Sunday, September 25, 2022

What Is Hormone Therapy For Prostate Cancer Side Effects

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Hormonal Therapy On Its Own For Early And Locally Advanced Prostate Cancer

Tips for Managing Hormone Therapy Side Effects | Ask a Prostate Cancer Expert, Mark Scholz, MD

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.

Hormone Replacement Therapy : : Any Feedback On Hrt

I was wondering if some of you can give me your feedback on HRT. My gynecologist would like to put me on Prometrium 100 mg and Estradiol 1 mg. I have not had a period for 10 months and had my hormones checked, I am perimenopausal. I sleep 3 hours a night, hot flashes and anxiety with ache muscles. I am thinking about going on HRT and trying this. Please let me know if anyone is taking what I have been prescribed and how it worked or suggestions on being on HRT and how it changed you from the symptoms I am having. My motivation for life has depleted and I want me back.

Evidence For Combining Hormone Therapy And Radiation Treatment

Bolla M, Collette L, Blank L, et al. Long-Term Results with Immediate Androgen Suppression and External Irradiation in Patients with Locally Advanced Prostate Cancer : A Phase III Randomised Trial. Lancet 2002 360:1036. PMID: 12126818.

Bolla M, Gonzalez D, Warde P, et al. Improved Survival in Patients with Locally Advanced Prostate Cancer Treated with Radiotherapy and Goserelin. New England Journal of Medicine 1997 337:295300. PMID: 9233866.

DAmico AV, Schultz D, Loffredo M, et al. Biochemical Outcome Following External Beam Radiation Therapy With or Without Androgen Suppression Therapy for Clinically Localized Prostate Cancer. Journal of the American Medical Association 2000 284:12803. PMID: 10979115.

DAmico AV, Manola J, Loffredo M, et al. Six-Month Androgen Suppression Plus Radiation Therapy Versus Radiation Therapy Alone for Patients with Clinically Localized Prostate Cancer: A Randomized Controlled Trial. Journal of the American Medical Association 2004 292:8217. PMID: 15315996.

Denham JW, Steigler A, Lamb DS, et al. Short-Term Androgen Deprivation and Radiotherapy for Locally Advanced Prostate Cancer: Results from the Trans-Tasman Radiation Oncology Group 96.01 Randomised Controlled Trial. Lancet Oncology 2005 6:84150. PMID: 16257791.

Nesslinger NJ, Sahota RA, Stone B, et al. Standard Treatments Induce Antigen-Specific Immune Responses in Prostate Cancer. Clinical Cancer Research 2007 13:1493502. PMID: 17332294.

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Confirming What Weve Practiced For Years

  • What was the grade of the cancer?
  • Was it at the edge of the removed prostate gland?
  • Was it in the attached seminal vesicles or extending beyond the capsule?
  • Was there cancer in any removed lymph nodes?
  • What is the trend of serum PSA since surgery?
  • How old is the patient, what are his other medical issues, and what are his goals?
  • We infrequently operate on men with a Gleason cancer aggressiveness score of 6 or lower given our robust surveillance program for such patients. Our focus has been on those with higher grade disease, where we have long added hormone therapy to radiation when disease recurs after surgery. The majority of patients on this study fit this profile, reassuring us we are concentrating on the right biology of patient.
  • When a mans PSA level is low, less than 0.5, we are more confident that radiation alone will prevent recurrence. Using early radiation and higher doses with modern techniques has improved outcomes, and thus the addition of hormones is more carefully measured in such patients. This study did not find survival benefit for patients with PSA levels of less than 0.7, supporting our emphasis on this strategy.
  • The study also confirms another of our standard practices: If a mans PSA is above 0.7, all patients do better with added hormone therapy.
  • What Have I Learned By Reading This

    Management Of Prostate Cancer

    You learned about:

    • Why you may need hormone therapy
    • How hormone therapy works
    • Ways to get hormone therapy
    • What to expect when you have hormone therapy
    • What side effects you may have from hormone therapy

    If you have any questions, please talk to your doctor or healthcare team. It is important that you understand what is going on with your treatment. This knowledge will help you take better care of yourself and feel more in control so that you can get the most from your treatment..

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    Prostate Cancer : : Erectile Dysfunction Reversible After Stopping Hormone Therapy

    My husband is 70 and had radiation therapy for eight weeks and has been on hormone therapy for going on 11 months what are the chances that the genital shrinkage and ED will reverse once the hormone therapy stopped. I am much younger than he is. The thought of never having sex again is depressing but I want to be supportive.

    What Are The Side Effects Of Hormone Therapy For Prostate Cancer

    Because androgens affect many other organs besides the prostate, ADT can have a wide range of side effects , including:

    • loss of interest in sex
  • Studer UE, Whelan P, Albrecht W, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer Trial 30891. Journal of Clinical Oncology 2006 24:18681876.

  • Zelefsky MJ, Eastham JA, Sartor AO. Castration-Resistant Prostate Cancer. In: Vincent T. DeVita J, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology, 9e. Philadelphia, PA: Lippincott Williams & Wilkins 2011.

  • Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. European Urology 2021 79:150158.

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    What Should I Tell My Doctor During My Checkups

    During each visit, you should tell your doctor about any:

    • Symptoms that you have
    • Pain that bothers you
    • Problems that keep you from doing your daily activities, such as fatigue , hot flashes, pain, problems with your bladder, bowel, or ability to have sex, trouble sleeping, and weight gain or loss
    • Medicines, vitamins, or herbs or over-the-counter products you are taking and any other treatments you may use
    • Emotional worries you may have, such as anxiety or depression

    It is important for you to look out for changes in your health and to tell your doctor or health care team so that they can help you.

