Treatment after hormone therapy for advanced prostate cancer
Over time prostate cancer cells can change and begin to grow, even without testosterone.
Despite your hormone therapy continuing to stop your body making testosterone, the cancer cells can start to grow and your PSA level can start to go up.
A steady rise in your PSA level may be the only sign that your cancer is not responding to the hormone therapy as well as before. If your PSA level rises slowly and you have no symptoms, your doctor may choose to monitor your PSA level for a while.
This is because it is not yet clear when it is best to start other treatments. If your PSA level rises more quickly, or if you have symptoms such as pain, your doctor will discuss which treatment options are open to you.
Other treatments for prostate cancer
Your prostate cancer may respond to other types of hormone therapy or to other treatments. The exact order in which treatments are given is not the same for all men. The aim is to control your prostate cancer and to improve any symptoms you may have.
When deciding which treatments are best for you, your doctor and you will balance the side-effects of treatment against the benefits of treatment.
You may be offered the following treatments:
- Withdrawal of hormone therapy
- Steroid therapy
- Other hormone therapies
- Radioactive injections
Withdrawal of hormone therapy
If you have been taking both hormone injections and tablets for advanced prostate cancer, your doctor may suggest stopping the tablets if your PSA level starts to rise again.
In some men, stopping these anti-androgens tablets once the PSA level starts to rise can help to make it fall again. This is known as anti-androgen withdrawal. Some men find that this helps to lower their PSA level for a few months or sometimes longer.
You might be given steroids, either to take along with another treatment or on their own. Steroids can help to reduce the amount of testosterone made in your adrenal glands. Side-effects from steroids include an increased appetite and an improved mood. They can also increase your risk of diabetes and cause bone-thinning, fluid retention and other body changes. Your doctor will check for these side-effects regularly.
Chemotherapy is a treatment using drugs to help kill cancer cells that have travelled to other parts of your body. It is used to control prostate cancer but cannot yet cure it. It may be used if your cancer has spread beyond the prostate and is no longer controlled by hormone therapy. In certain cases chemotherapy may be used at the start of your treatment for advanced prostate cancer, in combination with hormone therapy. Chemotherapy may reduce the size of the tumour and ease your symptoms.
In some cases, chemotherapy will improve your quality of life with better control of your symptoms. Chemotherapy is given to help:
Shrink your prostate cancer
Slow down the growth of your cancer
Control symptoms such as pain
Improve your quality of life
If you would like more details about chemotherapy, see our booklet Understanding Chemotherapy or order a print copy from the Cancer Nurseline Freephone 1800 200 700. You can also visit a Daffodil Centre if one is located in your hospital. You can also view some short films about chemotherapy.
Other hormone therapies
If your cancer is no longer responding well to the hormone therapy that you are taking, your doctor may suggest you try a different hormone therapy. The aim is still to prevent male hormones from helping the cancer to grow, but the drugs work in different ways.
The aims of treatment include:
to shrink the prostate cancer or slow its growth
to help with symptoms
to lower your PSA level
Your doctor will discuss when is the right time for you to receive these types of drugs. Examples of other hormone therapies include abiraterone (Zytiga®) and enzalutamide (Xtandi®). These drugs may be given before or after chemotherapy.
Different hormone therapy drugs have different side-effects, and reactions to drugs vary from person to person. Ask your doctor about any side-effects you may get from the drug you have been prescribed. Side-effects may include tiredness, low potassium, aching muscles and joints, high blood pressure, hot flushes, headaches and loss of fertility, depending on the drug used.
Radioactive injections can help the symptoms of prostate cancer that has spread to the bones. The radioactive substance can treat the bone cancer cells directly and may help to relieve pain.
Because the radiation is targeted at the cancer cells, side-effects are mild and may include diarrhoea and sickness and sometimes low levels of blood cells called platelets after a few weeks. An example of a radioactive injection used in this way is radium-223 (Xofigo®). After treatment, very small amounts of radiation may be present in your urine for a few hours or in your bowel motions for up to week. You can speak with your doctor or nurse about any precautions you need to take.