Cancers Treated With Hormone Therapy
Hormone therapy is used to treat prostate and breast cancers that use hormones to grow. Hormone therapy is most often used along with other cancer treatments. The types of treatment that you need depend on the type of cancer, if it has spread and how far, if it uses hormones to grow, and if you have other health problems.
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.
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How Hormone Therapy Is Used Against Cancer
Hormone therapy is used for two main reasons.
- Treat cancer. Hormone therapy can stop or slow cancer’s growth and reduce the chance it will return.
- Ease cancer symptoms. Hormone therapy may be used to reduce or prevent symptoms in men with prostate cancer who are not able to have surgery or radiation therapy.
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Will I Need To See My Doctor During And After Hormone Therapy
Yes, you will need regular medical checkups while getting hormone therapy. During these checkups your doctor will look at your medical history and give you a physical exam. Your checkup may include blood tests and imaging tests. For example:
Imaging studies are ways used by doctors to take pictures of the inside of your body, such as x-rays or a CT Scan . These check-ups are important because:
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. Its 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 dont understand prostate cancer or its treatment. They may stay away from you because theyre 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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Biochemical Recurrence And Hormone Therapy
Hormone therapy is the standard of care for patients with metastatic prostate cancer, but for patients whose only sign of cancer recurrence is a rising PSA level , the benefits are less clear.
Some doctors think that hormone therapy works better if its started as soon as possible, even if a man is not having any symptoms. Other doctors feel that, because of the side effects of hormone therapy and the chance that the cancer could become resistant to the therapy, treatment shouldnt be started until symptoms develop. This issue is being actively studied.
Drugs That Stop The Body From Making Androgens
Androgens can be produced in other areas of the body, such as the adrenal glands. Some prostate cancer cells can also make androgens. Three drugs help to stop the body from making androgens from tissue other than the testicles.
Two medicines, ketoconazole and aminoglutethimide , treat other diseases but are sometimes used to treat prostate cancer. The third, abiraterone treats advanced prostate cancer that has spread to other places in the body.
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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:
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:
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
If you have early stage prostate cancer, you and your doctor may decide on a course of hormone therapy prior to the start of your main prostate cancer treatment. This is called neoadjuvant or pre-therapy. This type of hormone therapy is used to help shrink your prostate cancer tumor. This helps make your main treatment more effective. This is very common with men who get radiation therapy.
Adjuvant hormone therapy
Adjuvant therapy is given to you at the same time you have your main prostate cancer treatment.
Salvage hormone therapy
Hormonal Therapy And Radiation
A retrospective review by DAmico and colleagues demonstrated the benefit of neoadjuvant hormone therapy for locally advanced CaP. Estimates of 5-year PSA outcome after radiation therapy with or without NHT were not statistically different among low-risk patients , whereas intermediate- and high-risk patients treated with radiation therapy plus ADT had significantly better outcomes than those treated with radiation therapy alone . Subsequently, several prospective randomized trials were published confirming the benefit of NHT to radiation.
Two additional RTOG trials also investigated the use of long-term ADT in patients with locally advanced CaP. RTOG 85-31 was designed to evaluate lifelong adjuvant androgen ablation combined with radiation therapy for clinical T3 or N positive disease versus radiation therapy and delayed androgen ablation . Hormonal therapy was begun in the last week of radiotherapy and continued indefinitely. Adjuvant therapy improved all clinical endpoints, including improving 10-year overall survival from 39% to 49%. While there was no survival advantage seen in patients with lower-grade tumors, a significant advantage was seen for patients with higher-grade cancers .
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Evidence About Hormone Therapy And Prostatectomy
Gleave ME, La Bianca S, Goldenberg SL. Neoadjuvant Hormonal Therapy Prior to Radical Prostatectomy: Promises and Pitfalls. Prostate Cancer and Prostatic Diseases 2000 3:13644. PMID: 12497089.
Hurtado-Coll A, Goldenberg SL, Klotz L, Gleave ME. Preoperative Neoadjuvant Androgen Withdrawal Therapy in Prostate Cancer: The Canadian Experience. Urology 2002 60:4551. PMID: 12231047.
Kumar S, Shelley M, Harrison C, et al. Neo-adjuvant and Adjuvant Hormone Therapy for Localized and Locally Advanced Prostate Cancer. Cochrane Database of Systematic Reviews 2006 CD006019. PMID: 17054269.
Soloway MS, Sharifi R, Wajsman Z, et al. Randomized Prospective Study Comparing Radical Prostatectomy Alone Versus Radical Prostatectomy Preceded by Androgen Blockade in Clinical Stage B2 Prostate Cancer. The Lupron Depot Neoadjuvant Prostate Cancer Study. Journal of Urology 1995 154:4248. PMID: 7541859.
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How Much Hormone Therapy Costs
The cost of hormone therapy depends on
- the types of hormone therapy you receive
- how long and how often you receive hormone therapy
- the part of the country where you live
Talk with your health insurance company about what services it will pay for. Most insurance plans pay for hormone therapy for their members. To learn more, talk with the business office where you go for treatment. You can also go to the National Cancer Institute database, Organizations that Offer Support Services and search “financial assistance.” Or call toll-free 1-800-4-CANCER to ask for help.
