Hormonal therapy for prostate cancer – what you need to know
Prostate cancer is one of the most widespread forms of cancer in western countries. In Europe, it is third most common cancer among population and in the United States, it occupies the first place.
What is prostate cancer?
Short information about prostate cancer
It is a cancerous tumor that develops in the prostate gland. The peculiarity of the disease is that it can be present for many years without causing any discomfort and when the first symptoms occur, it is already a late stage that is much harder to treat. Thus, for men, especially those in the risk group that we will discuss later, to go for urological examination once a year once they reach the age of 45 years.
The disease almost always develops in men aged 55 or older. But it is important to yearly check the condition of the prostate at urologist every year once a man reaches 45 to catch the disease onset at an early stage.
Who is in the risk group?
In general, all men older than 45 are in risk group but in some men the risk is higher:
- Men with the history of prostate cancer in their family (especially in father, grandfather, brother).
- Men of African descent (they are three times more likely to develop the disease);
- Men with obesity;
- Men who live a sedentary live and do not exercise;
- Men who eat unhealthy.
How to prevent prostate cancer?
Some factors cannot be changed but others can be. To prevent the disease development, you need to follow these simple rules:
- If you sit all day at work, make sure to walk or do regular physical exercises;
- Go to a urologist once a year and do all appointed tests;
- Eat healthy, make sure your diet is based on vegetables, whole grains and lean protein rather than sweets and fast-food;
- Quit smoking and abusing alcohol if you do;
- Treat any diseases that you have timely;
- Make an unscheduled appointment at a urologist if you have any worrying symptoms.
Can prostate cancer be cured?
There are several ways to treat the disease and they are chosen by a doctor based on the patient’s age, progression of the disease, individual features of a patient, i.e. intolerance or contraindications for some drugs use, and so on. The major segments of prostate cancer therapy are:
- Hormone therapy;
- Observation of dynamics without any treatment.
In this post we are going to discuss hormone therapy in particular. To know about other types of prostate cancer therapies you can read this article.
What is hormone therapy and when is it appointed?
The goal of this type of therapy is to decrease the level of male hormones – androgens and testosterone. Androgens, which are mainly produced in the testicles, contribute to the increased growth of malignant cells in the prostate. By lowering androgen levels, prostate cancer decreases or slows down significantly. Such therapy helps control cancer, but cannot cure it.
Hormone therapy is chosen in the following cases:
- In men for whom surgery and radiation therapy are contraindicated;
- In men whose cancer cells have spread to other organs, or those who relapse after initial therapy (late stages of the disease);
- In the case of a high risk of possible cancer relapse after therapy, this method is used together with radiation therapy;
- Sometimes it is used before surgery or radiation therapy to diminish the size of the tumor.
Since almost all types of prostate tumors eventually become insensitive to hormonal therapy, this method is chosen when hormonal medicines are used only for some time followed by a break. Then after a while, hormone therapy is restarted (this is called intermittent treatment). This helps to avoid some adverse reactions (impotence, deprivation of interest in sexual activity, etc.).
Types of hormone therapy
There are different types of hormone therapy, including surgery or medication that reduce testosterone levels or block the body's response to androgens.
- Removal of testicles. Although it is a surgical procedure, hormonal changes occur as a result. During the operation, the surgeon removes the testicles, which produce 90% of androgens, including testosterone. Although this is a fairly simple and cheap operation, the consequences are irreversible, and most men cannot accept it. After this operation, men mostly lose interest in their sex life and they can no longer achieve an erection.
- Analogue of luteinizing-releasing hormone (analogue of LHRH). These medications lower testosterone levels as successfully as removing testicles. An LHRH analog (or agonist) is injected once a month or once every 4, 6, or 12 months. Although this type of therapy is more expensive, and requires more procedures than with a testicle removal, it is necessary to see a doctor, men still most often choose this method. After the first dose of an LHRH analogue, testosterone levels increase for a short time, but then decline. This is called the "flash" effect. If the cancer cells have spread to the bones, then during this "flash" the bones may ache. To reduce the "flash" effect, several weeks before therapy with an LHRH analogue, it is necessary to take medications – antiandrogens such as Eulexin (Flutamide).
