Beyond Hormone Therapy: Other Options For Prostate Cancer Control
- Androgen deprivation therapy (ADT), also called hormone therapy, remains central to prostate cancer care, but emerging treatments like radioisotopes and antibody therapies (which use antibodies to help the body fight cancer) may reduce reliance on hormone therapy in the future.
- Dr. William Tester, professor of medical oncology at Thomas Jefferson University’s Sidney Kimmel Cancer Center, expresses optimism that ongoing research into targeted antibodies will provide more treatment options.
- He emphasizes that while ADT remains standard, its side effects, including sexual dysfunction, present a significant concern for many patients.
- Non-hormonal options, like chemotherapy and targeted radiation treatment with Pluvicto (lutetium Lu 177 vipivotide tetraxetan), are being considered earlier in the treatment timeline, reflecting a shift towards individualized care.
One of the major reasons behind a move away from ADT and towards a more individualized approach is the side effects profile of hormone therapy, which causes mood swings, hot flashes, night sweats, as well as urinary and sexual dysfunction.
Read MoreHow Hormone Therapy Impacts Patients
ADT works by lowering testosterone levels or blocking androgen receptors, which can significantly reduce the number of prostate cancer cells in a patient’s body, prolonging their survival. However, its impact on quality of life — especially sexual function — varies widely. Some patients find it easy to cope with these side effects, while others really struggle.“I’ve learned that different men will do things quite differently. Some will be extremely concerned about their sexual function, and others are not,” Dr. Tester explains.
For those deeply concerned about preserving sexual health, Dr. Tester often discusses alternative options. Non-hormonal therapies such as radioisotopes and chemotherapy may be considered — even in cases where hormone therapy is traditionally prescribed.
Radioisotopes are an “unstable form of a chemical element that releases radiation as it breaks down and becomes more stable,” according to the National Cancer Institute. Drugs like Pluvicto (lutetium Lu 177 vipivotide tetraxetan) contain a radioisotope.
The timing of when these treatments are used is related to how the clinical trials were done to get FDA approval. Pluvicto was first studied for use after chemotherapy, which limited its role in earlier stages of disease. Newer studies have now been done that led the FDA to approve its use prior to chemotherapy. This can benefit patients who are wary of the side effects of ADT and chemotherapy agents like Docetaxel and Cabazataxel. Patient preferences can play an important role in helping the clinician make optimal treatment recommendations to their patients.
“This is unusual,” Dr. Tester notes, “but I’ve had one man opt for chemotherapy over hormone therapy” to avoid some of the potential side effects which could affect his sexual function.
Managing Hormonal Therapy Side Effects During Prostate Cancer Treatment
When To Consider Non-Hormonal Therapies
Dr. Tester says treatments like Pluvicto continue to gain traction as an option earlier in the treatment timeline, offering promising results that may one day lessen the need for hormone therapy entirely.
“Radioisotopes like Pluvicto are being used in earlier stages and have been shown to be effective, so we might have to introduce that prior to hormone therapy,” he says.
Still, at the heart of the current standard remains ADT. In many cases, androgen receptor pathway inhibitors (ARPIs) are added to the treatment plan as a sort of assist — and some patients may want to use them in place of ADT.
“If you don’t give ADT and you give a drug like enzalutamide [an ARPI], the testosterone levels generally go up,” Dr. Tester explains. “But with enough of the androgen receptor inhibitors onboard, that circulating testosterone doesn’t have much effect. And you can see responses with single-agent therapy.”
Removing androgens like testosterone in men can cause male menopause of sorts, with similar side effects like hot flashes, osteoporosis, and weight gain. It can also lead to weaker muscles, high cholesterol, and a risk of diabetes.
Dr. Tester’s perspective on ADT underscores a key message: treatment isn’t one-size-fits-all. It’s about finding the right balance between effectiveness, personal values, and quality of life.
Questions To Ask Your Doctor
- Is hormone therapy the best option for me, or are there other treatments I should consider?
- What are the trade-offs between the different types of hormone therapy and other options based on my tumor profile?
- How might hormone therapy affect my sexual health and overall quality of life, and if it does, what resources are available to sustain intimacy?
- How long will it take for me to recover after treatment and return to my normal routine?
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