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How Many Hormone Injections For Prostate Cancer

How Is Prostate Cancer Diagnosed

Hormone Therapy & Advanced Therapies for Prostate Cancer, Celestia Higano, MD | 2021 Mid-Year Update

Prostate cancer may be suspected based on your symptoms or the results of a screening test.

Screening is when your doctor looks for cancer before you have any symptoms. This can help find cancer at an early stage when it may be easier to treat. Two of the most frequently used screening tests used today include the digital rectal exam and the prostate-specific antigen test.

  • A digital rectal exam is an exam of the rectum where the doctor inserts a lubricated, gloved finger into the lower part of the rectum to feel for lumps or enlargement in the prostate gland.
  • A prostate-specific antigen is a blood test that measures levels of PSA in your blood. However, PSA is reasonably nonspecific and high levels may be associated with prostate cancer, prostatitis , or an enlarged prostate gland. Very high levels of PSA .

There is controversy over whether screening tests should be used at all. The USPSTF recommends men aged 55 to 69 have a discussion with their doctor about the pros and cons of PSA screening to determine if it is an appropriate preventive test for them. For men aged 70 and older, the USPSTF does not recommend PSA screening.

The American Cancer Society, recommends early-detection screening starting at age 40 or 45 if men are at high risk or age 50 in men at average risk.

In some cases, a prostate biopsy or imaging test like an ultrasound or magnetic resonance imaging may also be used to rule out cancer.

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What Is Prostap Used For

  • In men, Prostap injections are given to treat prostate cancer. They are used for high risk localised cancers, locally advanced cancers and those that have spread. The injections might be used on their own, or alongside surgery or radiotherapy.
  • In women, Prostap injections are used to treat endometriosis and fibroids. You may also be given the injection to thin your womb lining before having a type of surgery called endometrial ablation or resection. They are also now used in the treatment of breast cancer suitable for hormonal manipulation.
  • In children, the injections are given to treat early puberty in girls aged under 9 years and boys under 10 years.

Prostate Cancer Risk Groups

Prostate cancer can be categorised into one of 5 risk groups in the Cambridge Prognostic Group .

Doctors will look at the Grade Group , prostate specific antigen level and tumour stage to decide which CPG group the prostate cancer is.

The risk group of the cancer will help determine which types of treatments will be necessary.

If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.

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How Long Do You Take Hormonal Therapy For

For early prostate cancer this depends on the prostate cancer risk group. If the cancer is:

  • intermediate-risk you may have hormonal therapy for a few months after radiotherapy
  • high-risk you may be advised to have hormonal therapy for up to 2 to 3 years after radiotherapy.

For locally advanced prostate cancer you usually have hormonal therapy for 2 to 3 years after radiotherapy.

Lowering Adrenal Gland Androgen Levels

Table 2 from Sipuleucel

Because LHRH agonists and antagonists only lower testosterone production levels in the testicles, other treatments may be needed to lower androgens made by the adrenal glands or the prostate cancer itself.

Medications that lower adrenal gland androgen levels include:

  • Zytiga® : Taken orally each day, this treatment is often used when cancer has spread to the bones or if the patient is high-risk or has castrate-resistant prostate cancer, meaning its still growing despite low testosterone levels.
  • Nizoral® : This treatment is also taken orally and works similarly to abiraterone. Its also used in men with advanced prostate cancer whose cancer has spread.

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Questions To Ask Your Doctor Or Nurse

  • What is the aim of treatment?
  • What type of hormone therapy are you recommending for me and why?
  • How often will I have my injections or implants?
  • How will my treatment be monitored?
  • How long will it be before we know if the hormone therapy is working?
  • What are the possible side effects, and how long will they last?
  • What will happen if I decide to stop my treatment?
  • Are there any clinical trials that I could take part in?

Hormone Therapies For Prostate Cancer Treatment

Male hormones cause prostate cancer cells to grow. Androgens support a healthy prostate gland however, they can also promote the growth of cancerous prostate cells.

When using hormone therapy for prostate cancer, the treatment can block the production or use of androgens in one of the following ways:

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Risk Of Other Health Problems

Evidence suggests that having hormone therapy might increase the chance of developing heart disease, stroke and type-2 diabetes. There is also some research that suggests having hormone therapy can increase your risk of getting blood clots and anaemia. But more research is needed to help us understand the links between these conditions.

Research shows that hormone therapy can cause:

  • an increase in weight, particularly around the waist
  • an increase in cholesterol levels
  • changes in insulin.

Talk to your hospital doctor and GP about how often you should have general health checks. You may be weighed and have your blood pressure checked regularly. You may also have blood tests to check for diabetes and to measure your cholesterol levels. Your GP may suggest you have these checks about every six months. Or you can ask for them yourself at your GP surgery.

If you already have heart problems or diabetes, talk to your doctor before you start hormone therapy. They will work with you to manage these conditions.

While the risk of getting these conditions may be worrying, its important to remember that hormone therapy helps men to live longer by controlling the cancer.

