Prostate Cancer Hormone Therapy Side Effects

Treatments for prostate cancer include radical prostatectomy, hormone therapy, chemotherapy, radiation (both external beam and brachytherapy), HIFU, and Cryotherapy.

The treatments for prostate cancer are all associated with varying degrees of side effects. When evaluating treatments to decide which one(s) may be most effective and also suitable for your preferences and lifestyle, one factor that drives that decision is the side effects associated with each treatment approach.

Side Effects of Hormone Therapy

Hormone therapy consists primarily of antiandrogens and luteinizing hormone, anabolic steroids therapy, releasing hormone (LH-RH) agonists, and in some cases, surgical removal of the testicles (orchiectomy). Estrogen therapy is rarely used.

    Breast pain and enlargement: Antiandrogens, estrogen, and orchiectomy may result in sensitive and/or painful nipples and/or an increase in breast tissue.
    Cardiovascular events: Continuous estrogen therapy is associated with blood clots, stroke, and other cardiovascular risks.
    Cholesterol changes: Antiandrogens can lower “good” cholesterol (high-density lipoprotein—HDL) when combined with LH-RH treatment. LH-RH treatment alone can significantly increase triglycerides.
    Diarrhea and/or constipation: Antiandrogens can cause these side effects.
    Erectile dysfunction/loss of libido: Antiandrogens, LH-RH agonists, and orchiectomy are associated with erectile dysfunction, while LH-RH agonists can also reduce libido.
    Fatigue: Antiandrogens, LH-RH agonists, and estrogen can all cause fatigue.
    Hair and skin changes: Antiandrogens and LH-RH agonists are associated with hair growth on the head, hair loss on the rest of the body, and dry skin.
    Hot flashes: Antiandrogens, LH-RH agonists, and orchiectomy are associated with hot flashes.
    Osteoporosis: Antiandrogens, LH-RH agonists, and orchiectomy contribute to bone loss. Other factors include a man’s bone health before therapy, the length of hormone therapy, and fracture history.
    Penis/scrotum shrinkage: Any reduction in testosterone can reduce the size of the penis and scrotum.
    Weight and/or belly fat gain: Antiandrogens and LH-RH agonists can contribute to these side effects.

Can Testosterone Replacement Therapy Cause Cancer?

One of the pressing questions men ask when faced with the possibility of starting testosterone hormone therapy is, “Can testosterone replacement therapy cause cancer?” Up until recently, this question would likely have been answered by most doctors with a resounding “yes.”

However, a great deal of research has been done to determine whether the “yes” response to the question about testosterone therapy and prostate cancer is accurate, and based on accumulating evidence, it appears the answer is “no.” One compelling reason for the “no” response can be attributed to the comprehensive investigative work done by Abraham Morganthaler, MD, FACS, author of Testosterone for Life, who evaluated the original work by urologist Charles Higgins in the 1940s, research that led to the misconception that taking testosterone can cause prostate cancer.

Morganthaler discovered that this idea arose out of one case study involving one patient. In other words, the fear that testosterone therapy can cause prostate cancer was based on nothing. In fact, in recent years there have been many studies that dispel the myth that testosterone replacement therapy causes prostate cancer or has a significant negative impact on the prostate. For example:

