Friday, August 27

Who requires prostate cancer hormone therapy?

There are a variety of methods for treating cancer that has spread to the prostate gland. On one end, there's cautious waiting (starting therapy only if symptoms appear) and on the other, there's active observation (periodic testing to see if cancer progresses). The surgical removal of the prostate, on the other hand, is an option.

Depending on the stage of localized cancer: radiation therapy, which may be administered alone or in combination with hormone therapy, commonly known as androgen deprivation therapy (ADT).

Dr Atish D. Choudhury, co-director of the Prostate Cancer Center at Harvard-affiliated Dana-Farber Disease Institute, states, "Hormone treatment is a strong weapon in the battle against prostate cancer because it starves the cancer of the fuel that drives its development and spread."

Slowing the rate of growth

Hormone treatment works by lowering androgen levels, the male sex hormones. Male features such as face and body hair, a loud voice, and big muscles are attributed to androgens. They also aid in the appropriate development and function of the prostate.

Testosterone and dihydrotestosterone are the most common androgens (DHT). The testicles produce 90 per cent to 95 per cent of androgens, with the remaining produced by the adrenal glands (situ above the kidneys). Prostate cancer relies on androgen signals to develop and spread. Dr Choudhury explains that androgens, particularly testosterone, are "fuel for cancer cells." "Hormone treatment lowers androgen levels and denies these signals to cancer cells, causing the tumour to shrink."


Side effects
Side effects might occur when androgen levels (male sex hormones) are reduced. Some men just have a few minor symptoms, while others have more severe symptoms. The most common are low libido and erectile dysfunction (ED). (Using ED medications while on hormone treatment may not be helpful.) Fatigue, heat flashes, weight gain, moodiness, and breast growth are all common side effects. When therapy is stopped, however, these issues generally go away. If you've been on hormone therapy for a long time or if your cancer is under control, your doctor may decide to take you off it for a bit to give your body a break from the side effects.

Hormone treatment can raise total cholesterol, triglyceride levels, and blood sugar levels, among other things. A low-calorie diet combined with cardio and weight training can help prevent weight gain, control cholesterol and blood sugar levels, decrease sexual adverse effects, and boost energy. Hot flashes can be relieved by applying cold packs and sipping cool water. Mood swings can be managed using relaxation practices.


Who is a potential candidate?

Based on their age, overall health, and Gleason score, men with biopsy-proven cancer that has not progressed outside the gland are given treatment options (a numerical value that grades prostate tumour cells according to how abnormal they appear compared with normal prostate cells). Surgery or radiation are usually recommended for moderate or high-risk localized cancers (with or without hormonal therapy).

Hormonal treatment can improve the effectiveness of radiation therapy by making cancer cells "sick" and shrink. The therapy is used when cancer has progressed beyond the point where surgery or radiation may successfully treat it, or when men are unable to get these treatments for whatever reason.

ADT advancements

Previously, the only option to stop cancer-fueling androgens was to have the testicles surgically removed. Many types of drugs now have the same effect as surgery without the need for surgery. The most frequent method involves altering androgen release from the testes. Others inhibit the enzyme that produces androgens or disrupts androgen-induced growth signals in cancer cells. "Your doctor will talk to you about whatever option is best for you," Dr Choudhury adds.

These medications have comparable effects, but the way they are taken and how often they're taken depends on the therapy's aims and the patient's preferences. In general, injections are given once a month or every three, four, or six months. Along the way, levels of prostate-specific antigen (PSA) are monitored.

Men are treated for six months for localized intermediate-risk cancer. Treatment for localized high-risk cancer can continue for up to two years. ADT is often used indefinitely to treat cancer that has spread beyond the prostate. Another option is to use intermittent ADT. When PSA falls below a particular level, therapy is paused, and then resumed if the numbers rise.
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