Understanding Hormone Therapy for Prostate Cancer
Hormone therapy works by either stopping your body from producing testosterone or by blocking it from reaching cancer cells. Prostate cancer cells typically need testosterone to grow, so reducing or blocking this hormone can help control the cancer. However, hormone therapy alone will not cure prostate cancer; it aims to manage and delay symptoms.
Recognising When Hormone Therapy Isn't Working
Regular PSA (prostate specific antigen) tests monitor the effectiveness of hormone therapy. A continuous rise in PSA levels can indicate that the therapy is losing its effectiveness. Your doctor may conduct additional PSA tests, ask about symptoms, and recommend scans to better understand how the cancer is progressing and to identify suitable treatments.
Why Hormone Therapy May Stop Working
Initially, hormone therapy can control prostate cancer for several months or years. However, over time, the cancer cells may adapt and start growing again despite low testosterone levels. This change necessitates alternative treatments.
Available Treatments When Hormone Therapy Stops Working
If your first hormone therapy isn't working well, several other treatments might be considered:
- Anti-androgens: These tablets, such as bicalutamide (Casodex®), block testosterone from reaching cancer cells. They may be combined with LHRH agonist injections for better effectiveness.
- Abiraterone (Zytiga®): This drug stops the body from making testosterone and is usually offered after other hormone therapies fail.
- Enzalutamide (Xtandi®): This capsule blocks testosterone's effect on cancer cells and can be used before or after chemotherapy.
- Darolutamide (Nubeqa®) and Apalutamide (Erleada®): These are other hormone therapies that delay cancer spread in certain cases.
- Chemotherapy: Drugs like docetaxel and cabazitaxel kill cancer cells throughout the body and can help improve and delay symptoms.
- Steroids: These can reduce testosterone levels, improve appetite, energy, and control pain.
- Radium-223 (Xofigo®): This radioisotope targets bones damaged by cancer to kill cancer cells and alleviate pain.
- Oestrogens: Rarely used, these hormone therapies can be effective for prostate cancer resistant to other treatments.
- Olaparib (Lynparza®): Suitable for men with specific genetic mutations (BRCA1 or BRCA2), this drug blocks proteins that repair damaged DNA in cancer cells.
Factors Influencing Treatment Choices
The best treatment for you will depend on several factors:
- Where the cancer has spread
- Symptoms you are experiencing
- How long the cancer responded to initial hormone therapy
- Your general health and other health conditions
- Potential side effects of treatments
- Your preferences and lifestyle considerations
Managing Symptoms
Additional treatments can help manage symptoms:
- Pain relief: Medications like paracetamol, ibuprofen, or morphine can help.
- Radiotherapy: This can slow cancer growth and reduce symptoms.
- Bisphosphonates: These drugs strengthen bones and alleviate bone pain.
- Medications or surgery: These can ease urinary problems.
Monitoring Treatment Effectiveness
During and after treatment, regular PSA tests and scans help monitor progress. If PSA levels drop and symptoms improve, it suggests the treatment is working. Regular check-ups and communication with your healthcare team are essential to manage symptoms and adjust treatments as needed.