    A Beth Israel Deaconess Medical Center review of 72 studies (Rhoden 2004) found “no compelling evidence that testosterone replacement therapy increases the incidence of prostate cancer.”
    A report by The Prostate Cancer Center Hamburg-Eppendorf in Germany. (Isbarn 2009) stated “the available research strongly suggested that testosterone therapy neither increases the risk of prostate cancer in normal men nor causes a recurrence of the cancer in men who have been treated successfully for prostate cancer.”
    In a study of 57 men who received testosterone supplementation for an average of 36 months after prostatectomy surgery, although mean testosterone levels rose in all the men before testosterone therapy, there was no increase in PSA values after testosterone therapy started. So, testosterone replacement therapy caused hormone levels to rise, PSA values to remain the same, and symptoms to be relieved. Baylor College of Medicine study (Khera 2009)
    A study conducted within the ongoing Osteoporotic Fractures in Men cohort looked at the association between testosterone, estradiol, estrone, and sex hormone-binding globulin and prostate cancer. Only estrone was strongly related to an increased risk of prostate cancer. University of California, San Francisco.
    In a landmark study reported in 2006, men who had low testosterone levels were given testosterone injections or placebo every two weeks for six months. Before and throughout the study, the investigators took measurements of testosterone and DHT from both blood samples and the prostate itself. The researchers found that although blood concentrations of testosterone and DHT rose substantially in men who were given hormone replacement therapy, the concentration of testosterone and DHT did not change at all in the prostate gland. In addition, testosterone therapy had no effect on biochemical markers of prostate cell growth. Therefore, the authors noted that while testosterone replacement therapy normalized blood levels of testosterone, treatment did not affect prostate tissue or prostate cell functions. According to Morganthaler, “it is as if once the prostate has been exposed to enough testosterone, any additional testosterone is treated as excess and does not accumulate in the prostate.” To state it another way, he said “we say the prostate has been saturated with regard to testosterone.”

According to a Johns Hopkins Prostate Disorders Special Report, “Testosterone-Replacement Therapy: Does It Increase Prostate Cancer Risk?” the jury is still out on whether testosterone replacement therapy is safe when men take it for a prolonged time. Morganthaler would take that a step further, as he has noted that “The relationship of testosterone to prostate cancer has undergone a significant reevaluation, and all recent evidence has reinforced the position that testosterone therapy is safe for the prostate.”

In addition, if you already have prostate cancer, the concern has been that taking testosterone could make the cancer progress faster, or that the hormone could promote tumor growth. These worries are the reasons why some doctors will not prescribe testosterone therapy for men who have a history of prostate cancer.

What is Testosterone Replacement Therapy?

Testosterone replacement therapy is the use of testosterone supplements to restore testosterone levels to a normal range in men who have a deficiency of the hormone. This therapeutic approach can be used to treat erectile dysfunction that is associated with a testosterone deficiency, and to treat symptoms of andropause (male menopause). Testosterone replacement therapy should not be used unless a man has a verified deficiency of testosterone.

To get the most accurate reading of your testosterone levels, a saliva test is recommended. A blood (serum) test does not measure all the hormone that is carried by red blood cells, and thus doctors could prescribe a dose that is too high.

Bio-identical testosterone gel or cream is the best way to get the hormone into your system. The term “bio-identical” means that the hormone is biochemically the same as the hormone the body produces naturally. Synthetic hormones are drugs and are foreign to the body, so the body essentially does not treat them like hormones. Because synthetic hormones are not true hormones, they do not provide the same benefits as the real thing.

A testosterone cream or gel allows the hormone to be absorbed through the skin and into the blood without having to pass through the liver, as an oral dose would have to do. Oral testosterone goes through the liver and 90 percent becomes bound to protein, severely limiting its effectiveness. Transdermal testosterone is at least 10 times more efficient than oral dosing. A compounding pharmacy can make up a testosterone cream that will provide you with the right dose to bring you back into balance. 

Testosterone Therapy vs Anabolic Steroid Use

There is a lot of confusion between the use of anabolic steroids and bioidentical testosterone replacement therapy. For this reason, many people shy away from testosterone therapy, thinking it’s a bad thing. Too many people believe that there is no difference between anabolic steroids and bioidentical testosterone replacement. Yet, although anabolic steroids are related to male sex hormones like testosterone, there are some vital differences.

Anabolic steroids are synthetic hormones that are similar in many ways to the androgens, or male sex hormones. Like bioidentical testosterone, the anabolic steroids do promote the growth of skeletal muscle and the secondary male sexual characteristics. Anabolic steroids can be used in productive ways to treat conditions that occur when the body produces abnormally low levels of testosterone. However, bioidentical hormones would actually be a better choice because there are fewer side effects associated with them; those side effects that are possible are less dangerous than those posed by synthetic hormones such as anabolic steroids.

