Male hormonal therapy
Men with prostate cancer often require treatment to suppress the production of testosterone within the body.
- This is called anti-androgen therapy.
- It is similar to the estrogen suppressing therapy used to treat breast cancer in women with hormone-sensitive breast cancer.
- It is sometimes used to treat prostate cancer by itself, or in combination with radiation therapy.
Lupron (leuproride) is the common drug used for suppressing testosterone made in the testicles.
Sometimes, another anti-androgen medication, may be used:
- The most common anti-androgens are:
- Flutamide (Eulexin): http://www.chemocare.com/bio/flutamide.asp
- Bicalutamide (Casodex): http://www.chemocare.com/bio/casodex.asp
- The most common use of these drugs are:
- In combination with Lupron to prevent a “flare” reaction from Lupron alone,
- Or, when prostate cancer is not controlled with Llupron alone.
- When these medications are no longer effective together, sometimes just stopping the anti-androgen can result in a decrease of PSA and control of prostate cancer for a while (while the patient is still on lupron).
Hormone refractory prostate cancer:
- When this hormonal manipulation is no longer effective, the next treatment your doctor may consider is a drug called Ketoconazole.
- It is an anti-fungal drug that can be used for treating prostate cancer (while still on Lupron).
- Ketoconazole can interact with some other drugs, especially a class of drug called statin that are used to treat cholesterol.
- Statin drugs need to be discontinued before a patient can start taking Ketoconazole.
- When some or all of these hormonal manipulations do not work anymore, chemotherapy or some other treatment may be considered.
Intermittent anti-androgen therapy
- Some patients may consider intermittent anti-androgen therapy, although it is not clear if this method is as effective as continuous Lupron without break.
Side effects of hormonal therapy:
1. Most common hormonal effects:
- Hot flashes (in 56% to 91% patients)
- Gynecomastia (breast enlargement, in 7% patients)
- Greast tenderness (in 7% to 14% patients),
- Impotence
- Decrease in testicular size.
2. Emotional and mental effects:
- Up to 45% of patients can develop symptoms including depression and emotional imbalance, anxiety, nervousness, decreased libido, and short-term memory loss.
- Insomnia can occur in 2% to 7% of patients.
3. Other side effects:
- Some patients develop constipation (7% patients),
- Anorexia (3% to 6% patients),
nausea and vomiting (5% patients), - Weight loss, increased flatulence, dyspepsia, and weight gain.
4. Musculoskeletal effects:
- Muscle weakness is common in patients receiving anti-androgen therapy for prostate cancer.
- Myalgias (muscle pain),
- Arthralgias (joint pain), muscle atrophy, limb pain,
- Osteoporosis is a common and important side effect of anti-androgen therapy that requires monitoring and treatment to prevent bone fractures (also see bone health).
- lower bone-density scores can also occur.
There are many ways to manage these side effects.
- Report side effects to your doctor.
- Inquire about medical and non-medical means to help minimize the side effects.
Physical therapy, including exercise is encouraged:
- to build muscle strength,
- maintain good bone density
- improve heart function
Hormonal therapy drugs:
