Prostate Cancer Questions and Answers With Dr. Manyak
Dr. Manyak, MD, is a board-certified specialist in urology. Here, he answers your
questions about prostate cancer treatment, side effects and ELIGARD.
What is hormonal prostate cancer therapy and when is it used?
Hormonal prostate cancer therapy is a treatment in which male hormones are inactivated
in the body in an effort to shrink prostate cancer tumors or slow tumor growth.
Sometimes hormonal prostate cancer therapy is used after radiation therapy or surgery
to help prevent the cancer from coming back. Hormonal therapy can't cure prostate
cancer. However, if the prostate cancer has spread, hormonal therapy can be used
to palliate the cancer for a period of time.
How does hormonal prostate cancer therapy work?
I would like to know more about LHRH agonists. How do they work?
LHRH (luteinizing hormone-releasing hormone) agonists are the most frequently used
hormonal therapies today. These drugs were developed to offer patients a nonsurgical
and reversible alternative to removal of the testicles. LHRH agonists are similar
to a naturally occurring hormone in the body that normally stimulates the production
of testosterone. Changing the pattern of LHRH release drastically reduces the hormone
production.
How do the various types of LHRH agonist therapies differ?
Most LHRH (luteinizing hormone-releasing hormone) agonists differ in how they are
given to the patient.
For instance, the administration of the drug and needle size vary
with each product. The volume (or amount) of the drug that gets injected
differs from product to product and may affect how the injection feels. The method
of the administration varies with each product, too. Some of the drugs are injected
once every 1, 3, 4 or 6 months, and others are surgically implanted annually.
Is it true that testosterone levels actually go up when you first start using an
LHRH agonist?
Yes, injections of LHRH agonists stimulate a short surge of testosterone for about
2 weeks. The body reads this as being too much testosterone and essentially shuts
down the hormone production. As a result, testosterone levels fall.
What is ELIGARD?
ELIGARD is an LHRH (luteinizing hormone-releasing hormone) agonist. It contains
leuprolide acetate, the most widely prescribed hormonal therapy for the palliative
treatment (management of symptoms) of advanced prostate cancer. Leuprolide acetate
limits the signal that tells the testicles to produce testosterone.
How is ELIGARD administered?
ELIGARD is injected just under the skin with a short needle. The injection is called
subcutaneous because it goes under the skin rather than directly into the muscle,
which is called intramuscular.
What are the benefits of using ELIGARD?
In clinical studies, patients on ELIGARD experienced reduced testosterone levels
and reduced serum prostate-specific antigen (PSA) levels. The small needle, low
injection volume and recent introduction of the 6-month dose make Eligard a convenient
treatment option for some patients. In addition, studies have shown that the majority
of the hot flashes that men experience as a side effect of ELIGARD therapy are typically
mild.
Does hormonal prostate cancer therapy eliminate a man's sex drive?
Testosterone is responsible for much of the male sex drive, called libido. Testosterone
also plays an important role in the ability to get an erection. When testosterone
is eliminated from the body, it is common for men to lose their sex drive and their
ability to achieve or maintain an erection. However, this doesn't happen to everyone.
I hear hot flashes are a common side effect of hormonal prostate cancer therapy.
What causes hot flashes?
It's not really understood how reducing testosterone brings on hot flashes. However,
it's true that hot flashes are a common side effect of LHRH agonist therapy. Hot
flashes can range from annoying to debilitating. Sometimes hot flashes are associated
with facial flushing, redness, and increased sweating and may cause nausea or interruption
of sleep. Hot flashes can be brought on by stress or heat, or they may occur for
no apparent reason at all. Studies have shown that the majority of the hot flashes
that men experience as a side effect of ELIGARD therapy are typically mild.
What can be done to treat hot flashes as a side effect of prostate cancer therapy?
There are several options for managing hot flashes. Some estrogen (female hormone)
therapies can be used to treat hot flashes. Soy products and vitamin E may also
help manage your hot flashes. Soy contains a small amount of "phytoestrogen," a
variant of the major female hormone. It can be found in foods such as bean curd
(tofu) and soy milk. Before you take vitamin E (or any vitamin), discuss it with
your doctor and take only the recommended dosage. Acupuncture may also help you
manage your hot flashes.
What does my diet have to do with prostate cancer?
A healthy, balanced diet can do many things for you. In addition to boosting your
overall health and well-being, a healthy diet can:
- Fight 3 possible side effects of hormone therapy—decreased muscle mass, increased
fat mass, and weight gain
- Enhance your strength and energy level
- Increase the body's ability to tolerate side effects
- Decrease risk of infection
- Increase your ability to heal and recover quickly
What is a healthy diet?
A healthy diet means eating a variety of foods that provide the nutrients you need
to maintain your health. These nutrients include protein, carbohydrates, fat, water,
vitamins, and minerals. Watch the fat, though, since studies suggest that beef,
dairy, and other high-fat products may stimulate prostate cancer to grow.
About Dr. Manyak
Michael J. Manyak, MD, is a consultant for sanofi-aventis. A board-certified specialist
in urology, Dr. Manyak is Professor of Urology and Microbiology and Tropical Medicine
at George Washington University Medical School in Washington, DC, and Interim Chairman
of the Department of Urology at George Washington University Medical Center.
Dr. Manyak served as a urologic consultant for 9 years to the Medical Therapy of
Prostate Symptoms (MTOPS) multicenter study on prostate cancer and benign prostatic
hyperplasia (BPH), sponsored by the National Institute of Diabetes and Digestive
and Kidney Diseases. Currently, he serves as a consultant to the US Food and Drug
Administration Panel on Gastrointestinal and Genitourinary Devices. A fellow of
the American College of Surgeons, his memberships include the American Association
of Clinical Urologists, American Society for Laser Medicine and Surgery, Society
for Urologic Oncology, and the Society for Urology and Engineering.