SDURO0120Revised - PDF document

Version 2 SDURO0120 • Revised Hormone Therapy for Prostate Cancer – A Patient Guide Urologic Oncology Program Comprehensive Phone number: 415-353-7171 Prostatecancer. therapy. testosterone Testosteroneprostatepreventscontrolsgrowth. improveseffectivenesstherapy. differentare recommended effectsare Please Note: words bold are  \r\f\n\t\b
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24; 2 What is testosterone? producetestosteroneproduceestrogen).Testosterone differentandrogenseffectsbody. puberty,boy’sproductiontestosteroneincreasesgrowth increasetestosteroneresponsible fertility.Increasingtestosterone increased increased enlargement increased(desire erection testosteroneprostate prostateproduceare testosteroneroleprostatetestosterone prostategrow. How is testosterone made? Twodifferentproducetestosterone (see Figure 1). testosterone produced adrenal glands testosteroneproduction hypothalamus pituitary gland testosterone. Figure 1 3 How does testosterone help prostate cancer grow? Testosteronethroughreachesprostatetestosterone wheregrow.testosterone cancer.moretestosteronemore grow,spreadbody. What is h

ormone therapy? testosteroneforceprostategrowth,treat testosteronereferred androgen deprivation therapy (ADT) therapy, LHRH or GnRH agonists are reducestestosteroneman’sbody. anti-androgens testosterone testosteronereduced,prostategrowth decreases, Prostate Specific Antigen (PSA) measuredcurecancer, controlprostate receivingtreatment has increaserecur,improving Who should be treated with hormone therapy? recommendedcircumstances: Gleason scores before(concurrent), surgery  recurrence). surgery. metastatic prostate(prostatespreadprostate localized prostate cancer arethree groupspredict returningtreatmentsurgeryaremore threegroupsarelow, 4 low risk prostatearetreatedsurgery radical prostatectomy external beam radiation or brachytherapy prostat

e).recommended treatmentprostatelargetreat program, intermediate or high risk prostatesurgery surgerysurgery preferred aretreatedexternalexternal brachytherapy.receiveresearch therapy.Treatment throughoutanywherefrom cancer.Your treatmentsare aresurgeryreasons: problems effects. treatmentsurgery serologic progression, bone scan or CT scan (however, are may score presenttreatmentsurgery recommend surgerycryosurgery). Finally,frequentlyprescribed metastatic disease prostate spreadsenvironment,are frequently,prostateorgans, rareprostatespread prostatethroughoutpatient’sentireregardlesstreat organs,prostate 5 What are the types of hormone therapy? Therearethree Orchiectomy Surgicalremoval LHRH agonists or antagonists fromtestosterone Anti-androge

ns preventsfromtestosterone Orchiectomy removesscrotalTesticlesproduce testosterone,prostatecancer’sirreversible; prosthesesscrotal more removingdifficult; greater problemorchiectomyeffect.distress undergosurgicalprocedure. LHRH agonists fromtestosterone. fromproducetestosteroneover-stimulatesrespond off.reason "flare"testosteronebefore anti-androgens areprescribed therapy. LHRH antagonists fromtestosterone "flare"testosterone anti-androgen necessary. resumeproduction; fromfrom Tabletestosteroneproduction.areconsidered 6 Table 1: LHRH Drugs - fromtestosterone. Generic Name Trade Name How is the drug given? How much drug is given & how often? Leuprolide Lupron ® Goserelin ® Leuprolide Eligard ® Leuprolide ® Surgically upper inner arm 65 mg annu

