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.
Gnrh Antagonists For Advanced Prostate Cancer
These drugs block messages from the brain to the testicles telling them to make testosterone. They work more quickly than LHRH agonists and do not cause tumour flare.
At the moment degarelix is the only GnRH antagonist available. You have it as an injection under the skin of your tummy once a month. It may be used for advanced prostate cancer that has spread to the spine . As well as hormonal side effects, it commonly causes skin reactions.
How Effective Is Hormone Therapy At Treating Prostate Cancer
While hormone therapy cant cure your prostate cancer, it can stop or slow the growth of the prostate cancer cells in your body. Hormone therapy is remarkably effective, says Dr. Ornstein. Probably over 90 percent of patients will have a nice drop in their PSA while they are on androgen deprivation therapy. The cancer should not grow or spread, because there is no more fuel, he explains.
In many men, however, some cells gain the ability to grow even in the low-testosterone environment created by hormone therapy. As these hormone therapy-resistant prostate cancer cells continue to multiply, the hormone therapy, not surprisingly, has less and less effect on the growth of the tumor.
Prostate cancer that is no longer responding to hormone therapy is referred to as castration-resistant prostate cancer.
Fortunately, men with castration-resistant prostate cancer have more options for treatment than ever before. At that point, we can add something new, such as a newer hormonal agent, chemotherapy, or a different chemotherapy, if you had one up front, or an immunotherapy, explains Ornstein.
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Hormonal Therapy On Its Own For Early And Locally Advanced Prostate Cancer
If your doctors are using the watchful waiting approach and the cancer starts to grow, you may have hormonal therapy on its own.
Some people with early prostate cancer decide to have hormonal therapy on its own instead of with surgery or radiotherapy. Some people with locally advanced cancer decide to have hormonal therapy on its own instead of radiotherapy. Unlike these treatments, hormonal therapy on its own will not get rid of all the cancer cells. Doctors do not usually advise this. But it may be suitable if you:
- are not well enough to have surgery or radiotherapy
- do not want these treatments.
Hormonal therapy can slow down or stop the cancer cells growing for many years. Not having surgery or radiotherapy means you avoid the side effects of these treatments. Hormonal therapy can also cause side effects . It is important to talk to your doctor or nurse about it before you decide.
What Is The Screening Test For Prostate Cancer
The screening test for prostate cancer is known as a PSA test. Its a simple blood test that you can get during any doctor visit.
The PSA test measures prostate-specific antigen , which is made only by certain cells within the male prostate gland. A high PSA level could indicate prostate cancer or something else, such as an enlarged or inflamed prostate.
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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.
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.
A recent trial showed possible long-term side effects of radical prostatectomy may include an inability to get an erection and urinary incontinence.
Before having any treatment, 67% of men said they could get erections firm enough for intercourse.
When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.
For urinary incontinence, 1% of men said they used absorbent pads before having any treatment.
When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.
Out of the men who were actively monitored instead, 4% were using absorbent pads at 6 months and 8% after 6 years.
In extremely rare cases, problems arising after surgery can be fatal.
Its 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.
After a radical prostatectomy, youll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.
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Survival For All Stages Of Prostate Cancer
Generally for men with prostate cancer in England:
- more than 95 out of 100 will survive their cancer for 1 year or more
- more than 85 out of 100 will survive their cancer for 5 years or more
- almost 80 out of 100 will survive their cancer for 10 years or more
Survival for prostate cancer is also reported in Scotland and Northern Ireland. But it is difficult to compare survival between these countries because of differences in the way the information is collected.
Cancer survival by stage at diagnosis for England, 2019Office for National Statistics
These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account the background mortality that they would have experienced if they had not had cancer.
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.
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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
There are several ways you can help to lower your osteoporosis risk
Cardiovascular problems
Medicare Supplement Plans For Cancer Treatment
Original Medicare coverage for cancer treatment does come with costs you need to pay, such as the coinsurance and deductibles mentioned above. If youre enrolled in Medicare Part A and Part B, you may be able to sign up for a Medicare Supplement plan to help pay for Original Medicares out-of-pocket costs associated with your cancer treatment. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.
