific times, but the treatment will be stopped temporarily before it starts again. After thyroid cancer treatment, hormone therapy is often a daily part of a person’s life.
Talk to your health care team about why they recommend a specific hormone therapy plan for you and what to expect.
Types Of Hormone Therapy
The table at the right provides an overview of three commonly used types of hormone therapy. These and others are discussed below. While hormone therapy is commonly used, side effects of the treatment are reported as well. They range from erectile dysfunction, hot flashes, weight gain and loss of bone density.
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Prostap Injection Key Facts
- Prostap injection may be given monthly or three-monthly depending on the condition being treated.
- The injection makes hormone levels increase at first and then fall, so symptoms may get worse temporarily for a short time after the first injection.
- The most common side effects in men include hot flushes, sweating, reduced sex drive, difficulty getting an erection and feeling weak.
- The most common side effects in women include hot flushes, mood swings, vaginal dryness, headaches and difficulty sleeping.
- The most common side effects in children are temporary worsening of puberty symptoms like mood swings and acne. Girls may get some vaginal bleeding or spotting.
- Women and girls having Prostap injections should find their periods stop. Tell your doctor if you’re still getting your period.
- Sexually active women should use a non-hormonal method of contraception to prevent pregnancy while having Prostap injections. The treatment can be harmful to a developing baby.
How Hormone Therapy Is Given
Hormone therapy may be given in many ways:
- 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.
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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 man’s body. Knowing this can help you understand what side effects you might get when you’re 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.
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.
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