- LGRG antagonists. These medications reduce testosterone levels much faster and do not cause a "flash" effect. However, in some men, this medication causes an allergic reaction. Therefore, it is prescribed only to those men who cannot use other types of hormone therapy. The medication is injected only in the doctor's office. In the first month, the medication is administered every two weeks, then every four weeks. You must stay in the doctor's office for about 30 minutes to ensure that you are not experiencing an allergic reaction.
- Antiandrogens. These medicines block the action of androgens. After testicular removal surgery, or during LHRH therapy, the adrenal gland produces lower volumes of androgens. Antiandrogens such as Eulexin (Flutamide) can be used in conjunction with LHRH analogs or after removal of the testicles, then it is called combined androgen blockade, to completely block androgen formation and action in the body. There is still no consensus among experts on whether combination therapy is superior to either monotherapy.
Adverse reactions of hormone cancer therapy
As the hormonal level of the body changes, all means and methods - removal of the testicles, analogues and antagonists of LHRH - cause similar side effects. This could be:
- Decreased sex drive;
- Impotence (erectile problems);
- Hot flashes (over time, this phenomenon decreases or disappears completely);
- Breast growth;
- A decrease in bone mass (osteoporosis), which can lead to bone fractures during;
- A decreased number of red blood cells;
- Memory impairment;
- Decrease in muscle mass;
- Weight gain;
- Severe weakness and fatigue;
- Increased blood cholesterol levels;
The risk of elevated arterial tension, diabetes, and heart attack is also increased.
Most adverse reactions can be avoided or managed. For example, with certain antidepressants, hot flashes will disappear. A short course of radiation therapy aimed at the breasts prevents breast growth. There are medications to prevent and treat osteoporosis. Depression is treated with antidepressants or psychotherapy. Adequate exercise helps prevent some adverse reactions (including rapid fatigue, weight gain) and reduces muscle and bone loss. If anemia occurs, it is usually mild and does not cause any problems.
Hormone therapy discussions
Many questions regarding hormone therapy are not yet fully resolved, such as when is the best time to start and end hormone therapy. Research is still ongoing in this area. Besides, it is proven that at an early stage of the disease the therapy doesn’t provide expected results but is highly effective in late (with metastases in other organs) stages. If you are offered to start hormone therapy, ask your doctor to familiarize you with the process of hormone therapy and possible side effects.
Which of treatment methods are the best for me?
If your oncologist proposes you different therapies, you must weigh many aspects, namely your age, general health, the purpose of the therapy, and your attitude to adverse reactions. For example, some men cannot even imagine that they will suffer from urinary incontinence or impotence. However, others do not care about it as much since they want to be completely free of cancer cells.
If you are 70 or older and already have health problems, you may perceive prostate cancer as another chronic disease. Perhaps it will not affect your life expectancy in any way. But cancer can cause trouble you wish to avoid. In this case, the goal of therapy is to reduce symptoms and avoid drug-induced side effects. Therefore, you can choose the tactics of observation or hormone therapy. But of course, when choosing a therapeutic strategy, age should not be a decisive factor. Many men over the age of 70 will have a fairly good physical and spiritual condition, but young men sometimes have serious health problems.
If you are relatively young, it is possible that you will be willing to endure the adverse reactions of therapy for a greater chance of complete healing. In the early stages of prostate cancer, by choosing external radiation, or radical prostatectomy or radioactive implants, the likelihood of cure is the same in all cases. But each situation is unique in its own way, and different factors can affect it.
Post by: Samuel Wrangler, M.D., Montgomery, Alabama
(Updated at Oct 3 / 2023)
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