    Planning Before You Start Hormone Therapy

    • What type of hormone therapy will you use?
    • If you are taking medicine for your hormone therapy, what kind of medicine are you taking and how often do you need to take it? Write down the medicine, the dose, and when you need to take it.
    • If you are having an orchiectomy where do you need to go, when will you have your surgery? Write down the place and your appointment time.

    Early Versus Delayed Treatment

    What is hormone therapy? | Ask a Nurse

    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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    Menopause : : Estrogen Hormone Replacement Therapy

    Estrogen hormone replacement therapy is now less scary than it was in 2002, and more women like myself are willing to take a second look at it. As I’ve said, I honestly think it is beneficial for a lot of reasons. I personally use estrogen to help with vaginal dryness, brain fog, short-term memory issues, and to help with insomnia.I honestly did not realize for many years how helpful it was with these symptoms. Of course, for me, these symptoms didnât really manifest themselves to any significant degree until I reached actual menopause. Once we reach menopause , our estrogen production in our body has decreased significantly. Hence, vaginal dryness, brain fog, short-term memory issues, and oh, the insomnia!

    What Are Male Sex Hormones

    Hormones are substances that are made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs.

    Androgens are a class of hormones that control the development and maintenance of male characteristics. The most abundant androgens in men are testosterone and dihydrotestosterone .

    Androgens are required for normal growth and function of the prostate, a gland in the male reproductive system that helps make semen. Androgens are also necessary for prostate cancers to grow. Androgens promote the growth of both normal and cancerous prostate cells by binding to and activating the androgen receptor, a protein that is expressed in prostate cells . Once activated, the androgen receptor stimulates the expression of specific genes that cause prostate cells to grow .

    Almost all testosterone is produced in the testicles a small amount is produced by the adrenal glands. Although prostate cells do not normally make testosterone, some prostate cancer cells acquire the ability to do so .

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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.

    Heres What The Results Showed

    Conditions In Depth: Prostate Cancer

    After a median follow-up of just over 10 years, 9.7% of men who were treated with radiation and leuporelin for 18 months had died from prostate cancer, compared to 13.3% of the men treated with radiation and leuporelin for six months. Adding zoledronic acid made no difference in either case.

    The authors concluded that hormonal therapy is more effective at preventing prostate cancer death when its given for 18 months rather than six. And similar benefits were noted for other endpoints as well. For instance, prostate tumors were less likely to metastasize, or spread, among men in the longer duration treatment group, and it took longer for their cancers to become resistant to hormone therapy if it was reinitiated later.

    In earlier clinical research, scientists discovered that hormonal therapy given for three years protects against prostate cancer death more effectively than a six-month treatment regimen. But three years of hormone therapy isnt easily tolerated, and evidence so far shows that 10-year survival rates after either 18 months or three years of hormonal therapy are similar, the authors of the new study claim.

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    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.

    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.

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    The Side Effects Of Anti

    Most men tolerate anti-androgen therapy well.

    • Hot flashes
    • Weight gain
    • Bone density loss
    • Irritability or mood swings
    • Enlargement of breasts
    • Starting patients on Vitamin D and calcium, providing consultation with our endocrinology team about preserving bone health, and getting baseline bone density scans when indicated
    • Encouraging men to commit to active physical therapy and aerobic exercise to limit weight gain, preserve muscle composition, and even retain urinary function and control it better
    • Recommending medications to help with hot flashes and mood changes that can arise during hormone therapy

    Hormone Replacement Therapy : : Bioidentical Better Than Standard Hrt

    Reducing Side Effects of Hormone Therapy for Prostate Cancer | Prostate Cancer Staging Guide

    I have read that bio-identical hormone replacement therapy is safer than the standard DRT which is derived from the urine of pregnant horses.However people interested in this therapy need to be aware that they must still take a version manufactured by a trusted pharmaceutical firm. Apparently there is something going the rounds now where the so-called bio-identical hormones are compounded in a pharmacy. This could be extremely risky, worse than standard HRT. I don’t know what countries might be affected, the warning I read was in newsletter originating in the US, so hopefully it isn’t even something most of us need to worry about, but thought I should bring up the topic as it has been mentioned a few times lately by those of us interested in finding safe ways to improve our bone density.

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    How Can I Lower My Testosterone With Surgery

    The majority of the testosterone in your body is made by your testicles. You can lower your testosterone with an operation called an orchiectomy. An orchiectomy is a simple and effective way to lower the amount of testosterone in your body. However, it is a permanent form of hormone therapy.

    Your surgery

    Before your orchiectomy, you will be given anesthesia. Anesthesia is a medicine given to you by an anesthesiologist so that you do not feel pain during your operation. An anesthesiologist is the doctor who gives you medicine to make you sleep during the surgery and who carefully watches you during the operation. Your doctor will make a small cut in your scrotum and remove your testicles. Most men who have an orchiectomy go home the same day of their surgery. Your penis and scrotum, the pouch of skin that holds your testicles, will not be damaged during this operation. It will take you about two weeks to heal from the surgery.

    Some men are concerned about how their body will look after their testicles are removed. There are testicular prostheses , or artificial testicles, that can be placed in your scrotum to replace the testicles removed during your surgery. The prostheses make your scrotum look like it did before surgery. If youare concerned about how your body will look, speak with your doctor or health care team about artificial testicles.

    After surgery

    Follow-up tests

    Possible side effects

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