More hormone therapy
You will normally keep having your original hormone
therapy even if your PSA has started to rise. It may still help
to keep the amount of testosterone in your body low.
You may also start taking another type of hormone therapy,
called an anti-androgen, as your cancer may respond to this
different type of hormone treatment. Some health professionals call
this combined or maximum androgen blockade.
If you have been having both injections and anti-androgen
tablets and your PSA is rising, your doctor may suggest that you
stop the anti-androgen treatment for a little while. This may cause
your PSA level to fall. You may hear this called a 'withdrawal
response'.
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Steroids
Steroids can help to stop other parts of the body producing as
much testosterone. A small amount of testosterone is produced by
the adrenal glands. These are two glands which sit above your
kidneys. Some cancer cells may also start to produce their own
testosterone.
Steroids you may take include:
- dexamethasone
- prednisolone or prednisone
- hydrocortisone.
Steroids may also help improve your appetite and energy levels,
and can treat pain. You might also have steroids in combination
with other treatments, including chemotherapy and abiraterone.
Like all medicines, steroids can cause some side
effects, such as indigestion, weight gain and and water
retention. These will depend on the dose you are taking and the
length of time you are on them. Steroids are given in a low dose to
treat prostate cancer, so most men do not get many side
effects.
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Oestrogens
Diethylstilbestrol (Stilboestrol®) is a tablet that is similar
to the hormone oestrogen. Oestrogen is a hormone found in both men
and women, but women usually produce more. Diethylstilbestrol is
sometimes used to treat prostate cancer that is no longer
responding to other types of hormone therapy.
Diethylstilbestrol can cause similar side effects to other types
of hormone therapy. It can also increase your risk of circulation
problems, such as blood clots. You will usually take drugs such as
aspirin or warfarin to reduce the risk of blood clots. You may not
be able to take diethylstilbestrol if you have a history of high
blood pressure, heart disease or strokes.
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Ketoconazole
Ketoconazole is a type of anti-fungal treatment that may also
help treat prostate cancer It can help reduce testosterone
production from the adrenal glands and cancer cells. It is not used
very often, but you may have it if you are not fit enough for
treatments such as chemotherapy.
Your doctor or nurse will need to monitor how well your liver is
working because ketoconazole can cause liver problems. If there are
any problems, you can stop taking the drug and your liver will
return to normal. Ketoconazole can also cause a dry mouth and make
some people feel very tired.
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Chemotherapy
Chemotherapy uses drugs to kill cancer
cells wherever they are in the body.
In the UK, docetaxel (Taxotere®) is the standard chemotherapy
treatment for men with advanced prostate cancer that is no longer
responding to hormone therapy.
If you have already had treatment with docetaxel and your cancer
has started to grow again, you may be able to take a newer
chemotherapy drug called cabazitaxel (Jevtana®).
Docetaxel and cabazitaxel may help some men to live longer. They
can also help to improve symptoms such as pain.
Chemotherapy may not be suitable for everyone as the side
effects are sometimes difficult to cope with. Your doctor will
first check your general health to make sure you are fit enough for
chemotherapy.
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Abiratarone
Abiraterone (Zytiga®) is a new type of hormone therapy for men
with advanced prostate cancer that has stopped responding to other
hormone therapy. It is suitable for men who have already had
docetaxel chemotherapy and whose cancer has started to grow again.
Abiraterone may help some men to live longer. It can also help
control symptoms.
Abiraterone is taken as a tablet and works by stopping the
production of testosterone.
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Clinical Trials
There are a number of clinical trials looking into new
treatments for prostate cancer that is no longer responding as well
to hormone therapy. There are also trials to find out whether
existing treatments work better in new combinations or doses.
Clinical trials can be a way of having newer treatments that are
not yet available on the NHS.
If you would like to find out about taking part in a clinical
trial, ask your doctor or specialist nurse. You can also find out
about different trials on the CancerHelp UK clinical trials database.
Personal experience
"Clinical trials gave us hope and my dad felt that he was doing
some good too."
You will also take a steroid called prednisone to reduce the
risk of side effects. Side effects include:
- fluid retention
- high blood pressure
- liver problems
- a lower than normal level of potassium in the blood. This could
make you feel tired and you may be a risk of a fast irregular
heartbeat. You should contact your doctor if you experience
this.
You will have your blood pressure checked regularly, and have
blood tests to check how well your liver is working.
Abiraterone is also effective in men who have stopped responding
to other types of hormone therapy but have not yet had
chemotherapy. However it is not widely available in the UK for
these men. If your doctor thinks it is suitable for you, they may
be able to apply for you to get it.
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Enzalumatide
Enzalutamide is a new type of hormone therapy for men whose
prostate cancer has stopped responding to other hormone therapy and
chemotherapy treatments.
Enzalutamide is taken as a tablet and works by stopping the
hormone testosterone from reaching the prostate cancer cells.
Enzalutamide is not available on the NHS. If you would like
more information about it, speak to your doctor or nurse, or call
our Specialist
Nurses.
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Other treatments
If you have prostate cancer that has spread to the bones or
other parts of the body you may develop symptoms such as bone pain
or urinary problems. There are treatments to help manage any
symptoms. Sometimes these are called palliative treatments because
they aim to reduce symptoms.
These types of treatments include:
There is also a new drug to treat bone problems called denosumab
(Xgeva®), which is similar to bisphosphonates. However, this is not
widely available in the UK. If your doctor thinks it is suitable
for you, they may be able to apply for it for you. Speak to your
doctor or nurse for more information.
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Where can I get
support?
All men are different but if your hormone therapy is no longer
controlling your cancer so well you may feel disappointed, angry or
worried about the future.
There are different ways to tackle this. Talking to someone or
getting support can be useful. Your partner and family may also
need support in emotional and practical ways. This information may
also be helpful for them.
Friends and family
Some men get all the back-up they need from their family and
friends. Get things off your chest by talking to a partner, friend
or family. Explaining how you feel can help those close to you
understand and give you support if you want it.
Personal experience: "Throughout my journey my partner has been
my biggest supporter and long may this continue."
Your doctor or nurse
Talk to your specialist nurse, doctor or other health professionals
involved in your care. They should be able to answer any questions
or concerns you might have, as well as providing support. You can
also speak to one of our Specialist
Nurses.
Personal experience: "Ask your doctor or specialist nurse
anything, including anything that may seem small. This can save
confusion and concerns later."
Counselling
Some people find it easier to talk to someone they do not know.
Counsellors are trained to listen and can help you to find your own
answers. Your GP may be able to refer you to a counsellor or you
can see a private counsellor. There are different types of
counselling available. To find out more contact the British Association
for Counselling and Psychotherapy.
Talking to someone affected by prostate
cancer
Talking to someone with similar experiences often helps. Our support volunteers are all
personally affected by prostate cancer. They are trained to listen
and offer support over the telephone.
You and your family can join our online community. You can
share your experiences with other men and their families. There are
also prostate cancer support groups across
the country, where you and your family can meet other people
affected by prostate cancer.
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Questions to ask your
doctor or nurse
Keep a note of any questions you have to take to your next
appointment.
-
If my hormone therapy is not working as well as before, what
other treatments are available to me?
-
Will I continue to have my original hormone therapy even if it
has stopped working as well?
-
What are the possible side effects of my new treatments?
-
Will I see any new health professionals?
-
Are there any clinical trials I could take part in?
-
What treatments are there to manage symptoms (for example pain
or tiredness)?
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