What can help?

A healthy lifestyle can help reduce your risk of heart disease, stroke and type-2 diabetes. This includes:

  • eating a healthy diet

Read more about diet and physical activity.

What Types Of Hormone Therapy Are There

Intermittent Hormone Therapy for Prostate Cancer 101 | Ask a Prostate Expert, Mark Scholz, MD

There are three main ways to have hormone therapy for prostate cancer. These are:

  • injections or implants
  • surgery to remove the testicles .

The type of hormone therapy you have will depend on whether your cancer has spread, any other treatments youre having, and your own personal choice. You may have more than one type of hormone therapy at the same time.

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Appendix: Summary Of Fda

The following table shows which treatments are appropriate for treating advanced prostate cancer, depending on whether the cancer is sensitive to androgen deprivation therapy and whether distant metastases are present. Please note that these are general guidelines and final decisions are made by the health care provider in consultation with the patient.

Disease State

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Checking Your Hormone Therapy Is Working

You have regular blood tests to check the level of a protein called prostate specific antigen . PSA is a protein made by both normal and cancerous prostate cells. It is in the blood in small amounts in all men, unless you have had the prostate gland completely removed.

While the hormone therapy is working, the level of PSA should stay stable or may go down. But if prostate cancer starts to grow and develop, the level of PSA may go up. This is hormone resistant prostate cancer or castrate resistant prostate cancer. Then your doctor may need to change your treatment. They will discuss this with you

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How Should I Use Eligard

Take Eligard exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Different brands or strengths of leuprolide are used to treat different conditions. It is very important that you receive exactly the brand and strength your doctor has prescribed. Always check your medication to make sure you have received the correct brand and type prescribed by your doctor.

Eligard is injected under the skin or into a muscle, once every month or once every 3 to 6 months. A healthcare provider can teach you how to properly use the medication by yourself.

Read and carefully follow any Instructions for Use provided with your medicine. Do not use Eligard if you dont understand all instructions for proper use. Ask your doctor or pharmacist if you have questions.

Your symptoms may become temporarily worse as your hormones adjust to leuprolide.

Keep using the medicine as directed, and tell your doctor if your condition is still worse after 2 months of using Eligard.

You may need frequent medical tests while using leuprolide.

Store Eligard in the refrigerator. Do not freeze. You may take the medicine out and allow it to reach room temperature before mixing and injecting your dose. Mixed medicine must be used within 30 minutes.

You may also store Eligard in its original packaging at room temperature for up to 8 weeks.

What The Researchers Did

Prostate Cancer

Dr. Crawfords team reviewed clinical data from nearly 23,000 men who were given ADT injections between 2007 and 2016. Each mans treatment varied by how their ADT was formulated. Some types of ADT are given once a month, and others are given at three-, four-, or six-month intervals. The researchers wanted to know how many men were late on their ADT treatments, and how that would affect the amounts of testosterone in their blood.

During this research, the investigators defined month in two ways: either as one lasting 28 days, which is how months were defined during the clinical trials that set dosing schedules for ADT, or as a calendar month lasting 31 days. ADT was deemed late if it was given after day 28 by the first definition or after day 32 by the second definition.

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How Do Prostap Injections Work

Prostap injections contain the active ingredient leuprorelin acetate, which is a type of medicine known as a gonadorelin analogue. It’s similar to a natural hormone called gonadotropin releasing hormone . GnRH acts on the pituitary gland in the brain, causing production of testosterone in men and oestrogen in women.

Leuprorelin acts on the pituitary gland in the same way as natural GnRH. It initially increases the production of testosterone and oestrogen, but with continued treatment it desensitises the pituitary gland. This stops the production of testosterone in men and oestrogen in women.

Prostate cancer

The growth of most prostate cancers is stimulated by testosterone. Leuprorelin deprives the tumour of testosterone, causing it to stop growing or shrink.

Endometriosis and fibroids

The growth of endometriotic tissue and uterine fibroids is stimulated by oestrogen. By stopping oestrogen production, leuprorelin brings on a temporary menopause that deprives these tissues of oestrogen and causes them to stop growing or shrink.

Breast cancer

Because of its effect on body hormones, leuprorelin can be used to treat hormone responsive early stage breast cancer in pre and perimenopausal women at higher risk of recurrence, and hormone responsive advanced breast cancer in pre and perimenopausal women.

Early puberty

What Kinds Of Medical Information Should I Keep

It is important for you to keep a copy of your prostate cancer treatment records. You may not always see the same doctor for your follow-up care, so having this information to share with another doctor can be very helpful. The following is a list of medical information you may want to keep.

Remember, you have the right to copies of all your medical paperwork and the actual slides, x-rays and any other information about your health care and treatment. A good idea would be to create two copies of your medical information and keep them in folders. Keep one folder at home and take the other one with you to your doctors appointments. Whenever you see a new doctor, it is important for you to let them know about your prostate cancer and any treatment that you have had.

