Heres What The Results Showed
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.
About the Author
Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases
When Hormone Therapy Is Recommended
Hormone therapy is typically given to patients with intermediate- or high-risk prostate cancer. It may be used in the following ways:
- In combination with radiation, mostly for patients with high Gleason scores or other high-risk factors.
- After radiation or surgery when PSA rises, indicating a recurrence.
- As therapy for patients unsuitable for radiation or surgery.
- As therapy for metastatic prostate cancer . It may be given instead of or in combination with chemotherapy.
HT is usually not prescribed for:
- Patients choosing a localized treatment for low-risk prostate cancer
- Low-risk patients preferring to monitor their cancer on an active surveillance program
HT may be an option for patients who are not candidates for surgery, radiation or other localized treatment because of age, pre-existing health conditions or concerns about potential side effects of localized treatments.
Surgery To Remove The Testicles
Surgery to remove your testicles isnt a common way of lowering the amount of testosterone you make.
You usually only have surgery to remove your testicles if you need your testosterone reduced urgently. For example, if your cancer has spread to your bones and is pressing on your spinal cord, your doctors might want to reduce the amount of testosterone quickly.
Your doctors might also suggest surgery as an option if you don’t want to have injections or tablets.
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The Future Of Hormone Therapy For Prostate Cancer
Some experts arent sure how much further we can improve hormone therapy for prostate cancer.
Im not saying that weve 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.
Its 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.
Diminution Of Muscular Strength
A mans muscular strength is reduced by 12% to 66% as the result of androgen deprivation. Moreover, muscle mass declines by 20% to 30% by age 70 . Because androgen deprivation reduces the amount of protein synthesis and the non-lipid body mass, obesity results. Thus, elderly patients should actively work against the loss of muscle by directed strength-training exercises .
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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 don’t get too tired.
What Type Of Hormone Therapy Works Best
Unfortunately, understanding the details of hormone therapy for prostate cancer can be difficult. Which drug or combination of drugs works best? In what order should they be tried? Research hasnt answered these questions yet.
Right now, theres a level of art to figuring out which agents to use, says Durado Brooks, MD, MPH, director of prostate cancer programs at the American Cancer Society. We dont have clear evidence yet.
LHRH agonists remain the usual first treatment. But in some cases, doctors are trying anti-androgens first. Anti-androgens may be especially appealing to younger men who are still sexually active, since these drugs dont completely shut down sex drive. When anti-androgens stop working based on PSA tests a person then might shift onto an LHRH agonist.
Other doctors prefer to begin therapy with a combination of two or even three drugs, especially for patients with symptoms or advanced disease, says Holden.
Researchers originally hoped that combined androgen blockade would significantly add to the benefits of LHRH agonists. However, the results, to date, have been mixed. Some studies have shown slightly longer survival with combined androgen blockade, but the results havent been as dramatic as many experts had hoped. Other studies have shown no benefit. A possible explanation may be the type of anti-androgen used, but further studies are needed to answer this question.
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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.
Medical Research Council Study
Two recent studies provide convincing clinical evidence supporting the early treatment of advanced prostate cancer: the randomized trial reported by the Medical Research Council 29 and the Eastern Cooperative Oncology Group /SWOG Stage D1 study.30 The MRC study randomized 934 patients with locally advanced prostate cancer or asymptomatic metastasis to either immediate treatment or to the same treatment deferred until an indication occurred. This study showed that there was a more rapid local and distant disease progression in the deferred treatment group, as evidenced by an earlier onset of pain and an increased need for transurethral resection of the prostate. There was also a 2-fold increase in serious complications, such as pathologic fractures, spinal cord compression, and extraskeletal metastasis, in the deferred treatment group compared with those who received immediate treatment .29
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How To Reduce The Side Effects Of Hormone Therapy For Prostate Cancer
Following hormone therapy, you may become anxious about your sexual functions. Discuss your feelings with your partner and healthcare team.
Lower levels of testosterone will have a negative on your bone density and muscle mass.
Lifestyle changes such as supplementation, exercise, and diet can help you manage this side effect.
You may consider taking calcium and vitamin D supplements. There is a negative relationship between smoking and bone density. Thus, stop smoking after hormone therapy.
Natural ways to help you manage the symptoms of hormone therapy include:
- A healthy diet and appropriate fluid intake to help you maintain a healthy body and mental state.
- Regular exercise help build muscle and bone strength as well as reduce obesity.
- Regular sleeping to help deal with potential fatigue and mental health problems.
How Often You Have Hormone Therapy
You usually have hormone therapy all the time . Or you may have a few months of treatment and then a break .
You might have:
- one hormone therapy drug on its own
- two hormone therapies together
- hormone therapy with chemotherapy, such as docetaxel
Your doctor will talk to you about which hormone therapy they recommend and for how long you take it.
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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?
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Figure : How Hormone Therapy Affects The Androgen Cascade
The male sex hormones are known as androgens. Probably the best known hormone in this family is testosterone. Most androgens are produced in the testicles.
Androgens fuel the growth of prostate cells, including prostate cancer cells. Hormone therapy also known as androgen-deprivation therapy seeks to cut off the fuel supply. But different therapies work in different ways.
A. The hypothalamus releases pulses of LHRH, which signals the pituitary gland to release the hormones FSH and LH.
B. LH travels through the bloodstream. When it reaches the testicles, it binds to specialized cells that secrete testosterone into the bloodstream.
C. In the prostate, the enzyme 5-alpha-reductase converts testosterone and other types of androgens into dihydrotestosterone , which stimulates the growth of prostate cells and fuels the growth of cancer, if it is present.
Centrally acting agents
LHRH agonists flood the pituitary gland with messages to crank out LH. This causes a temporary surge of testosterone until receptors in the pituitary are overloaded. Then testosterone levels drop sharply.
The GnRH antagonist jams receptors in the pituitary gland so that it cannot respond to the pulses of LHRH sent by the hypothalamus. This prevents the LH signal from being sent and no testosterone is made in the testicles.
DES inhibits secretion of LHRH from the hypothalamus.
Peripherally acting therapies
Orchiectomy removes the testicles, preventing testosterone production.
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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. This can allow for 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.
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.
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Will I Have Other Treatments In Addition To Hormone Therapy
Your RMCC oncologist may recommend using hormone therapy in combination with other cancer treatments, such as chemotherapy and radiation therapy. When used with other treatments, hormone therapy can:
- Make a tumor smaller before surgery or radiation therapy. This is called neoadjuvant therapy.
- Lower the risk that cancer will come back after the primary treatment. This is called adjuvant therapy.
- Destroy cancer cells that have returned or spread to other parts of your body.
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
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
Your scrotum may feel a little bit sore and may be swollen. You will be given medicines to relieve the soreness. You may use ice packs for the first day or two after your orchiectomy to help with the swelling. Remember, do not put the ice pack directly on your scrotum. Put a towel or piece of clothing over your scrotum, then place the ice pack on top of it. You will need to keep your incision clean and dry. Your doctor and health care team will tell you how to clean your incision. You will need to avoid heavy lifting or hard activity for one to two weeks following your surgery.
Follow-up tests
Possible side effects
More hormone treatment
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Lhrh Agonists And Antagonists
LHRH agonist and antagonist medications stop your body from producing testosterone.
These medications are injected under your skin or into a muscle monthly, every three months or every six months. Or they can be placed as an implant under your skin that slowly releases medication over a longer period of time.
These medications include:
Testosterone levels may increase briefly for a few weeks after you receive an LHRH agonist. Degarelix is an exception that doesn’t cause a testosterone flare.