PROSTATE PROS Episode 7: Hormone Therapy TIPs

Listen: https://soundcloud.com/prostate-oncology/hormone-therapy-tips

“[Hormone therapy] is very effective for men with prostate cancer.  Being a powerful treatment, you need to know how to use it, when to use it, and how to minimize side effects.”– Dr. Scholz 

Hormone therapy goes by many different names: androgen deprivation therapy (ADT), testosterone inactivating pharmaceuticals (TIP), Lupron, etc.  But no matter how you refer to it, there is no denying that hormone therapy is a very powerful anti-cancer drug for men with prostate cancer.  

How Hormone Therapy Works

Prostate cells and prostate cancer cells need testosterone to grow. Hormone therapy stops testosterone’s production or limits its activity (depending on the type of hormone therapy).  When cut off from the supply of testosterone, prostate cancer cells cannot reproduce and they die. For men first starting on TIP, PSAs should initially decrease drastically (by about 90%).

Application of Hormone Therapy

Hormone therapy can be used as a monotherapy or in combination with other treatments.  Hormone therapy is often used in combination with radiation to improve cure rates. Hormone therapy is a whole body treatment, meaning it targets prostate cancer throughout the entire body, not just the area surrounding the prostate.  Men of all stages may be eligible for hormone therapy, although the type and treatment protocol will differ from stage to stage and patient to patient. Take the staging quiz on keytopc.com to see how hormone therapy may be applied to your stage of prostate cancer.  

Hormone Resistance 

Some men may become resistant to hormone therapy.  Hormone resistance occurs when prostate cancer cells that are deprived of testosterone (from current or previous hormone therapy) begin making their own testosterone internally.  Resistance is shown by a rise in PSA while on hormone therapy. Men with high-grade prostate cancer (Gleason 8, 9, 10) or very high PSAs are more likely to become resistant to hormone therapy than men with lower-grade prostate cancer.  

One of the newer developments in hormone therapy are the second-generation hormones. These agents stop the production of testosterone, or limit the activity of testosterone inside the prostate cancer cells.  These drugs are Zytiga, Erleada, Xtandi, and Nubeqa.  Note that second-generation hormone therapy may also be used in combination with a hormone therapy like Lupron to increase cure rates for men who are not yet resistant to hormone therapy.  It is important to have regular PSA tests while on hormone therapy so that if the PSA begins to rise (signalizing hormone resistance) a second-generation hormone can be started right away.  

Taking a Treatment Holiday

Men on hormone therapy may be eligible for a treatment holiday.  A treatment holiday is a break from hormone therapy where men allow their testosterone levels to return to normal.  This allows a nice break from any side effects of having low testosterone, such as fatigue or mood swings. Studies have shown that treatment holidays are safe if the PSA is undetectable (less than 0.1), showing that the patient is sensitive to hormone therapy.  Once the PSA starts to rise back up to around 5, treatment should be resumed.  

Side Effects

One of the most prevalent side effects with hormone therapy is fatigue, which stems from muscle loss.  Testosterone helps preserve and build muscle, so with a lack of testosterone, muscle loss occurs at a faster rate.  The best thing men on hormone therapy can do for their health is to be on a consistent weight-bearing exercise program.  Regaining and maintaining muscle prevents fatigue. Weight-bearing exercise also helps prevent osteoporosis, another potential side effect of hormone therapy. 

Many patients on hormone therapy may also struggle with weight gain.  A plant-based diet may help men reduce their caloric intake and stay healthy while managing their prostate cancer.  Plant-based diets have been shown to be beneficial for men with prostate cancer.  

For many men, side effects from hormone therapy will reverse once treatment is stopped and testosterone levels return to normal.  Remember that choosing an expert physician, who is very familiar with hormone therapy for prostate cancer, is your best chance at managing and preventing side effects from hormone therapy.  

Conclusion

Hormone therapy is a powerful anti-cancer drug.  Choosing the type of hormone therapy, the administration schedule, and if it is used in combination or as a monotherapy requires a prostate cancer expert.  Regular, weight-bearing exercise along with a healthy diet are two of the most important things a man on hormone therapy can do for his health. Talk to your doctor about steps you can take to minimize side effects from hormone therapy.  

Counteracting Hormonal Therapy Side Effects: https://www.prostateoncology.com/2018/10/03/counteracting-side-effects-from-hormonal-therapy/ 

Listen to Dr. Scholz on the Empowered Patient Podcast with Karen Jagoda: http://empoweredpatientradio.com/developments-in-prostate-cancer-treatment-with-dr-mark-scholz-medical-oncologist 

Take the prostate cancer staging quiz: keytopc.com

Have questions or topics you think would be great for PROSTATE PROS? Email podcast@prostateoncology.com

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