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Prostate Cancer: Latest Treatments and Emerging Therapies

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What are the complications and side effects of radiation in treating advanced stage prostate cancer?

Common complications of radiation therapy include erectile dysfunction and urinary incontinence.

Impotence and urinary problems may occur in men treated with radiation therapy. Other complications may include:

  • Short-term bladder infections
  • Infections of the lining of the anus
  • Intestinal infections

Some men experience fatigue after multiple radiation sessions.

How can hormone therapy or androgen deprivation be used with advanced prostate cancer?

Most prostate tumors grow faster in the presence of testosterone and other male hormones -- androgens. Therapy can block the action of androgens or cut off the body's supply. Doing so can significantly delay the progression of the disease.

There are several methods for androgen deprivation. Any of them can be used alone or in combination. They include:

  • LHRH (luteinizing hormone-releasing hormone) agonists. These are drugs that mimic the action of a naturally occurring hormone. They essentially trick the body into exhausting its supply of testosterone. Commonly used LHRH agonists include Zoladex, Lupron, and Trelstar. These drugs are delivered in long-lasting injections either monthly or four times a year. Or they can be delivered in an implant that can be inserted under the skin once each year. These drugs carry a small risk of triggering diabetes, heart disease, and/or stroke. Before starting one of these drugs, patients should tell their doctor if they have a history of diabetes, heart disease, stroke, heart attack, high blood pressure, high cholesterol, or cigarette smoking.  
  • Anti-androgen drugs. These are also called androgen blockers. They are drugs that block the action of the hormone dihydrotestosterone on prostate cancer cells. These drugs are taken daily by mouth. They can be given either alone, or in combination with LHRH agonists. Common drugs in this category include Casodex, Eulexin, and Nilandron.
  • Orchiectomy (castration). This is a surgical procedure. It removes the testicles, the source of testosterone production. This technique has been used for many decades to treat men with advanced stage prostate cancer. Studies show drugs can achieve the same effect. Still, some men choose this option instead of having to have repeated injections of LHRH agonists.

 

What are the complications and side effects of hormonal therapy?

The use of LHRH agonists causes a temporary surge in testosterone production at the start of therapy. This results in a testosterone flare that can cause bone pain, urinary frequency, or difficulty urinating. These side effects can often be reduced by giving the LHRH agonists in combination with anti-androgens.

Other side effects of hormonal therapy include:

  • Erectile dysfunction
  • Loss of libido (sexual desire)
  • Hot flashes
  • Fatigue
  • Loss of bone density -- osteoporosis
  • Loss of muscle mass
  • Weight gain
  • Memory problems
  • Anemia

Hormonal therapy can be effective at suppressing prostate cancer growth and spread for many months or years. But it may eventually lose its effectiveness as prostate cancer cells that do not rely on testosterone begin to take over the tumor. This condition is known as hormone-refractory or hormone-resistant prostate cancer. Several clinical trials are testing new treatments for hormone-resistant disease.

WebMD Medical Reference

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