Hormone therapy for prostate cancer
Hormone therapy is a medical treatment for prostate cancer. Prostate cancer cells rely on male hormones, also known as androgens, for growth and survival. Testosterone and dihydrotestosterone are the main androgens. Testosterone is produced in the testicles and ,to a much lesser degree, in the adrenal glands.
Hormone therapy - how does it work?
Hormone therapy blocks the production or function of male hormones. A better name would be anti-hormone therapy.
Hormone therapy can be administered in 3 different ways:
- By injection - either monthly, or once every 3 or 6 months, depending on the medicine. The drug blocks the testosterone production in the testicles, which will cause a decrease of testosterone in the bloodstream. This is also known as chemical castration. The medicine is called LHRH agonist or LHRH antagonist. Both drugs have the same effects, although LHRH stimulates the testicles to produce extra testosterone during the first weeks after which production decreases to an extremely low level. LHRH antagonists cause a more rapid decrease in testosterone production.
- By surgically removing the testicles. Removing both testicles will prevent the production of testosterone. This is called an orchidectomy, or surgical castration, and used to be the only way to suppress testosterone production. One benefit of this treatment is the lack of injections. However, a big disadvantage to the treatment is that it is irreversible and is not suitable for men who only require a temporary suppression of testosterone.
- By antiandrogens, a drug that blocks off the tumor cells so testosterone in the body will no longer be able to promote growth in these tumor cells. This medication needs to be taken daily in pill form.
When is hormone therapy an option?
Hormone therapy is an option for patients with prostate cancer who are receiving radiation therapy as a curative treatment.
Hormone therapy can also be given to patients for whom recovery is no longer an option due to metastases, but who aim to keep the disease under control.
Androgen inhibitors can cause side effects. We will discuss the most common effects below. Many of these side effects can be kept under control through exercise and a healthy diet. We will discuss this further below.
Hot flashes: 80% of men will experience hot flashes. You may experience a sudden warm sensation in the face, head, or upper body, although your temperature will not actually rise. The hot flashes may cause perspiration which may affect your clothes or bed sheets, and may disrupt your sleep. Please consult your practicing physician to discuss your options to treat these side effects, if needed. There are several things you can do to help combat hot flashes, yourself:
- Quit smoking;
- Avoid coffee, alcohol, and spicy food;
- Keep your room at a lower temperature;
- Avoid transitions between hot and cold;
- Avoid clothes and bed sheets made from synthetic materials. Try to find clothes made of cotton, wool, or silk and wear thin layers so you can take something off if needed;
- Cover your bed in a thin sheet that can be easily removed and cleaned if needed.
Sexuality: hormone therapy can affect your sex drive. You may experience problems getting or maintaining an erection, which may cause tension between you and a potential partner. Intimacy can be achieved through many different means, such as holding hands, or hugging. Some people are able to stay sexually active in their own ways. Please try to keep communication open between you and your partner or practicing physician. If you are experiencing problems, you can ask for a referral to a sexuologist. To get or maintain an erection in other ways, please ask for a referral to our sexuality and cancer clinic.
Fatigue: this can have a variety of causes. Low testosterone levels can cause fatigue, or you may experience tension from your disease and treatment. Please try to stay physically active, as this can prevent long-term fatigue. You may need to find a new balance between rest and activity, and take frequent breaks. Other people experience fatigue due to anemia. Your practicing physician can check your blood values for you. You will not need to take iron supplements, as your anemia will not be caused by iron deficiency.
Muscle weakness and an increase in body fat: treatment may decrease your muscle mass and increase your fat percentage, especially around the waist. Hormone therapy affects your metabolism. You will be at a higher risk of cardiovascular disease and diabetes, so please try and eat healthy and exercise. You can find some lifestyle tips on this page.
Osteoporosis: absence of testosterone can cause osteoporosis over time. You will not notice the immediate effects of the therapy on your bones, but will be at a higher risk of fractures, depending on the length of your treatment. Please take calcium and vitamin D supplements during your treatment. Calcium can be found in dairy products, and vitamin D in fish. Caffeine found in coffee and cola decreases the absorption of calcium. Vitamin D is produced through sunlight on the skin. Exercise during which your bones have to support your weight also strengthens the bones, in combination with a diet containing sufficient calcium and vitamin D. Some sports like swimming or biking are healthy, but do not require your bones to support your body. See below on this page for tips on how to adopt a healthy lifestyle. Physical activity can also help stimulate muscle mass, which helps prevent the risk of falling. You could consider working with a physical therapist or gym to set up an exercise program. Only take nutritional supplements after consulting your practicing physician.
Breast development or tenderness: this is very rare in men who take LHRH agonists and LHRH antagonists, but tends to occur more commonly in men who take antiandrogens. Your nipples may be sensitive to the touch, and you may notice swollen breast tissue. A radiation therapy session on the breast tissue before your treatment may counter these effects. The swelling will not continue to grow after treatment, but also will not decrease. The pain, however, will be temporary. The developed breast tissue can be surgically removed.
Mood swings: some men experience mood swings or depression due to the fluctuations in hormone levels. You may be prone to anger, which can affect your loved ones. Please communicate these mood swings with those nearest to you, and your practicing physician.
Other side effects: the penis and testicles may appear smaller, you may lose “masculine” hair growth (beard, chest, arms), you may experience mental problems (with memory or sharpness). LHRH agonist or antagonist injections may also cause skin irritation.
What you can do
You can prevent many of these side effects though two important lifestyle rules: stay active, and eat healthy. Please discuss all problems you encounter with your practicing physician so you can find solutions together.
Exercise: this will help diminish fatigue, muscle weakness, osteoporosis, and depression. Physical activity can also help lower your risk of cardiovascular disease and diabetes. If you have a sedentary lifestyle, it can be hard to start exercising. You may wonder whether your health allows for activity. Please ask your practicing physician what your options are. You may need to ask a physical therapist or gym to help you come up with a program. It can be hard to stay motivated when you do not feel the effects of your activity levels. You may still lose muscle mass and gain fat, even when active. Consider that your activity may not increase your fitness, but help decrease it even further. Without exercise, the effects would be even stronger.
Some examples of physical exercise are: brisk walks, running, aerobics, dancing, weight lifting, football/soccer, tennis, and so on. Or take the stairs instead of the elevator, or walk to the store instead of taking the car.
Healthy diet: this will help decrease the risk of cardiovascular disease, diabetes, muscle weakness, increased body fat percentage, fatigue, and osteoporosis. Some general dietary guidelines are:
- Eat fruits, vegetables, and fibrous foods;
- Only drink coffee and alcohol in moderation, and quit smoking;
- Make sure that there is sufficient calcium and vitamin D in your diet (see the section on osteoporosis);
- Avoid saturated fats and consider fish or poultry instead of beef or pork, or substitute butter with oil;
- Avoid sugars in candy, cookies, baked goods, and sodas.