Posts Tagged ‘PSA elevation’

Treating Prostate Cancer With Hormone Therapy

September 28, 2014

For men with advanced prostate cancer, hormone therapy is a treatment option. The goal is to reduce levels of male hormones, called androgens or testosterone, in the body, or to prevent them from reaching prostate cancer cells. Using drugs to decrease the testosterone is one of the most common methods of treating advanced prostate cancer.

The main androgens are testosterone and dihydrotestosterone (DHT). Most of the body’s androgens come from the testicles, but the adrenal glands also make a small amount. Androgens stimulate prostate cancer cells to grow. Lowering androgen levels or stopping them from getting into prostate cancer cells often makes prostate cancers shrink or grow more slowly for a time. However, hormone therapy alone does not cure prostate cancer and eventually, it stops helping.

Hormone therapy may be used:

  • If you are not able to have surgery or radiation or can’t be cured by these treatments because the cancer has already spread beyond the prostate gland
  • If your cancer remains or comes back after treatment with surgery or radiation therapy
  • Along with radiation therapy as initial treatment if you are at higher risk of the cancer coming back after treatment (based on a high Gleason score, high PSA level, and/or growth of the cancer outside the prostate)
  • Before radiation to try to shrink the cancer to make treatment more effective

Several types of hormone therapy can be used to treat prostate cancer. Some lower the levels of testosterone or other androgens (male hormones). Others block the action of those hormones.

Treatments to lower androgen levels

Orchiectomy (surgical castration)

Even though this is a type of surgery, its main effect is as a form of hormone therapy. In this operation, the surgeon removes the testicles, where most of the androgens (testosterone and DHT) are made. With this source removed, most prostate cancers stop growing or shrink for a time.

This is done as a simple outpatient procedure. It is probably the least expensive and simplest way to reduce androgen levels in the body. But unlike some of the other methods of lowering androgen levels, it is permanent, and many men have trouble accepting the removal of their testicles.

Some men having the procedure are concerned about how it will look afterward. If wanted, artificial silicone sacs can be inserted into the scrotum. These look much like testicles.

Luteinizing hormone-releasing hormone (LHRH) drugs

These drugs lower the amount of testosterone made by the testicles. Treatment with these drugs is sometimes called chemical castration because they lower androgen levels just as well as orchiectomy.

Even though LHRH analogs (also called LHRH agonists) cost more than orchiectomy and require more frequent doctor visits, most men choose this method. These drugs allow the testicles to remain in place, but the testicles will shrink over time, and they may even become too small to feel.

LHRH analogs are injected or placed as small implants under the skin. Depending on the drug used, they are given anywhere from once a month up to once a year. The LHRH analogs available in the United States include leuprolide (Lupron®, Eligard®), goserelin (Zoladex®), triptorelin (Trelstar®), and histrelin (Vantas®).

When LHRH analogs are first given, testosterone levels go up briefly before falling to very low levels. This effect is called flare and results from the complex way in which LHRH analogs work. Men whose cancer has spread to the bones may have bone pain. If the cancer has spread to the spine, even a short-term increase in tumor growth as a result of the flare could compress the spinal cord and cause pain or paralysis. Flare can be avoided by giving drugs called anti-androgens for a few weeks when starting treatment with LHRH analogs. (Anti-androgens are discussed further on.)

Degarelix (Firmagon®)

Degarelix is an LHRH antagonist. LHRH antagonists work like LHRH agonists, but they reduce testosterone levels more quickly and do not cause tumor flare like the LHRH agonists do.

This drug is used to treat advanced prostate cancer. It is given as a monthly injection under the skin and quickly reduces testosterone levels. With degarelix no anti-androgens are necessary. The most common side effects are problems at the injection site (minimal pain, redness, and swelling) and increased levels of liver enzymes on lab tests. Other side effects are discussed in detail below.

Abiraterone (Zytiga®)

Drugs such as LHRH agonists can stop the testicles from making androgens, but other cells in the body, including prostate cancer cells themselves, can still make small amounts, which may fuel cancer growth. Abiraterone blocks an enzyme called CYP17, which helps stop these cells from making certain hormones, including androgens.

