Hormone therapy (HT) may help keep prostate cancer from returning after radiation or surgery and relieve symptoms such as pain relief.
But many patients with metastatic CRPC find their hormonal treatment no longer working after some time, which is when doctors turn to other options – some of which may even improve survival even though cancer cells have become resistant.
1. Bioidentical Hormones
Hormone therapy for prostate cancer works by blocking cancer cells from receiving the hormones they need to grow and multiply, such as by eliminating their source or replacing them with bioidentical hormones that mimic those produced naturally within the body. This may require surgical removal of glands producing these hormones or using laboratory-made equivalents of what your body already produces naturally, or bioidenticals from labs like these from manufacturers that match natural production levels exactly.
Menopause causes hormone levels to gradually decline and this can result in symptoms including vaginal dryness, urinary issues, thinning hair, trouble sleeping, hot flashes, moodiness, weight gain and irregular periods. Hormone replacement therapy can be used to restore balance by replacing estrogen and progesterone levels in your body with bioidentical hormones derived from plants like wild yams, cactus or soy and having similar chemical structures as those found naturally within you; they can be taken orally or administered via compounding pharmacies like Earth Compounding Pharmacy.
FDA-approved hormones have been thoroughly evaluated and have few side effects; bioidentical hormones, however, have yet to undergo the same testing and evaluation process; so, when considering hormone replacement therapy it is vital that you seek advice from a provider with expertise.
Bioidentical hormones have often been seen as safer and more natural alternatives to their FDA-approved counterparts, although this is simply not the case; both types have their own set of side effects, and one entirely safe hormone does not exist.
Bioidentical hormones have become incredibly popular in recent years in the US following results of Women’s Health Initiative clinical trials. Many doctors believe that bioidentical hormones can lower risks associated with heart disease, breast cancer, blood clots and osteoporosis, though this remains difficult to prove due to lack of testing/study and non-bioidentical plant sources like wild yams/cacti. As these products have more side effects compared with FDA approved hormones they carry greater risks of side effects overall.
2. GnRH Agonists
Androgen deprivation therapy (ADT), used for advanced prostate cancer treatments, reduces levels of luteinizing hormone and follicle stimulating hormone in order to stop testicles from producing androgens. GnRH agonists and antagonists may be used in ADT; both can be given via injection or orally; GnRH agonists tend to cause an increase in testosterone, which usually is not problematic with patients suffering localized disease but can pose problems when applied spinal metastases; many studies have also implicated GnRH agonist use in terms of cardiovascular conditions and bone degradation.
To minimize these side effects, many experts and the manufacturers of GnRH agonists recommend concurrent administration of anti-androgens such as bicalutamide alongside GnRH agonist therapy. GnRH antagonists that do not stimulate the pituitary gland and thus don’t trigger testosterone surges are another approach; two such medications approved in the US include degarelix for injection and Relugolix taken orally.
GnRH agonists are synthetic versions of natural decapeptide gonadotropin-releasing hormone, with modifications designed to prevent rapid degradation, such as double or single substitutions, including double and single substitutions. They are used in treatment of early stage, locally advanced or metastatic prostate cancer as either adjuvant therapy combined with radiotherapy, or salvage therapy after radiotherapy has failed. Their effectiveness is measured primarily by their PSA response in studies such as EORTC 30892 where PSA response has proven itself a strong predictor of progression-free survival, time to recurrence and overall survival outcomes.
GnRH agonists such as leuprorelin and buserelin tend to be effective and well tolerated medications, with 2-13% experiencing a surge in PSA levels that causes muscle spasms or diarrhea as a side effect. As an alternative solution, antagonists of GnRH were developed that did not cause this surge and did not require concurrent antiandrogen use; one such GnRH antagonist – Relugolix has recently undergone phase III trials before being added as part of ADT regimen against prostate cancer.
3. Anti-androgens
Hormone therapy works by suppressing your body’s natural testosterone production and stopping cancer cells from using it to proliferate. Hormone therapy may be administered alone or alongside chemotherapy or surgery for treatment purposes. Recurrence of prostate cancer treatment usually includes increasing PSA levels after previous surgeries, radiation treatments or drug therapies have failed, yet hasn’t spread beyond your prostate gland’s local region. Hormone therapy may also help men at risk of prostate disease to avoid further attacks (see below). Although hormone therapy is typically not recommended as the initial therapy option for localised or locally advanced prostate cancers, it can still be effective alongside other forms of hormone therapy or in cases that progressed after surgical removal of disease.
Flutamide and bicalutamide medications may be utilized as hormone therapy treatments for prostate cancer. Taken orally as tablets or capsules, these drugs attach to androgen receptors on prostate cancer cells to block them from receiving testosterone, effectively stopping tumors from growing further. They’re sometimes combined with orchiectomy (the surgical removal of testicles) or LHRH agonists in order to maximize androgen blockade; this process is known as combined androgen deprivation therapy.
Newer forms of hormone therapy, known as hormone replacement therapy (HRT), may also be administered as part of initial treatments for non-metastatic prostate cancer; or combined with GnRH agonists and LHRH antagonists to combat castration-resistant prostate cancer, such as Abiraterone (Zytiga(r)), Enzalutamide (Xtandi(r), Apalutamide (Erleada(r) or Darolutamide(Nubeqa(r). In clinical trials conducted using HRT in combination with these medications lived longer than those receiving only ADT alone;
These medicines, also known as androgen synthesis inhibitors or second-generation hormone therapies, are designed to be more effective than existing hormone therapy in terms of preventing or delaying prostate cancer from spreading further and are currently being researched as ways to combat its spread across other organs of the body. Treatment typically occurs in cycles with breaks between treatments to minimize side effects and improve quality of life.
4. Degarelix
Leuprorelin and goserelin are two LHRH agonists commonly prescribed as part of hormone therapy treatments; they work by inhibiting testosterone production within the body to halt cancer cells from expanding, as well as alter other male characteristics like muscle strength and erectile function. Another type of treatment called GnRH antagonists or blockers are available, which reduce testosterone surges more closely mirroring surgical castration; degarelix is currently the most frequently prescribed GnRH blocker in the UK.
Degarelix injections should be administered subpenis or abdomen skin by a nurse in a clinic or at home, and may feel hard, swollen, or sore at first but will improve over time with time and mild pain relief medication such as paracetamol. Treating your injection site carefully by avoiding waistband pressure can reduce pain; be sure to discuss this aspect of treatment with healthcare team prior to commencing any medication regimens.
Degarelix appears cost-effective as first-line hormone therapy for advanced prostate cancer in comparison with LHRH agonists and anti-androgen flare protection, according to a Cochrane review of trials comparing degarelix with these therapies, such as finasteride (Proscar) or dutasteride (Avodart). This includes men whose disease has progressed following treatment with PSA-lowering drugs such as Proscar or Dutasteride.
Degarelix can take months, even years, to control prostate cancer once it begins reemerging, so hormone therapy plans may form part of your treatment strategy. You will require regular blood tests and doctor appointments in order to see how your body responds to medications prescribed to you.
Side effects from any hormone therapy will vary from person to person and could appear during, after, or even several days or weeks post treatment – some could last a bit longer and become permanent; if severe side effects become distressful for you, please speak to your GP or nurse who can provide advice and support.
