Hormone treatment - making a decision

When a man is diagnosed with locally advanced or metastatic prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., one of the first treatment options is hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. therapy. This therapy counteracts the effect of male sex hormones, including testosterone, which may cause prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells to grow and spread.

The effectiveness of hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. treatment, known as androgenA type of steroid hormone that stimulates male development. Testosterone is an androgen. deprivation therapy or ADT, is well-established. Although it will not completely remove the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., it may help to halt its growth or shrink its size, at least for a time. Most patients with prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. respond to ADT, which may help to prolong survival in advanced but localised prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body..

ADT suppresses male sex hormones, such as testosterone, through oral or injection therapy. ADT can be a very effective way of aggressive prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.. Almost all tumours will respond to ADT to some extent, and the response may be prolonged for a considerable period.

However, ADT may have significant side effects, and these should be carefully considered before opting for treatment. Radical suppression of testosterone in men can cause symptoms similar to those experienced by women going through the menopauseThe time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle., such as hot flushes, irritability, tiredness and reduced libidoSexual drive., as well as reduced bone density that may lead to osteoporosis.

In addition, hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. treatment can lead to other problems such as anaemiaA reduced level of haemoglobin, which carries oxygen in the blood. Anaemia causes tiredness, breathlessness and abnormally pale skin., erectile dysfunctionInability to maintain a penile erection for sexual intercourse., muscleTissue made up of cells that can contract to bring about movement. wasting, breast enlargement, depression and reduced cognitive function. Perhaps of most concern, it may promote increases in body fatOne of the three main food constituents (with carbohydrate and protein), and the main form in which energy is stored in the body. and metabolic changes that can lead to long-term disorders such as diabetes and heart disease.

One study showed that men undergoing ADT had a 44 per cent increased risk of diabetes, a 16 per cent raised risk of coronaryRelating to the arteries supplying the heart itself. disease, an 11 per cent increase in heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. risk and a 16 per cent increased risk of sudden cardiac death. In contrast, although men treated with surgical removal of the testicles were 34 per cent more likely to develop diabetes, they did not seem to have a raised risk of coronaryRelating to the arteries supplying the heart itself. disease, heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. or sudden cardiac death. So the benefits of hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. treatment need to be weighed carefully against these potential risks. A specialist prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. nurse can discuss all your options with you.

Such treatment decisions will vary for each patient and are influenced by many factors such as age, extent of disease and personal preferences

If you do opt for ADT therapy, there are ways that you can try to minimise the side effects. For men with tumours in the early stages, intermittent rather than continuous hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. treatment may cause fewer problems. Taking regular exercise has also been shown to reduce the tiredness caused by ADT.

In addition, your doctor may be able to prescribe drugs to protect your bone density or to improve erectile dysfunctionInability to maintain a penile erection for sexual intercourse., and can monitor you for signs of diabetes or heart disease so that protective treatment can be started if necessary.

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