Friday, June 7, 2024

What Happens When Hormone Treatment For Prostate Cancer Stops Working

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How Long Will I Need To Have Hormone Therapy

Hormone Therapy for Prostate Cancer

Typically, you will need to visit your doctor every 3 months after starting hormone therapy to see how the treatment is working.

Some men need continuous hormone therapy others take the treatment for a while and then stop and take a break, called intermittent therapy. Your doctor will discuss with you whether you need hormone therapy for life or intermittently. This largely depends on how well your cancer is controlled and how your PSA level behaves over time.

Intermittent hormone therapy can potentially limit the side effects of treatment while still maintaining good overall cancer control. However, intermittent hormone treatment requires regular monitoring of your PSA levels. Your doctor will agree a PSA level with you that, once reached, means you will need to start hormone therapy again. The periods off treatment may also get briefer as the years go by.

Systemic Therapy For Metastatic Disease

The most common use of hormone therapy today is to treat men whose prostate cancer has metastasized to other parts of the body. If prostate cancer cells escape the prostate, they migrate first to surrounding structures, such as the seminal vesicles and lymph nodes, and later to the bones or, rarely, to other soft tissues.

Hormone therapy is recommended as a palliative treatment, to relieve symptoms such as bone pain. And while hormone therapy is not a cure, in that it cant eliminate prostate cancer completely, it often extends life for many years. By reducing testosterone levels, hormone therapy can shrink a prostate tumor and its metastases and slow further progression of the cancer for so long that sometimes a man with this disease dies of something other than prostate cancer.

Are There Side Effects With Hormone Therapy

Yes, there are side effects or unwanted changes in your body caused by hormone therapy. Side effects are different from person to person, and may be different from one treatment to the next. Some people have no or very mild side effects. The good news is that there are ways to deal with most of the side effects. The side effects that you have depend on:

  • The type of hormone therapy you are taking, and
  • Your general health

The side effects you have from hormone therapy may be acute or chronic. Acute side effects are sometimes called “early side effects.” These types of side effects happen soon after the treatment begins and usually go away after you finish your hormone therapy. Other side effects are called chronic side effects or “late side effects.” These side effects may happen several months after you start hormone therapy.

In order to reduce your chance of having side effects, your doctor may give you intermittent hormone therapy. If you are on intermittent hormone therapy, your doctor and health care team will carefully watch your PSA level. As it begins to go up, you are given hormone therapy medicine to lower your PSA. Another way for you to get intermittent hormone therapy is to take a medicine for a set period of time and then stop for a set period of time. For example, you may take a medicine for six months, stop for six months, and then start again for six months.

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How Will I Know How Well My Treatment Is Working

During and after your treatment your doctor or nurse will check how well your treatment is working.

You may have regular PSA tests, and other tests such as MRI scans or CT scans. Your PSA levels alone aren’t always enough to know if your treatment is working. So your doctor will use your PSA level and any other test results, along with information about how you’re feeling, to check how well the treatment is working.

If you are feeling better this could be a sign that the treatment is working. If the treatment isn’t controlling the cancer, then you and your doctor can discuss which treatment to try next.

One aim of your treatment will be to help manage any symptoms from your cancer, so that your daily life is as good as possible. But treatments can cause side effects. Let your doctor or nurse know how you are feeling and about any symptoms or side effects. If you have symptoms in between check-ups, tell your doctor or nurse as soon as possible.

Who Is A Candidate

Why does hormone therapy worsen some prostate cancers?

Most men with advanced prostate cancer are candidates for hormone therapy. Its usually considered when prostate cancer has spread beyond the prostate, and surgery to remove the tumor is no longer possible.

Prior to starting treatment, youll need to have a liver function test along with a blood test to make sure your liver can break down the medications properly.

Currently, enzalutamide is only approved for use in men with prostate cancer that has already spread to other parts of the body, and who no longer respond to medical or surgical treatments to lower testosterone levels.

In some cases, prostate cancer cells can resist hormone treatments and multiply even in the absence of male hormones. This is called hormone-resistant prostate cancer. Men with hormone-resistant prostate cancer arent candidates for further hormone therapy.

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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.