Most people are not as aware of the potential usefulness of anabolic steroids as they are of the potential for abuse. Athletes have been known to use anabolic steroids to develop muscle mass more quickly and become stronger or faster or just plain better at their sport. Of course, the public frowns upon the practice of using anabolic steroids. There are serious and undesirable side effects that can occur as a result of using anabolic steroids to achieve higher levels of athletic performance. For example, abusers can develop liver or kidney tumors, cancer, jaundice, high blood pressure, severe acne, and trembling. Men's testes may shrink and they can develop breasts. In women, anabolic steroid abuse can lead to a growth of facial hair, menstrual changes, and a deepening of the voice. Teens who abuse anabolic steroids may stop growing prematurely and permanently.

Bioidentical testosterone therapy is different from anabolic steroid use or abuse in several ways. First of all, bioidentical hormones are identical in structure and function to the hormones produced by the human body. Synthetic anabolic steroids, in contrast, differ ever-so-slightly from the testosterone produced in the human body. These slight biochemical differences between human testosterone and synthetic androgens are the reason for most of the dangerous side effects associated with the synthetic hormones.

As with most substances, abusing bioidentical testosterone could cause undesirable effects like feminization in men, hair loss and severe acne. Since bioidentical testosterone is typically used to replace testosterone that the body is not producing in adequate quantities either due to disease or old age, it is difficult to abuse. When the body has excess testosterone, it converts it into estrogen and DHT, causing feminizing effects in men. Replacement therapies simply replace missing testosterone; anabolic steroids, however, add more testosterone to the body than it needs, generating some nasty side effects.

Men who are considering bioidentical hormone therapy need to understand that anabolic steroids and bioidentical testosterone are not the same. Bioidentical doctors monitor liver function and lipid levels in men who are using bioidentical testosterone to replace what they are missing. Side effects of this type of therapy do exist, but they are less common than those experienced by men who use anabolic steroids. Bioidentical testosterone can have some important health benefits for aging men. Talking with a bioidentical hormone doctor can help clear up any fears and misunderstandings and help you understand how bioidentical testosterone can improve your overall health as you grow older.

Prostate Cancer Treatment. Part Two

X-ray therapy

There are two types of X-ray therapies for prostate cancer treatment:

1. outer radiation similar to profondometer is used. Sessions are made every day and each session takes several minutes. Course of treatment takes 6-7 weeks. Usage of computerized tomography helps to define tumor localization to radiumize tumor more aimingly.


2. infernal irradiation is used. The source of irradiation is placed directly into prostate gland and it acts during several months, after which it inactivates by itself.

X-ray therapy has side effects. Most patients complain on tiredness, indigestion (diarrhea, nausea), strangury, prolonged erection.

Hormonotherapy

Size of tumors in prostate gland depend on the amount of testosterone in blood of a man. Testosterone level lowering helps in tumor decrease and in slowing of its growth. To lower testosterone level also may help testes removal (orchectomy), because exactly in testes is produced a significant amount of testosterone. There is an alternative to this method - you may just take hormonal agents.

Hormonotherapy slows prostate cancer progression, but is not treating it. Hormonotherapy has such side effects as infertility, decreased interest, flushes, impotence and osteoporosis.

Chemotherapy

Treatment with medications that do kill cancerous cells in whole body is used only in case when tumor has spread in other organs. The main purpose of this treatment is decease of pain and lowering of tumor growths. According to latest researches, Taxotere (Docetaxel) medication increases life time in ill with prostate cancer with metastasis in other organs.

After-effect of prostate cancer treatments

On completing of prostate cancer treatment, patients remain under permanent control of the doctor. To detect possible recurrence of the disease it is recommended to make regular examinations including PSA-test. After detection of recurrent cancer of prostate gland, treatment should be chosen by taking into account methods which were used for the first time.

Latest achievements in the prostate cancer study

1) HPC1 gene

The discovery of this gene helps to believe that in the nearest future may appear new data about genetic mechanisms that do lead to prostate cancer. Probably, may be developed tests that would help to detect excessive predisposition to this illness, and this may help to examine men from risk groups in early age.

2) Angiogenesis

At the present day new medications are being tested which, according to expectations, will localize tumor by means of decline of blood supply. Also is performed Vascular endothelial growth factor (VEGF).

3) Prostate Cancer Vaccines

Several kinds of vaccines improving immunity to prostate cancer are tested.