Intermittent Hormonal Therapy For Locally Advanced Prostate Cancer
Intermittent hormonal therapy is where you stop taking the drugs and after a while start taking them again. This may be an option for locally-advanced prostate cancer. It gives you a break from the side effects of hormonal therapy.
Intermittent hormonal therapy is not suitable for everyone and should only be done on your doctors advice. Your doctor can explain more about this. They usually measure your PSA level using the PSA test every 3 months. If it goes up to a certain level or you get symptoms, your doctor will advise you to start hormonal therapy again.
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.
How Will I Know That My Hormone Therapy Is Working
Doctors cannot predict how long hormone therapy will be effective in suppressing the growth of any individual mans prostate cancer. Therefore, men who take hormone therapy for more than a few months are regularly tested to determine the level of PSA in their blood. An increase in PSA level may indicate that a mans cancer has started growing again. A PSA level that continues to increase while hormone therapy is successfully keeping androgen levels extremely low is an indicator that a mans prostate cancer has become resistant to the hormone therapy that is currently being used.
Options In Hormone Therapy
Testosterone levels in the body can be reduced either surgically or with drugs. The surgical option is castration, achieved by removing the testicles during a bilateral orchiectomy. Once the only option, it has since been supplanted by drugs that lower testosterone levels to amounts achieved by surgery.
For men, normal testosterone levels range from 300 to 1,000 ng/dl. The FDA requires that any new drug used in hormone therapy for prostate cancer lower testosterone levels to 50 ng/dl or less. In my practice, I usually try to lower levels even further, to 20 ng/dl.
T Cell In Colorectal Cancer Therapy
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Kinds Of Hormone Therapy
Hormone therapy is a category encompassing a number of treatments. In some conditions or diseases, certain hormones are prescribed in order to increase their levels. This is frequently referred to as hormone replacement therapy . Hormones can be natural or synthetic, meaning produced commercially . Patients who do not have prostate cancer but have symptoms from low testosterone levels, such as fatigue, may be prescribed testosterone as a type of HRT. In certain cases, patients with prostate cancer under control may receive this type of hormone therapy however, because of the risk of activating the cancer, some doctors advise against it. Male children or adults with hypogonadism are prescribed testosterone as HRT.
As mentioned previously, HT in prostate cancer aims to reduce production of the hormone testosterone, rather than increase it, thereby interfering with cancer cells ability to use it to grow.
The hormone therapies that have become standard prostate cancer treatments are the ones we discuss in detail in this guide. All decisions regarding these treatments should be carefully made by the patient and doctor together.
Side Effects Of Treatment
Any side effects you may encounter as a result of hormone therapy will depend largely on the kind of treatment you are undergoing. Many of these side effects will occur as a result of the decrease of testosterone in the body. Prolonged use of hormone therapy medications may also increase your chances of developing any of the side effects listed below:
- Difficulty with memory and concentration
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Male Hormones And Prostate Cancer
Androgens are male sex hormones. Testosterone is one main type of androgen. Most testosterone is made by the testicles. The adrenal glands also produce a small amount.
Androgens cause prostate cancer cells to grow. Hormone therapy for prostate cancer lowers the effect level of androgens in the body. It can do this by:
- Stopping the testicles from making androgens using surgery or medicines
- Blocking the action of androgens in the body
- Stopping the body from making androgens
Will Side Effects Limit What I Can Do
What you are able to do will depend on which side effects you have and how bad they are. Many men are able to work, cook meals, and enjoy their usual daily activities when they have hormone therapy for their prostate cancer. Other men find that they need more rest than before they started hormone therapy so they cant do as much. You should try to keep doing the things you enjoy as long as you dont get too tired.
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Questions To Ask The Health Care Team
What side effects are common from the hormone therapy treatment you are recommending for me?
When is it likely that side effects will occur? How often?
How long will side effects last? Could any of them be permanent?
Is there anything I can do to prepare for these side effects?
What can the health care team do to prevent or relieve side effects?
Who should I tell if I begin experiencing side effects from hormone therapy? How soon?
What side effects are considered emergencies? What should I do if I experience an urgent side effect?
Who do I contact if I have questions about specifci side effects?
How can I reach them during regular business hours? After hours?
Are there any support groups you can recommend to help cope with the fear of side effects?
Are there other ways I can cope with my fears about the effects of treatment?
Can you recommend a social worker, counselor, or supportive or palliative care specialist for me to talk with?
Intermittent Or Continuous Therapy
Once prescribed, hormone therapy used to continue for life, but scientists are now reevaluating that strategy and investigating whether hormone therapy can be taken intermittently, with so-called holidays from treatment. The thinking is that this may not only help restore quality of life as, for example, returning libido and sexual health but also delay the hormone resistance that eventually develops in men taking hormone therapy.
Clinical trials evaluating whether intermittent therapy is as effective or more effective than continuous therapy are now under way, so it is too early to say for sure.
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Orchiectomy Surgical Removal Of The Testicles
Once a common treatment, orchiectomy is rarely used now, thanks to the development of advanced ADT drugs. The procedure removes the testicles the source of most testosterone production. The scrotal sac is left intact, and patients can have testicular prostheses implanted for cosmetic purposes. Orchiectomy is effective in drastically reducing levels of testosterone, but it has several downsides. Removal of the testicles is permanent and irreversible. Loss of the testicles makes it challenging to have intermittent hormone therapy, an advantageous treatment. And there is a psychological effect: Many patients feel distress related to the idea of lost masculinity if they undergo this procedure.
Side Effects Of Hormonal Therapy
Side effects can happen with any type of treatment for cancer, but everyones experience is different. Some people have many side effects. Other people have few or none at all.
If you develop side effects, they can happen any time during, immediately after or a few days or weeks after hormonal therapy. Sometimes late side effects develop months or years after hormonal therapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.
