14th January 2008
[QUOTE=butch121;3390960]when are hormone shots necessary in the treatment of prostate cancer
Butch,
You used the word "necessary," but I would like to expand that slightly to desirable, and when you wrote "hormone shots," I would like to expand that to "hormone therapy" since some hormonal blockade therapy is delivered by an implant in the arm and not a shot (for example, Viadur is delivered that way). I'm not going to describe use of hormonal blockade as the primary therapy for low-risk patients, because that is an optional and not "necessary" use and is not clearly more desirable than other therapy options; in fact, it has a much shorter and less researched track record as primary therapy. (It still looks highly promising to me.)
Basically, hormonal blockade therapy, usually with an LHRH-agonist drug that stops the production of testosterone as the foundation, is necessary when prostate cancer is recognized as being systemic, meaning it is no longer localized in and immediately around the prostate, and also is beyond the likely range of radiation therapy. Usually systemic disease is thought of as being spread out in the body, but sometimes it is located in only one or a few places.
Hormonal therapy is also typically at least part of treatment when a man develops metastatic prostate cancer. It can be remarkably effective against metastases for a while.
Another use that I would class as desirable but almost necessary is to support radiation therapy. For cases that are somewhat challenging, patients getting radiation often do much better if they also get some hormonal blockade therapy, and there is evidence that several years of blockade is better than just a few months. There is a little evidence that hormonal therapy may also help boost effectiveness of surgery for some men, but that is controversial.
There are other options to the shots and implants, and they work basically by blocking testosterone and its relatives from docking with the cancer cell, which is necessary for growth. Some therapies just use antiandrogen drugs, like Casodex or flutamide, perhaps with either finasteride or Avodart. Those drugs do not stop the production of testosterone, and therefore they don't cause the side effects that stopping testosterone often causes to some degree (which can be fairly well managed for most of us). However, the antiandrogens often have some side effects of their own, and the antiandrogens are not as good as controlling the cancer for most of us. But, that said, I've heard one leading doctor say that this approach works for some patients as it delivers 80% of the benefits but only 20% of the side effect burden. Choosing this antiandrogen option depends on the balance between controlling the cancer and quality of life. For example, for a man in his 70s with low-risk, slow growing disease or a mild recurrence after surgery or radiation, this approach might work well. New research involving estrogen patches is showing some promise as another alternative.
I have been on intermittent hormonal blockade therapy for just over eight years for my challenging case of prostate cancer, and I am doing very well. For most of the time I have been on therapy, it has been the triple hormonal blockade version with Lupron, Casodex and finasteride, with Fosamax or Boniva in support of bone density. I am a fellow survivor and have never had any enrolled medical education.
I hope this long answer to your short question is not overwhelming, and I hope you get to see some other viewpoints.
Take care,
Jim
Butch,
You used the word "necessary," but I would like to expand that slightly to desirable, and when you wrote "hormone shots," I would like to expand that to "hormone therapy" since some hormonal blockade therapy is delivered by an implant in the arm and not a shot (for example, Viadur is delivered that way). I'm not going to describe use of hormonal blockade as the primary therapy for low-risk patients, because that is an optional and not "necessary" use and is not clearly more desirable than other therapy options; in fact, it has a much shorter and less researched track record as primary therapy. (It still looks highly promising to me.)
Basically, hormonal blockade therapy, usually with an LHRH-agonist drug that stops the production of testosterone as the foundation, is necessary when prostate cancer is recognized as being systemic, meaning it is no longer localized in and immediately around the prostate, and also is beyond the likely range of radiation therapy. Usually systemic disease is thought of as being spread out in the body, but sometimes it is located in only one or a few places.
Hormonal therapy is also typically at least part of treatment when a man develops metastatic prostate cancer. It can be remarkably effective against metastases for a while.
Another use that I would class as desirable but almost necessary is to support radiation therapy. For cases that are somewhat challenging, patients getting radiation often do much better if they also get some hormonal blockade therapy, and there is evidence that several years of blockade is better than just a few months. There is a little evidence that hormonal therapy may also help boost effectiveness of surgery for some men, but that is controversial.
There are other options to the shots and implants, and they work basically by blocking testosterone and its relatives from docking with the cancer cell, which is necessary for growth. Some therapies just use antiandrogen drugs, like Casodex or flutamide, perhaps with either finasteride or Avodart. Those drugs do not stop the production of testosterone, and therefore they don't cause the side effects that stopping testosterone often causes to some degree (which can be fairly well managed for most of us). However, the antiandrogens often have some side effects of their own, and the antiandrogens are not as good as controlling the cancer for most of us. But, that said, I've heard one leading doctor say that this approach works for some patients as it delivers 80% of the benefits but only 20% of the side effect burden. Choosing this antiandrogen option depends on the balance between controlling the cancer and quality of life. For example, for a man in his 70s with low-risk, slow growing disease or a mild recurrence after surgery or radiation, this approach might work well. New research involving estrogen patches is showing some promise as another alternative.
I have been on intermittent hormonal blockade therapy for just over eight years for my challenging case of prostate cancer, and I am doing very well. For most of the time I have been on therapy, it has been the triple hormonal blockade version with Lupron, Casodex and finasteride, with Fosamax or Boniva in support of bone density. I am a fellow survivor and have never had any enrolled medical education.
I hope this long answer to your short question is not overwhelming, and I hope you get to see some other viewpoints.
Take care,
Jim