ally Triptorelin Trelstar ® Degarelix Firmagon ® require anti-androgens. Anti-androgen drugs adrenalfromtestosterone; testosterone.anti-androgenfromTable Table combined androgen blockade (CAB). moreeffective anti-androgens frequentlyanti-androgen. 7 Table 2: Anti-androgens decreasecell’stestosterone. Generic Name Trade Name How is the drug given? How much drug is given & how often? ® Oral pills three ® Oral pills Nilandron ® Oral pills Finally,there reductasereduceproduction dihydrotestosteronebreakdownproducttestosterone. moreeffectivestandardtherefore,androgen TripleAndrogenprescribedUCSF. Starting hormone therapy forwardtherapy,thereare Am I better off with medical or surgical hormone therapy? testosteroneproductionfrom treatmentsurgicalproc

edure, providetreating intermittent therapy,appropriate. Should I use the testosterone lowering medication (LHRH analog or antagonist) alone or combine it with one of the testosterone blocking medications (anti-androgens) listed in Table 2? recommend anti-androgenprotecttestosteroneflareanti-androgen however, anti-androgenentiretreatment,preferred approach.remaintherapy,anti-androgen dropappropriately.effects, problems.Yourcareproviderapproach Is it possible to use a testosterone blocking drug (anti-androgen) on its own (Table 2) WITHOUT an LHRH agonist or antagonist? effectsaretestosterone. effectsandrogen(PAB). PAB, use testosteronereducingtestosteroneThree differentPABareTableareconsideredPAB consideredeffective consideredYourcareproviderPAB appropri

ate Table 3: Typesandrogen(PAB). Generic Name Trade Name How much drug is given & how often? ® Proscar ® ® three Avodart ® ® Intermittent hormone therapy consideredundergoing treatmentprostatecancer. reasonstreatment Improvedpatient—moreoffeffects. areeffective—in effectiveness. UCSF, reachespre-determined Tablerestarted testosteronerecovers therapy.off from therapy. off control.appropriateYourcareprovider recommended Table 4: restartandrogen If your PSA when starting hormone therapy is: You will restart hormone therapy when your PSA is approximately: Example: PSA treatment restarted approximately Greater treatment restarted approximately Side Effects of Hormonal Therapy and How to Deal With Them effectsarerelateddecreasedtestoste

rone.three reportedeffectsaredecreased decreasederectile effectsaretreatedare below, effects,effectsare reversible;testosterone recover. remembereffects.Therelarge severity. Hot flashes —aregreatlyfrequency,different arepresent Recommendations: treateddifferent megestrol(Effexor ® ® respectively), treatmentunnecessary.environmentsThere acupuncturedecreasingcaffeine Decreased libido decrease desireerectilearerecoveringsurgery Recommendations Working resultingfromremain 10 distressrelationship.Touchingromantic environment, Your Health Matters: Managing Impotence–A Patient Guide thorough www.urology.ucsf.edu/patientGuides/pdf/Manage_Impotence.pdf Depression, mood changes, anxiety and irritability testosterone resultdepression, severity,ther

eareanti-depressant differentlymore exercise produce groups,around Fatigue directlytestosteroneresult reductionredtestosterone Recommendations regularexercise. effects, reducingcardiovascularthree provide Your Health Matters: Cancer and Exercise areexercise (see UCSF Resources) Reduced muscle mass, and/or weight gain testosteroneresults testosteroneWeightbelly. Recommendations regularexercise areexercise (see UCSF Resources). Breast enlargement (gynecomastia) tenderness resultsmorerole estrogenman’sbody.moreanti-androgen breaststreatment preventative.estrogen preventing ncreased appetite increasedtestosterone Thi s increases . Exerciseimprovesprostate moreYourProstate www.urology.ucsf.edu/patientGuides/pdf/uroOnc/Nutrition_Prostate.pdf. 11 Br

ain function effect reporteffectsare Recommendations: treatment. word,cardreminders reminders Hair loss & gain testosteroneresults difference,treatment area;growmoreslowly,Conversely, thicker. growthrestartsrebuildtestosterone. Genital shrinkage reducedtestosterone. Recommendations: distressespartner, Your Health Matters: Managing Impotence–A Patient Guide www.urology.ucsf.edu/patientGuides/pdf/Manage_Impotence.pdf thorough Bone loss/osteoporosis —Osteoporosisare moreareareare Osteoporosis therapy. previously Recommendations: effectivelytreat osteoporosis,reduction ® zoledronic ® arerecentlyapproved ® subcutaneously, zoledroniceffects.areprescribedzoledronic ® creatinine bone-targeted therapy,are Yourmonitored.Yourrecommendaccording e

