The American Cancer Society estimates that 191,930 men will be diagnosed with prostate cancer in 2020.
Any cancer diagnosis is serious, but men diagnosed with prostate cancer have hope. In fact, most cases of prostate cancer are found early. Early detection and promising treatments make prostate cancer one of the most treatable of all cancers.
Among those promising therapies is hormone therapy. Read on to learn more about how hormone therapy can help fight prostate cancer and improve your overall health.
What Is Prostate Cancer?
The prostate is a small gland that produces the seminal fluid in which sperm travel. Prostate cancer is diagnosed when cells in the prostate grow abnormally.
Prostate Cancer Symptoms, Risk Factors, Screening, and Diagnosis
Second, only to skin cancer, prostate cancer is among the most common cancers in men. You can protect yourself by being aware of symptoms and risk factors. You can also discuss screening with your doctor.
Many cases of prostate cancer cause no symptoms. When the cancer does produce symptoms, they can include:
- Difficulty urinating
- Decreased urine flow
- Blood in the semen
- Pelvic pain
- Bone pain
- Erectile dysfunction (ED)
Some men face a greater risk of a prostate cancer diagnosis than others. Knowing your risk is an important factor in many health decisions, including screening.
Factors that may increase your risk of prostate cancer include:
- Age: The majority of prostate cancer cases are diagnosed in men 65 and older.
- Race: African American men are more likely to be diagnosed with prostate cancer.
- Family history: Men with a family history of prostate or breast cancer are more likely to be diagnosed.
- Obesity: Men who are obese are more likely to be diagnosed with a more aggressive form of prostate cancer.
Screening and Diagnosis
Experts debate the wisdom of regularly screening for prostate cancer among healthy men. However, the ACS recommends that men discuss screening with their doctors as early as age 40. Specific recommendations vary based on risk factors.
Men at the greatest risk should discuss screening beginning at 40. This category includes men who have more than one close relative with prostate cancer.
Men at high risk should begin discussions at age 45. This category includes African American men. It also includes men with one close relative who has been diagnosed with prostate cancer.
Finally, men at average risk should discuss screening with their doctors at age 50.
Screening tests include the prostate-specific antigen (PSA) test and the digital rectal exam (DRE).
If a doctor finds a suspicious lump during the DRE or the PSA test identifies elevated PSA levels, he may recommend additional testing. Importantly, an elevated PSA level, by itself, is not a cancer diagnosis. In fact, the PSA level varies for many reasons, and many men with elevated PSA levels do not have cancer.
If you choose to undergo screening, your doctor can help you interpret your results. Depending on your risk factors and PSA levels, your doctor may simply recommend more frequent screening to monitor for changes. If your doctor suspects cancer, he may conduct a prostate biopsy to diagnose or rule out cancer.
A prostate biopsy that reveals cancer will prompt further testing to stage the cancer and determine if it has spread.
Prostate Cancer Treatments
Prostate cancer is among the most treatable of all cancers. Treatment options include:
- A watch-and-wait approach
- Surgery to remove the prostate
- Radiation therapy
- Hormone therapy
If you are diagnosed with prostate cancer, you and your doctor will discuss which treatment options are best for you. This depends on a variety of factors, such as:
- Your age
- Your general health
- The stage of your prostate cancer and the likelihood of it spreading or returning after treatment
- Side effects associated with each treatment
Prostate Cancer Hormone Therapy
For men with certain risk factors or more aggressive forms of prostate cancer, men’s hormone therapy offers hope.
The specific term for prostate cancer hormone therapy is androgen suppression therapy. Understanding prostate cancer hormone therapy, thus, requires understanding androgens.
Like other hormones, androgens help cells communicate. The term “androgens” refers to a group of steroid hormones that includes testosterone. Besides testosterone, the other main androgen is dihydrotestosterone (DHT).
Both male and female bodies produce androgens. However, androgens occur at much higher rates in men. In women, the adrenal gland and ovaries are responsible for producing androgens. In men, the adrenal gland and testicles produce androgens.
Because they are present at much higher levels in men and because they are responsible for men’s sexual health, androgens are often referred to as “male hormones.”
One of the jobs of androgens is to produce and maintain male characteristics and male sex organs. However, they also affect metabolism, body composition, and insulin sensitivity.
