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Prostate cancer cells often rely on male hormones (“androgens”), such as testosterone, to grow.

A common misconception is that hormone therapy treatments introduce hormones into a man’s body. Instead, hormone therapy helps suppress testosterone that a man’s body may otherwise produce. This may help shrink cancer cells or slow tumor growth.

There are two common reasons why hormone therapy is recommended.

• to increase the effectiveness of other recommended treatments, such as radiation therapy. For prostate cancer that is still in or around the prostate, your doctor may recommend hormone therapy as the first step before radiation therapy. Hormone therapy can help shrink the tumor, which can make the radiation therapy more effective because the target is smaller.
• to help slow down cancer growth in more advanced cases. Doctors may recommend hormone therapy for prostate cancer that has spread too far to be treated by surgery or radiation. As a standalone treatment, hormone therapy can help improve the quality and length of life for men with prostate cancer.

There are many types of hormone therapy for prostate cancer. The two most common hormone therapies prescribed by our doctors are androgen deprivation therapies and antiandrogen therapies.

Androgen Deprivation Therapies

Androgen deprivation therapy (ADT) stops the testicles from making testosterone. As part of ADT, doctors may prescribe luteinizing hormone-releasing hormone (LHRH) agonist and antagonist medicines, such as leuprolide (Lupron), degarelix (Firmagon), or Orgovyx (Relugolix). These are often used when prostate cancer has spread or returned after treatment.

Many LHRH agonist and antagonist medicines are given as a shot. They are typically injected under the skin or into a muscle once a month or once every three months.

After taking an LHRH agonist, such as leuprolide, testosterone levels might increase temporarily. If needed, our doctors may prescribe antiandrogen medicine to help reduce the risk of a testosterone flare up.

Side effects of ADT may include decreased interest in sex, erectile dysfunction, hot flashes, decreased bone density, increased risk of broken bones, reduced muscle size and strength, resistance to insulin, sudden or intense mood changes, and extreme tiredness.

Antiandrogen Therapies

Antiandrogen therapies help to prevent testosterone from fueling tumor growth. They may be prescribed for men with hormone-sensitive or hormone-resistant prostate cancer that has spread or returned after treatments. Hormone-sensitive prostate cancer means that the cancer relies on male hormones, called androgens, to grow—and growth should stop when androgens aren’t present. Hormone-resistant prostate cancer grows despite reducing testosterone through ADT. In those cases, antiandrogen therapies may be considered.

There are various types of antiandrogen therapy medications. One of the most common types our doctors prescribe is abiraterone, a CYP17 inhibitor that prevents certain genes from producing testosterone. It is usually taken by mouth with water on an empty stomach. Abiraterone generally lowers testosterone levels more effectively than ADTs.

Abiraterone is often prescribed with a low dose of the steroid prednisone to help prevent side effects, such as fluid retention and high blood pressure.

Other side effects of antiandrogen therapy may include diarrhea, breast soreness, nausea, hot flashes, decreased interest in sex, and erectile dysfunction.

Managing Hormone Therapy Side Effects

For long-term hormone therapy, our doctors may prescribe medications to help manage certain side effects. For instance, a medication may be prescribed to help slow or reverse bone density loss. For some men, many of the sexual and emotional side effects of hormone therapy will subside when therapy ceases.

At Perlmutter �鶹��Ƶapp Center, our medical oncologists always weigh the risks and benefits of hormone therapy before prescribing it to patients.

Our prostate cancer care also extends beyond medical treatment, providing patients with access to integrative health services, like massage therapy and yoga, nutrition services, and support groups and counseling.

Chemotherapy for prostate cancer uses medications, such as docetaxel (Taxotere) or cabazitaxel (Jevtana), to fight fast-growing cancer cells by disrupting cancer cell growth. They’re administered by injection into a patient’s vein. They may be given to some men with hormone-sensitive or hormone-resistant prostate cancer.

Both docetaxel and cabazitaxel are prescribed with a steroid. Often times, docetaxel is prescribed first. If it’s ineffective, cabazitaxel is often the next course of action.

Side effects of chemotherapy may include hair loss, loss of appetite, mouth sores, skin changes, extreme tiredness, diarrhea or constipation, and increased risk of infection.

Managing Chemotherapy Side Effects

Side effects occur when chemotherapy drugs target healthy fast-growing cells. The severity of side effects can vary greatly from one patient to another. This is why our doctors tailor treatment and symptom management to your needs.

Most symptoms such as nausea, vomiting, and fatigue can be managed with medications. Other side effects may require changes to the amount of chemotherapy a patient receives.

When hormone-resistant prostate cancer has spread despite treatment with chemotherapy, doctors may explore other systemic therapies, such as targeted radionuclide therapy.

Traditional radiation therapy delivers a beam of high-energy X-rays to the main tumor. This only allows doctors to target a limited area of a patient’s body. Radionuclide therapy is more far-reaching, as it uses radioactive substances to target and destroy cancer cells in specific organs or tissues.

This type of therapy is injected into a vein, and seeks out and attaches to PSMA receptors on prostate cancer cells. These cells then absorb the radioactive material.

The radiopharmaceutical lutetium-177 PSMA-617 (Pluvicto) is a prostate-specific membrane antigen (PSMA) radionuclide therapy. This therapy targets PSMA receptors, or proteins, that sit on the surface of prostate cancer cells. They can be detected in the body with a PSMA PET/CT or PET/MRI scan.

Side effects of Pluvicto radionuclide therapy may include fatigue, dry mouth, feeling sick to your stomach, low red blood cell count, loss of appetite, change in bowel movements, vomiting, low blood platelet count, urinary tract infection, weight loss, and abdominal pain.

Managing Targeted Radionuclide Therapy Side Effects

The use of Pluvicto exposes patients to radioactivity. This can cause serious side effects, such as low blood cell counts, kidney problems, and even increased risk of cancer for long-term use. Our oncologists will run lab work periodically to check how patients are tolerating their treatment.

Patients should also share any side effects they are experiencing with their doctors right away. Depending on the severity, our doctors may recommend delaying your next dose, decreasing your next dose, or stopping treatment.

Immunotherapy for prostate cancer trains the immune system to identify and attack prostate cancer cells.

For men with advanced hormone-resistant prostate cancer and less noticeable symptoms, doctors may prescribe an immunotherapy called sipuleucel-T, or Provenge. Sipuleucel-T is made specifically for each person. Using a special machine, white blood cells are removed from a patient’s blood. Next, the white blood cells are sent to a lab and exposed to a protein from the prostate cancer cells, which trains them to identify and attack them. Then, the trained cells are sent back to the doctor or hospital, where they are infused back into the patient.

Sipuleucel-T does not stop prostate cancer growth. However, it may help to increase the lifespan of men whose prostate cancer continues to grow, despite the low levels of testosterone in the body.

Side effects of sipuleucel-T may include fever, fatigue, chills, back and joint pain, headache, skin changes, and nausea.

Managing Immunotherapy Side Effects

In some cases, the immune system may also attack other parts of the body other than prostate cancer cells. This can lead to side effects. Some, like rashes, can occur during or after treatment. Others may arise over weeks or months as treatment progresses.

Our prostate cancer doctors work with patients to identify symptoms early and create a plan for managing them. We may also prescribe anti-nausea medicines or medications, like steroids, if needed. In some cases, it may be best to reduce or stop treatment.

Our researchers are developing promising new treatments for prostate cancer through . This includes immunotherapies and targeted drugs, which treat specific genetic mutations detected in an individual’s cancer. You and your doctor can discuss whether a clinical trial might be right for you.