Who needs hormone therapy for prostate cancer?

The spectrum for treating cancer confined to the prostate gland has a range of options. On one end is watchful waiting (beginning treatment only if symptoms arise) or active surveillance (periodic testing to see if the cancer progresses). On the other is the surgical removal of the prostate.

Depending on the stage of localized cancer, a man’s doctor instead might recommend something in the middle: radiation therapy, which can be delivered alone or combined with hormonal therapy, also known as androgen deprivation therapy (ADT).

“Hormone therapy is a powerful weapon in the fight against prostate cancer because it starves the cancer of the fuel that stimulates its growth and spread,” says Dr. Atish D. Choudhury, co-director of the Prostate Cancer Center at Harvard-affiliated Dana-Farber Cancer Institute.

Slowing the growth

Hormone therapy serves to decrease levels of androgens, the male sex hormones. Androgens give men characteristics like facial and body hair, a deep voice, and large muscles. They also help with the prostate’s normal growth and function.

The most abundant androgens are testosterone and dihydrotestosterone (DHT). The testicles make about 90% to 95% of androgens, while the adrenal glands (located above your kidneys) produce the rest. Prostate cancer uses signals from androgens to grow and spread. “Androgens — especially testosterone — are fuel for cancer cells,” says Dr. Choudhury. “Hormone therapy decreases androgen levels and deprives cancer cells of these signals, causing the cancer to shrink.”

A side of effectsReducing levels of androgens (the male sex hormones) can cause side effects. Some men experience only a few mild symptoms, while others have more bothersome ones. Low libido and erectile dysfunction (ED) are the most familiar. (Taking ED drugs while on hormone therapy may not help.) Other typical problems include fatigue, hot flashes, weight gain, moodiness, and breast enlargement. However, when treatment stops, these problems usually go away. If you take hormone therapy for long periods, or if your cancer is well controlled, your doctor may take you off the treatment for a while to give your body a break from any side effects.Hormone therapy also can increase total cholesterol, triglyceride levels, and blood sugar levels. Adopting a low-calorie diet and staying active with cardio and weight training can help curb possible weight gain, manage cholesterol and blood sugar levels, reduce sexual side effects, and increase energy. Men can soothe hot flashes by using cold packs and drinking cool water. Relaxation techniques help manage mood swings.

Who’s a candidate?

Men with biopsy-proven cancer that has not spread outside the gland are offered therapeutic choices based on their age, overall health, and Gleason score (a numerical value that grades prostate tumor cells according to how abnormal they appear compared with normal prostate cells). The usual recommendation for intermediate or high-risk localized cancer is surgery or radiation (with or without hormonal therapy).

Hormonal therapy can boost radiation therapy’s effectiveness by making the cancer cells “sick” and reducing a tumor’s size. The therapy is also used when cancer has spread beyond where it can be successfully treated with surgery or radiation, or if men can’t have these treatments for any reason.

Advances in ADT

Previously, the only way to stop cancer-fueling androgens was surgical castration to remove the testicles. Now, many types of drugs can have the same effect without surgery. The most common work by affecting the release of androgens from the testes. Others block the enzyme needed to make androgens or stop growth signals from androgens in the cancer cells. “Your doctor will discuss which one is the best choice for you,” says Dr. Choudhury.

These drugs produce similar results, but how they are taken and how often varies based on the therapy’s goals and patient preference. In general, injections are given monthly or at three-, four-, or six-month intervals. Prostate-specific antigen (PSA) levels are monitored along the way.

For localized intermediate-risk cancer, men receive the therapy for six months. For localized high-risk cancer, the treatment can last up to two years. For cancer that has spread beyond the prostate, ADT is usually administered indefinitely. Intermittent ADT is another strategy. Therapy is paused once PSA falls below a certain level and then begins again if numbers rise.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

Yours, Lord, is the greatness and the power and the glory and the majesty and the splendor, for everything in heaven and earth is yours. Yours, Lord, is the kingdom; you are exalted as head over all. 1 Chronicles 29:11 NIV

Love the Lord your God with all your heart and with all your soul and with all your mind and with all your strength. Mark 12:30 NIV

Now to him who is able to do immeasurably more than all we ask or imagine, according to his power that is at work within us, to him be glory in the church and in Christ Jesus throughout all generations, for ever and ever! Amen. Ephesians 3:20-21 NIV

So he said to me, “This is the word of the Lord to Zerubbabel: ‘Not by might nor by power, but by my Spirit,’ says the Lord Almighty.” Zechariah 4:6 NIV

For the message of the cross is foolishness to those who are perishing, but to us who are being saved it is the power of God. 1 Corinthians 1:18 NIV

For who is God besides the Lord? And who is the Rock except our God? Psalm 18:31 NIV

It was not by their sword that they won the land, nor did their arm bring them victory; it was your right hand, your arm, and the light of your face, for you loved them. Psalm 44:3 NIV

For since the creation of the world God’s invisible qualities—his eternal power and divine nature—have been clearly seen, being understood from what has been made, so that people are without excuse. Romans 1:20 NIV

For in Christ all the fullness of the Deity lives in bodily form, and in Christ you have been brought to fullness. He is the head over every power and authority. Colossians 2:9-10 NIV

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