Standard hormone therapy

The prostate gland and prostate cancer are under the influence of testosterone, the male sex hormone, which drives the tumour to grow and spread. By blocking the body’s production of testosterone, or preventing its action, hormone therapy may greatly reduce the cancer’s capacity to grow. When the cancer has spread away from the prostate, usually going to either the lymph nodes or bones, hormone therapy can be effective at shrinking the tumour and reducing the side effects of the disease. It will often keep the cancer in check for a number of years. This can be assessed by keeping an eye on the PSA blood test.

Hormone therapy is also often used in conjunction with external beam radiotherapy as for some cancers it improves their response to the radiotherapy. In these circumstances, patients typically have hormone therapy for 3 months prior to the radiotherapy starting and may continue with the medication for between three months and two years.

There are two basic types of hormone therapy. Anti-androgens, delivered daily in tablet form, do not stop the production of testosterone, but block its effects on the prostate. An LH-RH analogue comes in the form of a slowly dissolving pellet that is usually injected every month or three months to prevent the production of testosterone by the testicles (Prostap and Zoladex are drugs commonly used for this purpose). The injection is straightforward and can be given at a GP’s surgery or is sometimes self-administered. It is common for anti-androgens to be prescribed for a short period before Prostap or Zoladex are injected.

Possible side effects from the treatment with hormones include weight gain, hot flushes, tiredness, mood change, reduced sex drive and loss of erection. Some patients may experience tenderness in the breast area and in rare cases some degree of breast enlargement. It is important to discuss the relative effectiveness of different hormone treatments and the likelihood of possible side effects with your consultant or clinical nurse specialist.

Two newer forms of hormonal treatment are now available and may be given after the standard hormone therapies. These are Abiaterone or Enzalutamide. Both these treatments block the effects of testosterone inside the prostate cancer cell. They are effective but have more side effects so careful monitoring is required with more frequent hospital visits.

Chemotherapy

Chemotherapy involves the administration of powerful drugs that poison the cancer cells with the aim of slowing the growth of the cancer and shrinking tumours. We now know that in some instances it is beneficial to receive this as soon as prostate cancer has spread outside of the prostate gland. In this instance chemotherapy is usually given with hormone treatment. Alternatively chemotherapy is given after hormone therapy if the PSA readings start to rise.

The commonly used chemotherapy drug for patients with prostate cancer is Docetaxel, which is administered through a drip in up to ten outpatient sessions lasting for an hour or so, with three-week intervals between each session. It is often used in conjunction with a steroid such as Prednisolone, taken daily in pill form to enhance the effectiveness of the treatment and help reduce side effects. Hormone treatment may be continued in parallel.

Chemotherapy affects some healthy cells as well as attacking the cancer. Side effects and their severity vary from patient to patient but can include nausea, indigestion, hair loss, mouth ulcers, fatigue and reduction in red and white blood cells. These days careful monitoring and the use of drugs to mitigate their impact mean that side effects tend to be less significant than in the past and many patients will experience little more than bouts of fatigue (which tend to become more of a problem towards the end of treatment). However, because the reduction in white cells compromises the immune system, any infections should be reported to your doctor immediately so that they can be dealt with. Your blood count, liver and kidney functions will be checked before each treatment cycle.

After the chemotherapy cycle has finished you will receive check-ups at intervals to be agreed with your consultant. In many cases the treatment remains effective for a considerable time. If the cancer starts to grow again, treatment with Docetaxel will not be repeated but other forms of chemotherapy may be considered.