Prostate cancer - androgen deprivation therapy

What is prostate cancer?

The prostate gland is part of the male reproductive system and is a small gland that surrounds the urethra. The prostate produces some of the fluid that makes up semen, which enriches and protects sperm.

Prostate cancer occurs when abnormal cells develop in the prostate. These cells have the potential to continue to multiply, and possibly spread beyond the prostate. Cancers that are confined to the prostate are called localised prostate cancer.

If the cancer extends into the surrounding tissues near the prostate or into the pelvic lymph nodes, it is called locally advanced prostate cancer. Sometimes it can spread to other parts of the body including other organs, lymph nodes (outside of the pelvis) and bones. This is called advanced or metastatic prostate cancer.

Around 5,000 Victorians will be diagnosed with prostate cancer each year.

What is hormone therapy?

Hormone therapy or androgen deprivation therapy (ADT) uses medicines to reduce testosterone levels and treat prostate cancer. Testosterone is one of several male hormones known as androgens that are important for a healthy prostate. Unfortunately, testosterone can also help prostate cancer cells to grow and spread. By using hormone therapy to reduce the levels of testosterone, it is possible to slow the growth of prostate cancer.

Hormone therapy is the standard first line treatment for advanced prostate cancer and is also used in combination with radiation therapy to treat localised and locally advanced prostate cancer.

Hormone therapy can keep prostate cancer under control for several years by shrinking it, delaying its growth and reducing symptoms. How well hormone therapy controls the cancer is different from one man to another.

There are many different types of hormone therapy medicines, so if one type is not effective for you, your doctor may prescribe a different hormone therapy medication. Depending on the type of your cancer and what other treatments you have had or are having, you could be on hormone therapy for a few months, for several years, or indefinitely.

Hormone therapy can be given in many forms including oral tablets, injections, as an injectable implant, or a combination of these. Hormone therapy treats prostate cancer cells wherever they are in the body.

Who can have hormone therapy?

You may be offered hormone therapy:

• if you have prostate cancer that has spread outside the prostate gland or spread to other parts of the body (this is known as advanced or metastatic prostate cancer)
• before, during and/or after prostate radiation therapy to reduce the chance of the cancer spreading and improve the likelihood of a cure
• in combination with other treatments such as new/novel anti-androgens and chemotherapy.

What are the benefits of hormone therapy?

A rapid and often long-term reduction in the growth of prostate cancer, as seen by a reduction in your PSA level.

What does hormone therapy involve?

Hormone therapy can be given as medications (injections, implants or tablets) to block the production of testosterone or to block the effects of testosterone on cells.

These methods of hormone therapy are reversible and, in most cases, once treatment is stopped your testosterone level and its effects on the body will return to normal after a period of time.

Testosterone production can be permanently stopped by a surgical procedure to remove the testicles (called an orchidectomy). However, this is rarely done these days. It will stop 95% of the body’s production of testosterone. This procedure is not often recommended anymore as injections or implants are commonly used instead. The operation is performed as an inpatient procedure and it is unlikely that you will need to stay in hospital overnight. Many men have trouble accepting the removal of their testicles and some are very concerned about what they will look like afterwards. It is possible to have implants inserted. These are small and soft, and they look and feel like normal testicles

Possible side effects of hormone therapy

If you are troubled by the side effects of hormone therapy, contact your GP, nurse or a member of healthcare team for advice.

All prostate cancer treatments, including hormone therapy, come with potential side effects. The likelihood of having side effects depends on the type of hormone therapy you are taking and the length of time that you are on it. If you are having other treatments as well, you may also experience side effects from that treatment.

Hormone therapy can affect people differently. Some men may experience minimal or no side effects, while others may be very troubled by side effects. After stopping hormone therapy, some side effects may diminish with time, but sometimes the side effects never go away.

Recovery from hormone therapy side effects after stopping treatment will depend on your age, the type of hormone therapy you were on, whether you were on a short course of hormone therapy over a few months or a longer course over several years, and whether the hormone therapy was continuous or intermittent.

Ask your doctor how long you will be on hormone therapy and what to expect when you stop taking the medication. It is important to find out as much information as you can about your treatment and the side effects before you start, so that you can be better prepared.

Possible side effects include:

• Loss of libido or sex drive
• Erection problems
• Hot flushes and night sweats
• Fatigue (tiredness)
• Weight gain from increased body fat
• Declining bone density (osteoporosis)
• Loss of muscle mass and muscle weakness
• Depression or mood swings
• Poor memory, concentration and physical unsteadiness
• Breast swelling and breast tenderness
• Increased risk of cardiovascular disease and diabetes.

Other side effects can also include headaches, itching, dry skin, rashes, gastrointestinal issues, and vomiting.

For further management of each of these side effects please read or download Understanding Hormone Therapy for prostate cancer.

Looking after yourself

Hormone therapy can impact all areas of your life so it’s important to look after yourself.

If you have prostate cancer, it is normal to have a wide range of feelings and emotions such as shock, sadness, anxiety, anger, fear and frustration. You may also experience physical effects of stress like nausea, stomach upsets, feeling irritable or on edge, and trouble sleeping. Some days will be worse than others. It can help to talk through your problems with a partner or good friend, gather information and advice from trusted sources, and focus on keeping well. If you are distressed and having trouble managing, talk to your GP or a member of your healthcare team.

Physical activity and exercise

Physical activity is very important for maintaining and improving your physical and psychological health. It is important to do some physical activity most days, if not every day. Targeted exercises can help slow the progression of your prostate cancer, reduce the side effects of treatments and enhance your recovery. Exercise can also improve your quality of life and help with anxiety and depression. The most effective forms of exercise are:

• cardiorespiratory exercise such as fast walking, jogging, cycling and swimming
• resistance training exercises such as lifting weights, stair climbing and high intensity resistance workouts.
• for best results consult an Accredited Exercise physiologist. You can find more information at www.essa.org.au/find-aep or call Tel. (07) 3171 3335

Diet and nutrition

A healthy, balanced diet can improve your strength, vitality and wellbeing, help you manage your cancer experience, and improve your outcomes from treatment.

For the best diet:

• eat plenty of fruit and vegetables, wholegrain foods and lean meat, fish, poultry and low-fat dairy
• avoid animal fats, processed meals, biscuits, cakes and pies, salt and added sugars
• drink plenty of water
• limit alcohol
• stop smoking.

Where to get help

• Your GP (doctor)
• Urologist
• Androgen deprivation therapy - Healthymale (Andrology Australia)
• Prostate Cancer Foundation of Australia (PCFA) Tel. 1800 22 00 99 (freecall)
• Beyond Blue: the National Depression Initiative – providing information about, and support for, anxiety and depression. Tel. 1300 22 46 36
• Cancer Council Australia: professional telephone and online support, information and referral service. Tel. 13 11 20
• Dietitians Australia: find an accredited practising dietitian Tel. (02) 6189 1200
• Exercise & Sport Science Australia (ESSA): find an accredited exercise physiologist Tel. (07) 3171 3335
• Heart Foundation: information on heart disease. Tel. 13 11 12
• Lifeline Australia: personal crisis support and suicide prevention. Tel. 13 11 14 (24-hour service)
• Healthy Bones Australia: information on osteoporosis. Tel. 1800 242 141