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Advising The Patient About Hormonal Therapy
Finally, Mark Moyad, MD, Director of Complementary and Preventive Medicine, University of Michigan, Department of Urology and Oncology, delivered an excellent discussion of the 10 steps he takes in advising patients about initiation of androgen deprivation therapy. Step 1 is to introduce patients to the common and less common side effects of androgen deprivation therapy . Step 2 is to introduce the patient to moderate, practical, and realistic dietary and lifestyle changes that promote general health during the androgen deprivation therapy. Dr. Moyad stated that recommendations for cardiovascular well-being extrapolate well to provide benefit to patients receiving androgen deprivation therapy. Step 3 is to emphasize that when it comes to over-the-counter supplements and other alternative approaches, less is more. He emphasized that some of these agents might have adverse effects on surgery or radiation therapy and that patients should discontinue these agents at least 1 week before definitive treatment. Step 4 is to remind patients that there might be dyslipidemia associated with androgen deprivation therapy patients should be told, know your lipid levels as well as your PSA.
Types Of Hormone Therapy For Prostate Cancer
The overwhelming majority of patients get androgen deprivation by way of medical therapy, explains Moshe Ornstein, MD, a genitourinary medical oncologist at the Cleveland Clinic.
Doctors use several types of medication to lower testosterone levels, but these therapies do so only temporarily. When you stop taking them, testosterone levels begin to rise again.
Here are some of the most commonly used hormone therapies.
Luteinizing Hormone-Releasing Hormone Agonists and Antagonists LHRH is one of the key hormones released by the body before testosterone is produced. LHRH agonists and antagonists lower testosterone levels by blocking the release of LHRH. Treatment with these drugs is sometimes called medical castration because they lower androgen levels as much as orchiectomy, or removal of the testicles, does.
LHRH agonists and antagonists include:
CYP17 Inhibitors An LHRH agonist or antagonist can stop the testicles from making androgens, but other cells in the body still make small amounts of androgens. These small amounts of hormones can continue to stimulate cancer growth. The medication abiraterone blocks a key enzyme involved in androgen production called the CYP17 enzyme. Zytiga can be used to treat metastatic prostate cancer that has become resistant to traditional hormone therapies.
Traditional anti-androgens may be given along with LHRH agonists and antagonists. They include:
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Cancer That Is Thought To Still Be In Or Around The Prostate
If the cancer is still thought to be just in the area of the prostate, a second attempt to cure it might be possible.
After surgery: If youve had a radical prostatectomy, radiation therapy might be an option, sometimes along with hormone therapy.
After radiation therapy: If your first treatment was radiation, treatment options might include cryotherapy or radical prostatectomy, but when these treatments are done after radiation, they carry a higher risk for side effects such as incontinence. Having radiation therapy again is usually not an option because of the increased potential for serious side effects, although in some cases brachytherapy may be an option as a second treatment after external radiation.
Sometimes it might not be clear exactly where the remaining cancer is in the body. If the only sign of cancer recurrence is a rising PSA level , another option for some men might be active surveillance instead of active treatment. Prostate cancer often grows slowly, so even if it does come back, it might not cause problems for many years, at which time further treatment could then be considered.
Factors such as how quickly the PSA is going up and the original Gleason score of the cancer can help predict how soon the cancer might show up in distant parts of the body and cause problems. If the PSA is going up very quickly, some doctors might recommend that you start treatment even before the cancer can be seen on tests or causes symptoms.
Evidence For Hormone Therapy For Prostate Cancer
The addition of radiation therapy to hormone therapy for the treatment of locally advanced prostate cancer reduces prostate cancer deaths by 50%, according to the results of a Scandinavian study published in the Lancet.
In 1996 researchers from the Scandinavian Prostate Cancer Group and the Swedish Association for Urological Oncology initiated a Phase III trial to evaluate the benefits of adding radiation to hormone therapy. The trial involved 875 patients who were randomized to receive either hormone therapy alone or combined hormone/radiation therapy . After nearly eight years of follow-up, 79 men in the hormone-only group had died of prostate cancer compared with 37 in the combination group. Furthermore, the rate of recurrence was substantially higher in the hormone-only group: 74.7% versus 25.9% in the combination group. After five years urinary, rectal, and sexual problems were slightly more frequent in the combination group.
The researchers concluded that the combination of radiation therapy and hormone therapy was superior to hormone therapy alone and cut the rate of prostate cancer deaths in half. Furthermore, the side-effect profile for the combination therapy was acceptable.
The Birmingham Prostate Clinic is a centre of excellence for external beam radiotherapy and we would be happy to discuss your needs and treatment options with you.
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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.
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What Are The Limitations Of Hormone Therapy For Prostate Cancer
While hormone therapy may help treat prostate cancer, limitations include the following:
- Hormone therapy can cause side effects that can have a significant effect on a patients daily life.
- Some side effects, such as breast enlargement, are permanent.
- If used alone, hormone therapy does not cure cancer, but only keeps it under control, sometimes for several years.
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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.
Intermittent Hormonal Therapy For Locally Advanced Prostate Cancer
Intermittent hormonal therapy is where you stop taking the drugs and after a while start taking them again. This may be an option for locally-advanced prostate cancer. It gives you a break from the side effects of hormonal therapy.
Intermittent hormonal therapy is not suitable for everyone and should only be done on your doctors advice. Your doctor can explain more about this. They usually measure your PSA level using the PSA test every 3 months. If it goes up to a certain level or you get symptoms, your doctor will advise you to start hormonal therapy again.
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How Will I Know If My Treatment Is Working
You will have regular appointments to check how well your treatment is working and monitor any side effects. These will involve regular prostate specific antigen blood tests to measure the amount of PSA in your blood.
PSA is a protein produced by cells in your prostate and also by prostate cancer cells, even if they have spread to other parts of your body. The PSA test is a good way to check how well your treatment is working.
How your treatment is monitored will depend on whether youre having hormone therapy as part of treatment that aims to cure your prostate cancer, or having life-long hormone therapy to keep advanced prostate cancer under control.
You can contact your nurse at the hospital, or our Specialist Nurses, between appointments if you have any side effects or symptoms that youd like to talk about.