Treatment for metastatic prostate cancer continued...
androgen deprivation (orchiectomy or an LH-RH agonist) and an antiandrogen are
used together. This is called a combined androgen blockade (CAB). But the slight benefit of CAB may be offset by side effects.
Both orchiectomy and hormone therapy medicine make
testosterone levels drop, causing some of the same side effects. These include
hot flashes, loss of sexual desire, and the inability
to have an erection. Treatment options for these problems include:
- Taking a temporary break from hormone therapy. This can make
some side effects go away. (Side effects after orchiectomy are
- Radiation treatment of the breasts to prevent breast growth.
This is done before starting hormone therapy.
- Radiation treatment or the anti-estrogen breast cancer medicine
called tamoxifen to relieve breast pain. Tamoxifen can also help reverse breast
growth. It also causes hot flashes.
- Taking medicines to control hot flashes, such as paroxetine or
venlafaxine. If these don't work, sometimes estrogen or
megestrol may help reduce hot flashes. But all of these medicines have
different side effects, so if you are having a problem with hot flashes, talk
with your doctor.
Other serious side effects of hormone therapy may include thin or brittle bones (osteoporosis), reduced muscle mass, increased body mass (BMI), low red blood cell counts (anemia), fatigue, cognitive impairment (trouble thinking clearly), depression, and an increased risk for diabetes and heart disease.
Hormone therapy usually works well at first to stop
cancer growth. But in most cases the cancer returns in a few years. At this
point, the cancer is described as hormone-resistant,
meaning it is not responding to standard hormone therapy. When this happens,
other kinds of hormone treatment may be tried. If the cancer continues to grow,
chemotherapy or immunotherapy may be recommended.
Some men choose
to start hormone therapy only after they have symptoms. But some doctors
recommend starting hormone therapy right away if cancer is found in the
lymph nodes during surgery to remove the prostate. Other doctors say to wait, because waiting delays
the bothersome and serious side effects of hormone therapy.
With intermittent androgen deprivation, known as IAD,
men take cycles of hormone therapy medicines. Taking breaks between
hormone therapy cycles gives men the chance to recover their ability to
function sexually. It also gives relief from the other side effects of hormone
therapy, including hot
flashes, the loss of energy, and the loss of bone and muscle mass.
Treatment for pain
Pain is one of the main concerns of people who have metastatic cancer. But cancer pain can almost always be controlled. You and your doctor have several options to help your pain, including pain-relieving medicines and radiation, such as external beam radiation therapy and bone-targeted radioisotopes.
Additional information about prostate cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/prostate.