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 PSA level
  • Your age
  • 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

Adjuvant hormone therapy

Salvage hormone therapy

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When Hormone Therapy Stops Working

After some months or years the hormone treatment usually stops working and the cancer starts to grow again. Your doctor might recommend stopping or changing hormone treatment at this stage.

If you’re having anti androgens and your PSA level has started to rise again your doctor might get you to stop taking them. In some cases this can cause the cancer to shrink and stop growing for some time. This is called anti androgen withdrawal response .

There are different treatment options for when hormone therapy stops working, such as chemotherapy or steroids.

Gnrh Antagonists For Advanced Prostate Cancer

Hormone Therapy Basics | Ask a Prostate Cancer Expert, Mark Scholz, MD

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.

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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 Treatment Stops Working: Blame Resistance

In the upside down world of prostate cancer, the good guys want to win the war and the bad guys are leading the resistance.

Imagine Ricks Café in Casablanca, except its the bad guys, with a nod from Humphrey Bogart, who are the ones singing La Marseillaise drowning out the song of the good guys with the German accents. Upside down, indeed.

In prostate cancer, resistance is bad. Resistance can be lethal.

Our goal is to figure out how to shut down prostate cancers resistance once and for all.

Its a matter of evolution. In the beginning, when they are very young, cancer cells arent that different from normal cells. They have fairly well-defined borders, they gather in orderly groups, their growth is fairly restrained, and as cancer cells go, theyre tame. If a normal cell looks like a clean-cut soldier, then early cancer cells look pretty much the same. Maybe the soldier has five oclock shadow maybe his uniform is missing a button, maybe his boots are a little scuffed, but hes still basically presentable. Some cancer cells dont ever go beyond this point. Those are the Gleason 3 + 3 or 3 + 4 cells, the ones that tend to stay in the prostate.

Advanced cancer cells are like the velociraptors in Jurassic Park, constantly testing the electric fences, looking for points of weakness. They keep getting more resistant, and more dangerous.

How do we treat metastasis?

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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.

Combined Hormonal Therapy For Advanced Prostate Cancer

Hormone Therapy for Prostate Cancer Treatment

If the cancer starts growing during treatment with an injection or implant, your doctor may advise taking an anti-androgen tablet as well.

Having the two drugs together can help to slow the cancer from growing or spreading. You will not usually have combined hormonal therapy as your first treatment. This is because you may have more side effects if you are taking two drugs. Your doctor or specialist nurse can explain more about this.

There are different types of hormonal therapy that may be used. Your doctor or nurse will explain the drug that is most suitable for your situation.

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Controversies In Hormone Therapy

The use of hormone therapy requires as much art as science. Physicians do not always agree about when it is best to start treatment, whether it needs to be continuous or can be stopped and started up again periodically, and whether monotherapy or combination therapy is best. Here are the salient issues, what the studies say and what I believe and follow in my own practice.

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

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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.


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

There are several ways you can help to lower your osteoporosis risk

Cardiovascular problems

Sequencing Treatments After Zytiga Or Xtandi

Intermittent Hormone Therapy: PSA and Hormone Replacement | Ask a Prostate Expert, Mark Scholz, MD

Restoring Sexual Function after Lupron/Cancer Treatment. Facts about Prostate Cancer: Prostate cancer is a highly prevalent disease afflicting one in five American men. It is the most commonly diagnosed cancer in men and the second leading cause of cancer death after lung cancer Even though treatment for low-risk prostate cancer is generally not recommended, in the recent study, more than 85% of the men with low-risk prostate cancer chose to have some sort of treatment. The most common treatment was radiation therapy , and the second most common was surgery Radiation therapy for prostate cancer can be divided into two main categories. External beam radiation : Using a machine outside the body, beams of radiation are focused on the prostate gland. This can help relieve symptoms such as pain while limiting the damage to the tissues surrounding the prostate Life after radiation therapy. For most people, the cancer experience doesn’t end on the last day of radiation therapy. Radiation therapy usually does not have an immediate effect, and it could take days, weeks or months to see any change in the cancer. The cancer cells may then keep dying for weeks or months after the end of treatment

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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.

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.

After a radical prostatectomy, you’ll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.

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