Abiraterone can be used in men with advanced castrate-resistant prostate cancer (cancer that is still growing despite low testosterone levels from LHRH agonists, LHRH antagonists, or orchiectomy). Abiraterone has been shown to shrink or slow the growth of some of these tumors and help some of these men live longer.

This drug is a pill and the most common dose is 4 pills every day. Since this drug doesn’t stop the testicles from making testosterone, men who haven’t had an orchiectomy need to continue with treatment to stop the testicles from making testosterone (LHRH agonist or antagonist therapy). Because abiraterone lowers the level of other hormones in the body, prednisone (a cortisone-like drug) needs to be taken during treatment as well to avoid the side effects caused by lower levels of these other hormones.

Bottom Line:  Nearly 250,000 cases of prostate cancer are identified each year.  Nearly 40,000 men die from prostate cancer, second most common cause of death due to dancer after lung cancer.  For men who have elevated PSA levels after treatment, hormonal therapy is a consideration.

PSA Elevation After Treatment For Prostate Cancer

July 24, 2014

Prostate cancer represents the second most common cancer in men following lung cancer. Prostate cancer will be diagnosed in nearly 250,000 men annually and causes nearly 40,000 deaths each year. If you already have had prostate cancer treatment, changes in PSA levels can tell whether treatment is working.

After surgical removal of your prostate, your PSA levels should be undetectable. After radiation therapy, the PSA levels should drop and remain at low levels.
Signs that your cancer has returned may include one of these:
Three consecutive PSA rises above the lowest level over time
Confirmed rise of more than 2 ng/mL from your lowest level

The key is monitoring your PSA levels over time. A rapid rise suggests rapid cancer growth and the need for treatment. A very slow rise of the PSA can often be watched.
But PSA levels can also be somewhat confusing. For example, they can go up and down a bit for no reason. The PSA test is not precise, and minor changes from test to test are to be expected.
Low rises of PSA levels can’t predict your longevity or symptoms when you have cancer. But high or rapidly rising PSA levels can suggest future problems.
That’s why doctors take other factors into account when evaluating your situation. Talk with your doctor to get a better idea of what to expect, so the numbers don’t add to your anxiety.

Advanced Prostate Cancer and PSA Levels Over Time
If you have advanced prostate cancer that has spread outside the prostate, your doctor will be looking less at your actual PSA levels than at whether and how quickly PSA levels change.
Doctors use changes in PSA levels over time (called PSA velocity) to tell how extensive and aggressive your cancer is.

Your doctor won’t just look at one PSA reading at a time. He or she will confirm it with multiple tests over many months, especially after any radiation therapy. That’s because you can have a temporary bump in PSA levels for about one to two years after radiation treatment.
To determine how aggressive your cancer is and whether further treatment makes sense, your doctor may also consider your:
PSA levels before cancer
Grade of cancer or the Gleason score. The higher the Gleason score, the more aggressive the cancer.
Overall health and life expectancy
PSA Levels and Treatment for Advanced Prostate Cancer
Your symptoms and how long it takes for your PSA levels to double (PSA doubling time) affect decisions about how soon to try treatment such as hormone therapy.
Your doctor will look at how quickly or slowly PSA rises before deciding on which treatment to suggest. You may need continued monitoring before moving to a new treatment. Your doctor may suggest waiting for a while to delay the appearance of treatment-related side effects. Discuss with your doctor how to weigh these considerations.

PSA levels may also be useful in checking if your treatment for advanced prostate cancer is working after you have had:
Hormone therapy
Chemotherapy
Vaccine therapy
Treatment should lower PSA levels, keep them from rising, or slow the rise, at least for a while.
Doctors monitor PSA regularly based on the type of treatment you had first. For example, after hormone therapy, PSA should drop to a lower level quickly, i.e., within weeks. It may fall further over time as you continue hormone therapy.

Combined with symptoms and other tests, PSA tests can also show if it’s time to try another type of treatment.

Bottom Line: PSA is an imprecise test for diagnosing and monitoring prostate cancer. If the PSA rises quickly after treatment, whether it is surgery, radiation, or hormone treatment, this is of concern and you may need to have additional treatment. Speak to your doctor if you have any questions.