Side effects of hormonal therapy will depend mainly on the type of hormonal therapy, the dose of a drug or combination of drugs and your overall health.
It is important to report side effects and your concerns about side effects to the healthcare team. Doctors may measure how severe certain side effects are. Sometimes hormonal drug therapy may need to be adjusted if side effects are severe.
The following are the most common side effects that people tend to experience with hormonal therapy.
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Neoadjuvant And Adjuvant Hormone Therapy For Early
Hormone therapy is sometimes given in conjunction with a definitive prostate cancer treatment, such as radiation therapy, in order to improve health outcomes. When hormone therapy is given in advance of a primary treatment, its known as neoadjuvant therapy when its given during or after a primary treatment, its known as adjuvant therapy.
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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Hormone Therapy: Immediate Versus Delayed
Medical Research Council Prostate Cancer Working Party Investigators Group. Immediate Versus Deferred Treatment for Advanced Prostatic Cancer. British Journal of Urology 1997 79:23546. PMID: 9052476.
Messing EM, Manola J, Sarosdy M, et al. Immediate Hormonal Therapy Compared with Observation after Radical Prostatectomy and Pelvic Lymphadenectomy in Men with Node-Positive Prostate Cancer. New England Journal of Medicine 1999 341:17818. PMID: 10588962.
Messing EM, Manola J, Yao J, et al. Immediate Versus Deferred Androgen Deprivation Treatment in Patients with Node-Positive Prostate Cancer after Radical Prostatectomy and Pelvic Lymphadenectomy. Lancet Oncology 2006 7:4729. PMID: 16750497.
Nair B, Wilt T, MacDonald R, Rutks I. Early Versus Deferred Androgen Suppression in the Treatment of Advanced Prostatic Cancer. Cochrane Database of Systematic Reviews 2002 CD003506. PMID: 11869665.
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.
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Prostate Cancer Hormone Therapy Tied To Higher Depression Risk
By Lisa Rapaport, Reuters Health
4 Min Read
Men who take hormone therapy for prostate cancer may have a higher risk of depression than patients who receive different treatment for these malignancies, a U.S. study suggests.
Prostate cancer cells need testosterone to grow and spread. Researchers focused on a common treatment known as androgen deprivation therapy , which works by depriving tumor cells of testosterone. Side effects can include sexual dysfunction, weight gain and fatigue.
Patients with prostate cancer who received hormone therapy were 23 percent more likely to develop depression and 29 percent more likely to have inpatient psychiatric treatment than men who received alternative treatments, the study found.
The take-home message is that the list of potential side effects of hormone therapy is continuing to grow, said senior study author Dr. Paul Nguyen of Brigham and Womens Hospital and Harvard Medical School in Boston.
Any man with prostate cancer considering hormone therapy should find out from their doctor exactly how big the benefit is expected to be in their specific situation so they can weigh it against the list of possible side effects, Nguyen added by email.
To explore the link between hormone therapy and depression, Nguyen and colleagues examined data on more than 78,000 men age 66 and older who were treated for prostate cancer from 1992 to 2006.
SOURCE: bit.ly/1WqaypW Journal of Clinical Oncology, online April 11, 2016.
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.
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When Is Hormone Therapy Used
Hormone therapy may be used:
- If the cancer has spread too far to be cured by surgery or radiation, or if you cant have these treatments for some other reason
- If the cancer remains or comes back after treatment with surgery or radiation therapy
- Along with radiation therapy as the initial treatment, if you are at higher risk of the cancer coming back after treatment
- Before radiation to try to shrink the cancer to make treatment more effective
Problems Getting An Erection
Hormone therapy lowers the amount of testosterone in the body and this affects your ability to have and maintain an erection. This may get better within 3 to 12 months after the treatment ends.
For some men, erection problems are permanent. It depends on the drug you are having and how long you have been taking it.
Your doctor or clinical nurse specialist will be able to offer you advice.
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Hot Flushes And Sweating
Hot flushes and sweating can be troublesome. They may last for 2 to 30 minutes and you may have a few a month or more often. They are the same as the hot flushes women have when going through menopause.
Lowered testosterone levels cause hot flushes. They are most likely to happen when taking LHRH agonists, also called LH blockers , because these drugs cut testosterone production off altogether.
Getting overheated, drinking tea or coffee, and smoking can all make flushes worse.
They may gradually get better as you get used to the treatment. But, in some men the flushes keep on happening as long as you take the drug.
Talk to your doctor or clinical nurse specialist if you have problems coping with hot flushes and sweating. There are treatments that may help.
Managing Hormone Therapy Side Effects
Hormone therapy side effects can last for a short period, or they can last until the end of your treatment and beyond.
Some ways to help manage your side effects and make hormone therapy easier on your body include:
- Eating a healthy, balanced diet.
- Getting enough rest.
- Quitting smoking.
- Getting enough exercise.
Having a strong social and emotional support system can also help you during hormone therapy for cancer.
Your UPMC Hillman Cancer Center care team will closely monitor your health and work with you to reduce any side effects that may occur.
They can also suggest other things you can do to ease symptoms and maintain your overall wellbeing.
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Hormonal Therapy With Radiotherapy
Hormonal therapy is often used to treat early and locally advanced prostate cancer. If you have low-risk early prostate cancer you do not usually need hormonal therapy.
Doctors often advise having hormonal therapy with radiotherapy , to make your treatment more effective. You may have hormonal therapy before, during and after radiotherapy. It can be given:
- a few months before radiotherapy, to shrink the cancer
- after radiotherapy, to reduce the chance of the cancer coming back .
Your doctor will talk to you about how long you take hormonal therapy for. They will also explain the possible side effects.
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:
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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