Hormonal therapy for prostate cancer can be rough with unpleasant side effects. Johns Hopkins provides advice to help soften the impact.
The male hormone testosterone influences more than a man’s sex life. It also plays a role in bone health, muscle mass, levels of energy, and even psychological well-being. Hormonal therapies for prostate cancer, known as androgen-deprivation therapy, shut down testosterone production. When testosterone levels plummet, the effects are swift and unpleasant.
Knowing what side effects can be expected with androgen-deprivation treatments, and the strategies that help relieve them, can provide a useful perspective for conversations with your doctor about your prostate cancer treatment options.
Is Intermittent Treatment the Answer? Prostate cancer specialists continue to look for new ways to reduce or compensate for the side effects of androgen-deprivation therapy. One approach, which is still being evaluated for effectiveness, is intermittent therapy. In this type of treatment, the anti-androgen agents are given until prostate-specific antigen (PSA) levels drop. At that point, the treatment is stopped and not resumed until PSA levels rise again.
This strategy gives prostate cancer patients a break from treatment side effects. Some evidence suggests that intermittent therapy also may slow the development of hormone-refractory prostate cancer, in which the cancer cells become resistant to hormone treatment. Early studies suggest that intermittent therapy for prostate cancer may be as effective as traditional treatment.
Help for the Big Three The three most common side effects of androgen-deprivation therapy are hot flashes, loss of libido (sex drive), and erectile dysfunction (ED). Because ED and loss of libido are inevitable consequences of this prostate cancer treatment, it’s important that couples know what to expect beforehand. ED drugs -- Viagra (sildenafil), Levitra (vardenafil), and Cialis (tadalafil) -- and mechanical devices can be used to treat ED, but they have no effect on libido. Counseling with a sex therapist can help couples to explore their needs and expectations and to sort out the emotional issues related to their changing sexual relationship.
The hot flashes familiar to postmenopausal women can be just as disruptive and frustrating for a man. They can interfere significantly with nighttime sleep, which in turn affects mood, energy level, and cognitive ability the next day. The antidepressant Effexor (venlafaxine) or the anticonvulsant Neurontin (gabapentin) will relieve hot flashes in some men.
More Side Effect Strategies Androgen-deprivation therapy for prostate cancer is associated with a range of other side effects. These strategies may help reduce the side effects:
- Weight gain. Men on androgen-deprivation therapy for prostate cancer typically gain weight. Working with a dietitian from the outset and establishing a routine of regular aerobic exercise, like walking, can help keep weight under control.
- Muscle mass. Testosterone plays an important role in building and maintaining muscle mass and strength. A regular program of strength training can help preserve both.
- Anemia. Anemia is common among men on androgen-deprivation therapy for prostate cancer. If anemia is severe, a medication called Procrit (epoetin alfa) or Aranesp (darbepoetin alfa) may be prescribed.
- Bone loss. Suppression of testosterone significantly decreases bone mineral density and increases the risk of fractures. Getting sufficient calcium and vitamin D is important, as is regular weight-bearing exercise such as walking. Several osteoporosis medications, as well as estrogen supplementation, also help to prevent and treat osteoporosis.
- Zometa. For men whose prostate cancer has spread to the bones, an injectable medication called Zometa (zoledronic acid) will help prevent fractures and other bone complications. Zometa can provide significant pain relief as well. It’s also important to not smoke and to reduce your intake of alcohol and caffeine.
- Breast enlargement. Breast enlargement (gynecomastia) is a common and embarrassing side effect of androgen-deprivation treatment for prostate cancer. Irradiation of the breasts before treatment may reduce the likelihood that this will happen.
- Fatigue and lack of energy. Restful sleep, strength training, and aerobic exercise can help both problems. For men who are depressed, treating the depression also may reduce fatigue and listlessness.
- Depression. Prostate cancer patients may be depressed for a variety of reasons, including the effects of androgen deprivation. Daily exercise and adequate sleep can improve mood, but if depression is severe or long lasting, a prescription antidepressant may be needed.
- Cognitive changes. Many men complain of memory problems or other cognitive difficulties during prostate cancer treatment. Some research suggests that giving men supplemental estrogen improves some types of cognitive functioning.
- Insulin resistance. In a study conducted at Johns Hopkins, researchers found that men treated with androgen-deprivation therapy for prostate cancer for at least a year have more insulin resistance and higher glucose levels than do healthy men or men who have been treated with surgery or radiation. In fact, 44% of the men in the study had glucose levels above 126 mg/dL (the cutoff point for a diagnosis of diabetes).
Insulin resistance and diabetes also are significant risk factors for heart disease, stroke, and other serious medical conditions. And several studies have reported an increase in cardiovascular deaths. It is recommended that men who are on long-term androgen-deprivation therapy be screened for abnormal lipid levels and diabetes at least once a year and treated if necessary.