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Can Hormone Therapy Cure My Prostate Cancer
No, hormone therapy cannot cure your prostate cancer. The goal of hormone therapy is to stop or slow the growth of the prostate cancer cells in your body. Hormone therapy can shrink prostate cancer tumors and may stop or limit the spread of your prostate cancer. Hormone therapy is used to control your prostate cancer.
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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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
What Causes Size Changes In The Penis During Prostate Cancer Therapy
According to another study reported in the Journal of Endourology, the penis length can undergo a significant reduction after undergoing the treatment for prostate cancer. The exact reason for this bothersome side effect is not completely clear, but the most possible and logical answer for this phenomena was presented in the journal Urology. According to authors of this paper, resection of prostate and then reassembly can lead to the shrinkage of penis. Moreover, treatment via hormonal therapy can also cause the shrinkage of penile tissues or may even lead to formation of fibrosis that may reduce the size of penis.
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Secondary Treatment Following Relapse
Hormone therapy may also be used as a secondary or salvage treatment when PSA levels rise following initial prostate cancer treatment, indicating the cancer has returned. This situation is known as biochemical recurrence. The salient points to keep in mind are that hormone therapy is most often used as a salvage treatment when PSA doubling time is less than six months, indicating that the cancer is aggressive or may have already metastasized.
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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Mental And Emotional Health
A cancer diagnosis and cancer treatment may affect how you feel mentally and emotionally. Hormone therapy can cause:
- Mood swings
MedlinePlus: âSildenafil.â
National Cancer Institute: âSexual Health Issues in Men with Cancer,â âHormone Therapy for Prostate Cancer.â
American Cancer Society: âAnxiety, Fear, and Emotional Distress,â âHormone Therapy for Prostate Cancer,â âDepression.â
Mayo Clinic: âHormone therapy for prostate cancer,â âBone density test,â âProstate cancer.â
ZERO: âPSA Screening.â
National Kidney Foundation: âWhat You Should Know About Blood Lipids.â
Urology: âCognitive Effects of Androgen Deprivation Therapy in Men with Advanced Prostate Cancer.â
Prostate Cancer UK: âLiving with hormone therapy: A guide for men with prostate cancer.â
American Cancer Society.
Hormonal Therapy For Endometrial Cancer
Cancer of the uterus or its lining, the endometrium, may respond to hormone therapy with progestins. Other types of hormone therapy for endometrial cancer include:
- Tamoxifen
- LHRH agonists
- Aromatase inhibitors
When and why theyre used: Hormone therapy is typically reserved for advanced uterine or endometrial cancer, or for cancer that has returned after treatment. Its often combined with chemotherapy.
Risks: Side effects are similar to those seen with hormone treatment for other types of cancer.
Expert
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What Is Hormone Herapy
To help you understand what hormone therapy is and how it may affect your prostate cancer, it is good for you to understand what hormones are and how they work in your body. Hormones control or manage your bodys activities. Hormones are made by glands in your body and are carried by your blood to all areas in your body. Glands are groups of cells in your body that make and release materials needed by your body.
Testosterone is the main male hormone in your body. It makes you grow hair on your face and body and have a mans body shape and controls your desire for sex. Testosterone also controls your prostate gland. Your testicles make most of the testosterone in your body. A small amount of testosterone is also made by your adrenal glands. Your adrenal glands are located on top of each kidney. Your adrenal glands also make other hormones.
Prostate cancer is hormone sensitive or hormone dependent. This means that the testosterone in your body helps your prostate cancer to grow. The goal of hormone therapy is to lower the amount of testosterone in your body to stop or slow the growth of your prostate cancer. You can lower the amount of testosterone in your body by taking medicines or having surgery.
When To Consider Hormone Therapy
Hormone therapy is a treatment option for men with prostate cancer in any of the following situations:
- when cancer has metastasized beyond the prostate
- when cancer is confined to the prostate, but hormone therapy is used to boost the effectiveness of radiation therapy or to shrink the size of a tumor before brachytherapy
- when PSA begins to rise sometime after initial treatment with surgery or radiation therapy, indicating the cancer may have recurred.
Not all doctors agree on when to use hormone therapy, or how to administer it. Indeed, this is an area that requires a physician to exercise as much art as science in clinical practice. You should also be aware that side effects can be daunting, although most men tolerate treatment reasonably well .
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