Androgens and Prostate Cancer
Prostate cancer occurs when cells in the prostate grow abnormally. Androgens contribute to prostate cancer by fueling this growth.
Reducing the androgens your body produces or preventing them from reaching the prostate can slow the growth of prostate cancer cells. Prostate cancer hormone therapy has shown promise in shrinking prostate cancer tumors and slowing their growth.
Who Might Benefit from Prostate Cancer Hormone Therapy?
Hormone therapy is most often used to treat aggressive forms of prostate cancer. Patients who might benefit from hormone therapy include those whose prostate cancer:
- Has spread to other parts of the body
- Has come back after treatment with surgery or radiation
- Has a high risk of spreading or recurring after treatment
Upon the initial diagnosis, your doctor will use your PSA levels, the grade of your cancer on the Gleason scale, and the results of other imaging. If these results suggest your cancer has already spread too far to make surgery an effective option, your doctor may recommend hormone therapy.
Similarly, if your test results indicate that your cancer is likely to spread or recur after treatment with surgery or radiation, your doctor may recommend hormone therapy.
In these cases, hormone therapy may be used in conjunction with radiation to make radiation more effective.
Prostate Cancer Hormone Therapy Options
Prostate cancer hormone therapy refers to a range of treatment options. Each aims to reduce the supply of androgens fueling the cancer cells’ growth.
Androgen Deprivation Therapy
Androgen deprivation therapy (ADT) can combine surgery and medication. The goal of ADT is to reduce the levels of androgens produced by the testicles.
One way to prevent the testicles from producing androgens is to surgically remove the testicles.
This outpatient procedure shows promise in shrinking prostate cancer tumors or slowing their growth. It is also among the least expensive hormone therapy treatments for prostate cancer.
However, the removal of the testicles is permanent. Thus, for many men, it is a difficult choice and often not the first choice.
Medication: LHRH Agonists
Medications can also reduce androgen levels in the testicles. Hormone therapy that uses medication to reduce androgen levels is sometimes called medical castration. Drugs in this category are luteinizing hormone-releasing hormone (LHRH) agonists.
Common LHRH agonists include:
- Leuprolide (Lupron, Eligard)
- Goserelin (Zoladex)
- Triptorelin (Trelstar)
- Histrelin (Vantas)
Hormone therapy using medication is more expensive than surgery. It also requires more frequent doctor visits. However, most men prefer it as an alternative to surgical castration.
LHRH agonist therapy is administered monthly as an injection. Alternatively, it can be delivered via an implant under the skin. Over time, LHRH agonists reduce androgen levels in the testicles.
Side Effects and LHRH “Flare”
Many men who opt for hormone therapy using LHRH agonists experience a temporary “flare” in testosterone levels when treatment begins.
Side effects of this flare are most significant for men whose cancer has spread to the bone and spine. During the flare period, these men may experience increased bone pain or paralysis. Men whose prostate gland hasn’t been removed may also experience difficulty urinating.
Fortunately, another category of drugs—anti-androgens—can prevent this flare.
Medication: LHRH Antagonists
LHRH antagonists, or anti-androgens, offer another form of medical castration. Degarelix (Firmagon) is the most common anti-androgen.
Like LHRH agonists, LHRH antagonists lower testosterone levels. However, these drugs work more quickly and do not produce a flare.
Anti-androgens are likewise given as a monthly injection. The most common side effect is pain at the injection site.
Side Effects of Surgical or Medical Castration
Surgery and medications that reduce testosterone levels in the testicles can produce similar side effects. These include:
- Reduced sexual desire
- Erectile dysfunction
- Shrinking of the penis or testicles
- Breast tenderness and swelling
- Hot flashes
- Decreased mental acuity
- Muscle loss
- Weight gain
- Increased cholesterol levels
Men who are considering prostate cancer hormone therapy should discuss these treatments and their side effects with their doctor. Together, they can weigh the risks and benefits of any potential treatment. Often, patients and their doctors can take steps to lessen the impact of these side effects.
After successful prostate cancer treatment, these steps can include testosterone replacement therapy.