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Scientists Make A Prostate Cancer Breakthrough

By Gwyn Wright via SWNS

A prostate cancer breakthrough could stop the tumor from spreading after it becomes resistant to current therapy, scientists say.

Anti-hormonal treatment blocks the signal sent out by testosterone that stimulates tumor growth.

But eventually, the cancer cells become resistant and the growth spreads through the body becoming fatal.

An international research team led by Dutch scientists found proteins that normally regulate the circadian rhythm, or body clock, dampen the effects of the anti-hormonal therapy.

The breakthrough means current drugs could be repurposed and has saved a decade of testing.

The exact process of how tumor cells become resistant to hormone therapy had been a mystery until now.

For the study, the team looked at tissue from 56 people with high-risk prostate cancer who had undergone three months of anti-hormonal therapy before their surgery.

The team examined the tissue at DNA level after the three months were up.

Genes keeping the cells alive despite the treatment were controlled by a protein that normally regulates the body clock.

This protein was found to make prostate cancer cells more sensitive to anti-hormonal therapy in the lab as well as in mice.

The researchers say there is no evidence to suggest people with out-of-kilter body clocks, such as night shift workers, could be at a higher risk of the disease.

These circadian clock proteins acquire an entirely new function in the tumor cells upon hormonal therapy.

Who Can And Can’t Have Prostap Injections

What is the Best Hormone Therapy for Prostate Cancer?

Most people can have Prostap injections, however they are not suitable for:

  • Women who are pregnant. If you could get pregnant you’ll need to use a non-hormonal method of contraception, eg condoms or diaphragm, while you’re having Prostap injections and for a few months after your last injection. Ask your doctor for further advice.
  • Women who are breastfeeding.
  • Women with vaginal bleeding where the cause is not known.

Your doctor will need to weigh up the risks and benefits of having Prostap injections and may need to do some extra monitoring if you have:

  • osteoporosis or a risk of developing it, for example due to a family history, anorexia or bulimia, smoking, excessive alcohol consumption, low body mass index , or long-term treatment with corticosteroid or anticonvulsant medicines
  • liver problems.

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Hormone Therapies For Breast Cancer Treatment

Several treatment options are available for treating hormone-sensitive breast cancers. Some drugs block the effects of estrogen on the cancer cells in the breast, while others prevent estrogen production altogether.

Common hormone therapy drugs include Tamoxifen , Arimidex® , and Femara® , along with Faslodex® for recurrent breast cancer.

Breast cancer in males may also be treated with tamoxifen. Tamoxifen is currently being studied as hormone therapy for the treatment of other types of cancer.

What To Expect During Hormone Therapy

As you go through hormone deprivation therapy, youâll have follow-up visits with your cancer doctor. Theyâll ask about side effects and check your PSA levels.

Doctors donât know how long hormone therapy works to keep prostate cancer in check. So, while you take it, your doctor will regularly draw blood to check your PSA levels. Undetectable or low PSA levels usually mean that the treatment is working. If your PSA levels go up, itâs a sign that the cancer has started growing again. If this happens, your cancer is considered castrate-resistant, and hormone deprivation therapy is no longer an effective treatment.

Youâll also get other blood tests to see if the cancer is affecting other parts of your body like your liver, kidneys, or bones. Scans will show how well your cancer is responding to hormone therapy.

To lessen the side effects of hormone therapy drugs, researchers suggest that you take them for just a set amount of time or until your PSA drops to a low level. If the cancer comes back or gets worse, you may need to start treatment again.

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What Other Drugs Will Affect Eligard

Eligard can cause a serious heart problem. Your risk may be higher if you also use certain other medicines for infections, asthma, heart problems, high blood pressure, depression, mental illness, cancer, malaria, or HIV.

Other drugs may interact with leuprolide, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.

How Are Hormone Therapy Medicines Used

Prostrate Cancer Hormone Therapy

Hormone therapy medicines may be used alone, with another type of hormone therapy, or with another type of prostate cancer treatment.

Monotherapy

Monotherapy is when only one type of hormone therapy medicine is used to lower the amount of testosterone in your body. Monotherapy can be effective in shrinking a prostate cancer tumor, slowing the spread of your prostate cancer, and relieving pain caused by your prostate cancer. Monotherapy may be used with neoadjuvant therapy or adjuvant therapy. Please read When is Hormone Therapy Used for Prostate Cancer? to learn more about neoadjuvant and adjuvant therapy.

Combination therapy

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Hormone Therapy Available At Willamette Valley Cancer Institute

Some cancers grow because of hormones present in the body. Usually, there is too much of a hormone that is fueling the cancers growth. A cancer treatment that slows or stops the growth of cancers that use hormones to grow is called hormone therapy. Prostate and breast cancers are commonly treated with hormone therapies.

Hormone therapy, also called hormonal therapy or endocrine therapy, is commonly used in addition to other cancer treatments. The types of treatment you are prescribed are based on the type of cancer, if it has spread, and how far, if it uses hormones to grow, and if you have other health problems.

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