Prostate Cancer Treatment: Hormone Therapy and Side Effects

If you're undergoing hormone therapy to treat prostate cancer, there are some common side effects to watch out for. 

There are several treatment options for prostate cancer, including surgeries, radiation therapy, and prostate cancer hormone therapy. Each has its own set of pros and cons, as well as side effects that should be considered before treatment begins.

Prostate cancer hormone therapy, also known as androgen deprivation therapy (ADT), is given by injection every few months, usually to men with aggressive, high-risk prostate cancers. The purpose of this type of therapy is to stop the male hormone, testosterone, from stimulating prostate cancer cells to grow, either by blocking testosterone after it is made or by decreasing the amount that the body normally makes.

ADT can be effective — one recent study published in the Journal of the American Medical Association found that only 14 percent of patients on the drugs died of their cancer, compared with 22 percent of men not on the drugs — but there are a number of potential side effects. If your prostate cancer treatment plan involves hormone injections, you should be prepared to manage these effects.


Prostate Cancer Hormone Therapy: Side Effects
Unfortunately, the side effects that go along with hormone therapy can't really be prevented. But there are still ways to reduce and manage them.

"The side effects … are part and parcel of that particular approach to therapy," says Durado Brooks, MD, MPH, director of prostate and colorectal cancer at the American Cancer Society.

"One thing done at times is to cycle men on and off at least some of these medications," depending on their PSA (prostate-specific antigen) levels, as determined by a blood test, Dr. Brooks says. "If PSA levels drop to a very low level, their doctors will take them off and allow the anti-hormones [the injections] to clear from their bodies, and that will decrease the side effects in many cases. If the PSA starts to rise again, as is often the case, they'll go back on the hormones."

Here are some of the most common side effects that you can expect during hormone therapy, and ways to combat them:

• Decreased mental capacity, tiredness, and feelings of depression. Talk to your doctor about taking a mild antidepressant to battle these symptoms. Exercise is also a good way to manage depression and have more energy.
• Decreased muscle mass and decreased bone mass (osteoporosis). Try strength-training exercise and ask your doctor about medications that can help minimize bone loss.
• Gaining weight. Try to maintain a healthy, low-fat diet and get regular exercise.
• Hot flashes. Dress in light clothing, keep the air conditioning on, and avoid eating or drinking anything hot or spicy.
• Anemia. Talk to your doctor about treatment to help hormone-therapy-related anemia. If the situation becomes serious, a blood transfusion may be needed.
• Growth of excess breast tissue and sore breasts. You may be able to decrease this side effect with some radiation therapy for the breasts.
• Sexual problems. "Most men who are taking hormone treatments will lose their interest and desire for sexual relations, and most men will end up having erectile difficulties," says Brooks. "Sometimes with erectile difficulties, there is still an interest in having sex." There are many medications available to help with that side effect. 

 
Prostate Cancer Hormone Therapy: Other Health Concerns
Aside from managing and decreasing the physical discomfort of side effects, patients should be aware of some of the potential health conditions that may result from hormone therapy to treat prostate cancer.

"There are some questions about whether or not hormonal therapy may increase the risk of diabetes, heart disease, and sudden cardiac death," Brooks says. These risks are not well-substantiated, he notes, but are still concerns. According to some recent research published in the journal Heart, for every 1,000 men who underwent ADT therapy for five years, there will be an additional 360 extra cases of diabetes, 315 cases of heart disease, 42 more strokes, and 28 additional heart attacks. Other studies have shown no increased risk, but prostate cancer patients undergoing hormone therapy should still carefully monitor themselves to watch for early warning signs of these conditions.
Men undergoing prostate cancer treatment should be aware of possible symptoms of diabetes, according to Brooks, including urinary symptoms such as having to urinate frequently or urgently. Unfortunately, these symptoms are often ignored.

"The challenge for many men with prostate disease is that they already have similar symptoms," he says. "Weight loss is another indicator. If they are taking hormonal therapy and they are losing weight instead of gaining weight, they should talk to their doctor." He also notes that men need to be aware of any potential symptoms of heart disease, particularly shortness of breath or fatigue, especially after exertion. If so, patients should "bring it to their doctor's attention right away," says Brooks.
Bottom line: If you're undergoing hormone therapy for prostate cancer, be aware of side effects you can manage, and be alert for those that may signal additional health concerns.