How Is Hormone Therapy Used To Treat Hormone
Hormone therapy may be used in several ways to treat hormone-sensitive prostate cancer, including:
Early-stage prostate cancer with an intermediate or high risk of recurrence. Men with early-stage prostate cancer that has an intermediate or high risk of recurrence often receive hormone therapy before, during, and/or after radiation therapy, or after prostatectomy . Factors that are used to determine the risk of prostate cancer recurrence include the grade of the tumor , the extent to which the tumor has spread into surrounding tissue, and whether tumor cells are found in nearby lymph nodes during surgery.
The use of hormone therapy before prostatectomy has not been shown to be of benefit and is not a standard treatment. More intensive androgen blockade prior to prostatectomy is being studied in clinical trials.
Relapsed/recurrent prostate cancer. Hormone therapy used alone is the standard treatment for men who have a prostate cancer recurrence as documented by CT, MRI, or bone scan after treatment with radiation therapy or prostatectomy.
Hormone therapy is sometimes recommended for men who have a “biochemical” recurrencea rise in prostate-specific antigen level following primary local treatment with surgery or radiationespecially if the PSA level doubles in fewer than 3 months.
Epidemiological Data From Germany
More than 58 000 men are given the diagnosis of prostate cancer in Germany each year . This figure corresponds to 25.4% of the new cancer diagnoses in men prostate cancer is thus the most common form of cancer in men. The mean age at diagnosis is 69 years. The annual incidence is 720 per 100 000 per year in the 70-to-74-year-old age group and peaks at approximately 750 per 100 000 per year in men aged 75 to 79. The relative 5-year survival rate of patients with prostate cancer is currently 87% . These epidemiological figures reveal the importance of an appropriate choice of initial therapy.
What Types Of Hormone Therapy Are Used For Prostate Cancer
Hormone therapy for prostate cancer can block the production or use of androgens . Currently available treatments can do so in several ways:
- reducing androgen production by the testicles
- blocking the action of androgens throughout the body
- block androgen production throughout the body
Treatments that reduce androgen production by the testicles are the most commonly used hormone therapies for prostate cancer and the first type of hormone therapy that most men with prostate cancer receive. This form of hormone therapy includes:
Treatments that block the action of androgens in the body are typically used when ADT stops working. Such treatments include:
Treatments that block the production of androgens throughout the body include:
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Your Cancer Care Team
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
Questions To Ask Your Doctor Or Nurse
- What is the aim of treatment?
- What type of hormone therapy are you recommending for me and why?
- How often will I have my injections or implants?
- How will my treatment be monitored?
- How long will it be before we know if the hormone therapy is working?
- What are the possible side effects, and how long will they last?
- What will happen if I decide to stop my treatment?
- Are there any clinical trials that I could take part in?
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Hormonal Therapy For Aggressive Prostate Cancer: How Long Is Enough
- By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
Men weighing treatment options for intermediate- or high-risk cancer that is still localized to the prostate can face a tricky question. A standard approach in these cases is to give radiation to the prostate along with drugs that block testosterone, a hormone that makes the cancer cells grow faster. For how long should this hormone therapy last? Thats not entirely clear. The drugs have side effects, such as fatigue, impotence, and a loss of muscle mass. But radiation doesnt control prostate cancer effectively without them. Doctors therefore aim to give hormone therapy only for as long as it takes to help their patients, without causing any undue harm.
Now, newly published results from a phase 3 clinical trial are providing some needed guidance.
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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Staging Of Prostate Cancer
Doctors will use the results of your prostate examination, biopsy and scans to identify the “stage” of your prostate cancer .
The stage of the cancer will determine which types of treatments will be necessary.
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.
Early Versus Delayed Treatment
For men who need hormone therapy, such as men whose PSA levels are rising after surgery or radiation or men with advanced prostate cancer who dont yet have symptoms, its not always clear when it is best to start hormone treatment. Some doctors think that hormone therapy works better if its started as soon as possible, even if a man feels well and is not having any symptoms. Some studies have shown that hormone treatment may slow the disease down and perhaps even help men live longer.
But not all doctors agree with this approach. Some are waiting for more evidence of benefit. They feel that because of the side effects of hormone therapy and the chance that the cancer could become resistant to therapy sooner, treatment shouldnt be started until a man has symptoms from the cancer. This issue is being studied.
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If Treatment Does Not Work
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for many people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
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.
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What Are The Long
A new five-year study identifies how different treatment options affect long-term bowel, bladder and sexual function.
Any man who is diagnosed with prostate cancer and faces treatment choices must grapple with the risk of side effects. Urinary incontinence and erectile dysfunction are the most common. Sometimes, these side effects are temporary and get better with time.
Until now, however, there havent been good long-term data to help oncologists help men with prostate cancer make informed choices about treatment that take these side-effect risks into account.
The new study included more than 2,000 men who were followed for five years after receiving various types of prostate cancer treatment. The resulting paper quantifies key differences in those treatments associations with long-term bowel, bladder and sexual function. The study, called CEASAR, for the Comprehensive Effectiveness Analysis of Surgery and Radiation for Localized Prostate Cancer, is coordinated by the Vanderbilt University Medical Cancer and follows men who were diagnosed with localized prostate cancer between 2011 and 2012.
The 1,386 men with favorable-risk prostate cancer received one of these treatments:
The 619 men with unfavorable-risk prostate cancer received one of two treatments:
There were no clinically significant differences in bowel function after five years across the treatment types.
To read a press release about the study, .
To read the study abstract, .
Read More About:
Complications Of Hormonal Therapy
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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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.
What Things Should I Think About Before Starting Hormone Therapy
If you and your doctor are talking about hormone therapy as a way to control your prostate cancer, you should think about the following things:
- There are several kinds of hormone therapy. They work in different ways and have different side effects.
- Hormone therapy does not cure prostate cancer. It controls the growth of prostate cancer cells for a period of time. Speak with your doctor or health care team about what kind of hormone therapy is best for you.
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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.
Treating Prostate Cancer With Hormone Therapy
Hormone therapy, also known as androgen deprivation therapy , has long been the backbone of treatment for metastatic prostate cancer.
The male sex hormone testosterone is known to stimulate the growth of prostate cancer cells.
Hormone therapy, depending on the form, reduces this effect by either decreasing the bodys production of testosterone or blocking testosterone from binding to cancer cells.
There are several scenarios in which hormone therapy is typically used:
- When prostate cancer has spread too far to be cured by surgery or radiation, or has recurred after surgical or radiation treatment
- As an initial treatment for patients who are at higher risk of recurrence after treatment, such as those with a high PSA level or a high Gleason score
- For patients who have a high PSA level following surgery or radiation, even if they have no evidence of disease. Not all doctors, however, agree with this approach
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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.”
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. The hope is that giving men a break from androgen suppression will also give them 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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