This information explains hormonal therapy for prostate cancer patients receiving radiation therapy.
Testosterone is a male hormone that stimulates the growth of prostate cancer cells. The main goals of hormonal therapy are to prevent prostate cancer cells from growing by:
- Decreasing the amount of testosterone made by the testicles
- Blocking the action of testosterone and other male hormones
Your doctor may recommend hormonal therapy to:
- Decrease the size of the prostate before radiation therapy. This will help reduce the amount of normal tissue that gets radiation. This helps to decrease treatment side effects
- Make it easier for radiation to kill prostate cancer cells
- Relieve pain
- Slow the spread of the disease in advanced prostate cancer
Types of Therapies
There are two types of hormonal therapies for the treatment of prostate cancer. They may be used alone or in combination.
- Luteinizing hormone-releasing hormone (LH-R)H agonists block the signal from the pituitary gland that tells the testicles to make testosterone. Leuprolide (Lupron®) and goserelin (Zoladex®) are LH-RH agonists. They are given by injection. They can be given once a month, every 3 months, or every 4 months.
- Anti-androgens block testosterone from binding to cancer cells. This prevents it from helping cancer cells to grow. Bicalutamide (Casodex®) is an anti-androgen pill. It is taken once a day.
Hormonal therapy can cause a number of side effects. These may go away gradually during treatment. Sometimes they last many months after the therapy is stopped. You may not have all of these side effects.
- Hot flashes or sweats
- Erectile dysfunction (difficulty or inability to have or maintain an erection)
- Decreased sexual desire
- Diarrhea or constipation
- Generalized pain
- Breast tenderness or swelling
- Weight gain
- Muscle weakness
- A small rise in liver enzymes, which your doctor will discuss with you
- If your doctor has prescribed bicalutamide (Casodex®), take it at the same time each day, with or without food. Start at least 3 days before your first LH-RH agonist injection.
- After your first injection, you may have:
- A temporary increase in urinary frequency
- Difficulty urinating
- Increased pain or burning while urinating
These side effects should go away in 3 to 4 weeks.
- During each visit for your injection, you will have blood tests. These are to check your prostate specific antigen (PSA), testosterone, and liver enzymes.
- Alcohol may interfere with this drug. Please check with your doctor if you want to drink alcohol.
- Tell your doctor or nurse if you are taking any other medicines or have changed medicines. Some may change the way this drug works. Include:
- Medications that do and do not require a prescription
- Herbal remedies
- Dietary supplements
- Hormonal therapy may increase your risk for diabetes and heart disease. Maintaining a healthy lifestyle can help reduce this risk.
- Do not smoke. If you currently smoke, the Tobacco Treatment Program can help you quit. Call 212-610-0507 to speak with a counselor.
- Maintain or achieve a healthy body weight. You will meet with a registered dietitian to determine what a healthy weight is for you.
- Follow a healthy diet. This should be a diet high in fiber, low in fat, and low in concentrated sweets. The dietitian will guide you in how to select healthy foods.
- Exercise regularly. Examples include brisk walking, jogging, biking, aerobics, and yard work. It is recommended that you exercise 30 minutes per day in addition to your daily routine. Even if you cannot exercise every day, whatever you can do will be helpful.
- Long-term hormonal therapy may increase the risk for bone loss. This is called osteoporosis; it can lead to bone fractures. Taking enough calcium and vitamin D can help reduce this risk.
- Calcium is found in many things you eat and drink. Examples include milk, cheese, yogurt, canned salmon, tofu, cottage cheese, fortified orange juice, spinach, and almonds.
- If you aren’t getting enough calcium from your diet, a calcium supplement may be recommended by your physician or dietitian. Calcium supplements come in 2 forms: calcium citrate and calcium carbonate.
- Calcium citrate can be taken at any time of day. Calcium carbonate should be taken with meals. The recommended calcium intake for males is 1200 to 1500 mg daily from food and/or dietary supplements. If taking a supplement, take it in two separate 500 to 600 mg doses for better absorption.
- Vitamin D also plays an important role in preventing osteoporosis. Your body needs vitamin D to absorb calcium. There are three ways to get vitamin D: sunlight, food, and supplements. If you wear sunscreen or are indoors most of the time, you may need to get vitamin D from other sources.
- Food sources of vitamin D include fatty fish (salmon, mackerel, and tuna), egg yolks, liver, and some fortified products like milk and orange juice.
- It is difficult to get all the vitamin D you need from food so a supplement is often recommended. Before adding a separate vitamin D supplement, check to see if your multivitamin or calcium supplement contains vitamin D. The recommended dose is 800 IU (international units) per day.
- Weight bearing exercises will also help reduce your risk of osteoporosis. Examples include jogging, hiking stair-climbing, playing tennis, and any other sport that require your muscles to work against gravity.
- Long-term hormonal therapy may also increase the risk for anemia, a decrease in the number of red blood cells or less than normal amount of the part of the blood (hemoglobin) that carries oxygen. This can cause tiredness. Your doctor will discuss this with you and may prescribe medicine to help prevent anemia.
Call Your Doctor or Nurse If You Have Any
- Problems you do not expect
- Questions or concerns
Your injections may be given in your radiation oncologist’s office. If so, the dates are below. If you will have them in your prostate cancer doctor’s office, the nurse will tell when you will have them.
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If you have any questions or concerns, talk with a member of your healthcare team. You can reach them Monday through Friday from 9:00 am to 5:00 pm at ____________________. After 5:00 pm, during the weekend, and on holidays, please call____________________. If there’s no number listed, or you’re not sure, call 212-639-2000.