xerciserecommended.particular,resistance exerciserecommendedthreeweekly.before, stronglyinitially. Your Health Matters: Cancer and Exercise areexercise (see UCSF Resources). 12    Anemia resultreduction red Recommendations: ironsureiron Abnormal liver function anti-androgensliver, resultingmeasure anti-androgenseffects. thereafter. Typically,arebeforethereare results anti-androgen Recommendations: arereduce(Tylenol) reviewdoctor. Cardiovascular disease recent increasestroke,remainscontroversial. alreadypressure, cholesterol Recommendations surecholesterolpressure carearetherapy.Thereare controlcholesterol.exerciseare aerobicexercisereduce providedfree (see UCSF Resources) Your Health Matters: Prostate Cancer and Nutrition prostate www.urology.u

csf.edu/patientGuides/pdf/uroOnc/Nutrition_Prostate.pdf arecardiovascularbeforetherapy, sureYourResource Diabetes mellitus testosteroneincreaseare requireare increase. Recommendations: aresurecare are monitoredperiodically.exercise control Erectile dysfunction reduceserectile Recommendations: therapy.prostheses appropriate; Your Health Matters: Managing 13 Impotence—A Patient Guide (www.urology.ucsf.edu/patientGuides/pdf/Manage_Impotence.pdf) thorough Yourprostategroupsource addressingeffectstherapy.(www.ustoo.org (www.cancer.org),CaliforniaProstate (www.prostatecalif.org)group. Other Considerations effectivenessEventually, currentprostateresearch treatmentsprostatecancer.Thereare more Indications that resistance to hormone therapy may be devel

oping: are testosteroneeffectiveness. treatmenteffectiveare reachesinitially, offshorter. Should the hormone therapy be stopped at this point? necessarily. process,respondstandardtreatment. are Therearelargeprostategrowing testosteroneYour UCSF Resources thereareresources Resource Divisadero. programslectures,treatment.library, You 14 Twoprogramsarereceivefree TherearelecturesProstate provideYouexercise counselor,exercisecapacity,program,direct progress; effects encounter.programsstressmore. referral. Glossary of Terms Adrenal glands: areresponsibleproducing steroidstestosterone. Androgens: androgentestosterone;estrogen. Anti-androgens: testosterone Bone scan: Brachytherapy: treatmentwhereprostate. CT scan: CAT organs. Erection: engorgedresultingerect Exte

rnal beam radiation high-energy(protons)from treatcancer. Gleason grade or score: aggressivenessprostate cancer.aremicroscope aredifferent fromare scoresthrougharerarely GnRH antagonists and agonists (also called LHRH antagonists and agonists): Gonadotropin releasingproductiontestosterone Hypothalamus: regulatorysecrete resultsproductiontestosterone. LHRH (Luteinizing Hormone Releasing Hormone): released releasetestosteronefrom 15 Libido: desireactivity. Locally advanced prostate cancer: prostate prostate; Lymph nodes or glands: organismsprostate aregroin. Metastatic disease: prostate MRI: resonance prostate. Orchiectomy: surgicalremoval Pituitary gland: controllingregulatory adrenal Prostate: surroundsurethraproduces PSA: Prostateproteinproducedprostatea

re cancerous;measuredprostatecancer, treatment. presencemoreprostate Radical prostatectomy: Surgicalremovalprostate Serologic Progression: prostatectomy Testicles: Tworesidescrotumproducetestosterone Testosterone: producedresponsible adrenalproduce testosterone. Prepared by UCSF health care professionals and advocates  \r\f\n\t\b
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