Hormone Therapies That Reduce Testosterone Levels Produced in the Adrenal Glands
The testicles produce the majority of testosterone in the male body. However, the adrenal glands are also responsible for some androgen production. Thus, hormone therapy aimed at reducing androgen levels sometimes targets the adrenal glands as well. Drugs commonly used for this purpose include abiraterone (Zytiga) and ketoconazole (Nizoral).
Taken daily as a pill, abiraterone blocks an enzyme necessary for the adrenal glands to make androgens. Importantly, it does not reduce testosterone production in the testicles. Thus, it should be used in conjunction with LHRH agonists or surgical castration.
Like abiraterone, ketoconazole can benefit men with aggressive forms of prostate cancer. Ketoconazole is an anti-fungal medication that likewise prevents the adrenal glands from making androgens.
Patients taking abiraterone or ketoconazole also need to take prednisone to avoid side effects during their treatment.
Hormone Therapies That Prevent Androgens From Working
Another way to slow cancer growth is to prevent androgens from reaching the prostate. To affect the prostate, androgens need to attach to proteins called androgen receptors.
Androgen receptor antagonists beat androgens to these receptors. In this way, they prevent androgens from attaching and fueling cancer growth.
Androgen receptor antagonists include:
- Flutamide (Eulexin)
- Bicalutamide (Casodex)
- Nilutamide (Nilandron)
Currently, these drugs, which are taken as pills, are not used in isolation. Rather, they are added to a hormone therapy treatment regimen if existing therapies do not produce the desired results.
Hormone Therapies for Castrate Resistant Prostate Cancer (CRPC)
CRPC includes cancers that fail to respond to medical or surgical castration. It also includes cancers that stop responding to castration.
Some newer anti-androgens may help men with this type of cancer. However, other options are available.
Estrogens used to be among the first treatments for men with prostate cancer. However, their side effects have significantly reduced their use. When other options are effective, doctors and patients prefer them to estrogen therapy. Sometimes, though, other treatment options are ineffective. In these cases, estrogens may be used to treat CRPC.
Bipolar Androgen Therapy
Another option that shows promise for castrate-resistant prostate cancers is hormone therapy that causes alternately high and low levels of testosterone. Research continues on this treatment. However, existing studies show lower PSA levels and smaller tumors in patients who have taken high doses of testosterone.
Experts believe cycling between high and low levels of testosterone can reduce hormone-sensitivity. It may also reverse resistance to testosterone-blocking drugs. In these ways, bipolar androgen therapy offers promise in treating CRPC.
Testosterone Replacement Therapy in Prostate Cancer Patients
Because testosterone fuels prostate cancer cell growth, prostate cancer patients—and even healthy men—may be concerned about including testosterone replacements in their overall health plan.
Of course, you should always discuss any new therapies with a medical professional. However, it is important to note that androgens do not cause prostate cancer. Testosterone and other androgens are hormones naturally present in all healthy bodies.
In bodies where cancer is present, androgens can stimulate tumor growth. However, no evidence suggests testosterone or testosterone replacement therapy causes prostate cancer. Testosterone also does not increase prostate cancer risk in healthy men.
This means that healthy men—and even men who have been successfully treated for prostate cancer—need not avoid testosterone replacement therapies and their benefits.
Testosterone contributes to the following functions of a healthy body:
- Maintaining bone density
- Maintaining a healthy ratio of fat to muscle
- Promoting sex drive
- Producing red blood cells
- Producing sperm
- Promoting facial and body hair growth
However, testosterone levels fall with age. Men with hypogonadism also have low testosterone levels. Finally, men who have undergone surgical or medical castration as a treatment for prostate cancer will have no or very low levels of testosterone.
For men with low levels of testosterone, testosterone replacement therapy, guided by medical professionals, offers promise. This promise may extend to men who have been treated for prostate cancer.
Hormones for Health: The Promise of Prostate Cancer Hormone Therapies
Hormones do not cause prostate cancer, but they play a role in prostate cancer growth. Thus, hormone therapy offers promise to men who are diagnosed with prostate cancer. Prostate cancer patients should discuss these therapies with their doctors.
Meanwhile, all men should discuss hormone health with their doctors. Regulating hormone levels through therapies and lifestyle choices is an important component of every person’s overall health plan.
Contact the experts at Rebuilding Life to find out more about how hormone health can reignite your passion for life.