| Possible side effects for Hormonal Therapy |
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| Bone flare - Hormone therapy for prostate cancer can involve the use of a chemical to block production of testosterone, which results in shrinking of the prostate. Chemicals called luteinizing hormone releasing hormone agonists (LHRH agonists), decrease the production of testosterone in the long term. The first reaction of the body to these chemicals is to overproduce testosterone, so for a short period of time patients may experience a flare, or an increase in cancer related symptoms, including bone pain in patients with cancer that has spread to the bone. This bone flare will recede after the body adjusts to the presence of these LHRH agonists and shuts down production of testosterone. Often physicians will give some other drug in addition to the LHRH agonist for the first few weeks, to avoid this initial flare-up of cancer related symptoms. |
Discuss with your doctor:
- What are the chances that I will experience a bone flare?
- What is the treatment for a bone flare?
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| Diarrhea - Diarrhea is defined as bnormally loose bowel movements, of either semisolid or fluid fecal matter. Diarrhea can be one side effect of radiation therapy or total androgen blockade achieved with combination hormone therapy for prostate cancer. In particular, anti-androgens like flutamide and bicalutamide, which block the function of male hormones, can cause diarrhea as a side effect. |
Discuss with your doctor:
- Is this side effect temporary or permanent?
- What is the incidence of diarrhea for your patients that received hormonal therapy?
- What medication(s) that I am on, or will be on, might cause diarrhea?
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| Swelling & tenderness of the breast (gynecomastia) - One kind of hormone therapy involves use of estrogen to block testosterone production. Men who receive estrogen for this reason can experience swelling and tenderness of their breast tissue. This side effect can be dramatically reduced when three low-dose radiation treatments to the breast tissue are given before estrogen therapy is initiated. Although estrogen is the most common therapy leading to this problem, other kinds of hormone therapy can also cause breast swelling and tenderness to a smaller degree. If the swelling is severe, it can be treated surgically. |
Discuss with your doctor:
- Is this side effect temporary or permanent?
- What is the treatment for gynecomastia?
- Am I on estrogen or will I be on estrogen in the future?
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Hot flashes - A hot flash is a sudden feeling of warmth that spreads throughout the upper body and can last up to an hour. This occurs when hormones change the way the body controls its temperature. Hot flashes are most commonly associated with menopause in women. Prostate cancer treatment that involves blocking the production or the effects of the male hormone testosterone can cause hot flashes in men. Patients on this type of therapy commonly experience hot flashes.
Treatment of hot flashes in men undergoing hormone therapy for prostate cancer is accomplished in several ways. Identifying and avoiding certain triggers is an important part of therapy. Triggers can include stress, alcohol or caffeine, hot or spicy food, external heat, and smoking. In addition, medications are available that can help control them. This symptom can be distressing for some patients. Talk with your doctor or oncology nurse about the likelihood of hot flashes following this therapy. If you experience hot flashes during or afterward, ask about available treatments and techniques that have been helpful to others. |
Discuss with your doctor:
- What has the incidence of hot flashes been for your patients receiving hormonal therapy?
- Am I likely to experience hot flashes?
- What is the treatment for hot flashes?
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Decrease in erection durability (impotence) - Impotence or "erectile dysfunction" (ED) is defined as difficulty attaining and maintaining an erection. Impotence is one of several side effects within the larger category of sexual dysfunction associated with cancer and its treatment.
When the cause is related to prostate cancer surgery, it is due to damage to the nerves. When the cause is related to radiation therapy, it tends to be due to damage to the arteries. ED also can be due to lack of testosterone associated with hormone therapy. Depending on the cause, it can be either temporary or permanent.
For men who are good surgical candidates, nerve-sparing surgery appears to decrease the likelihood of impotence following surgery. And brachytherapy (seed implants) has a slightly lower impotence rate than external-beam radiation therapy.
There are a number of approaches for treating impotence, including medication, surgery, assistive devices, and alternative methods to achieve intimacy. Talk with your doctor or oncology nurse before your treatment about the likelihood of impotence following therapy. If you experience impotence after cancer therapy, ask about available treatments and techniques that have been helpful to others.
Sexuality is an important aspect of human emotional expression, and inability to function in this area can negatively impact quality of life. |
Discuss with your doctor:
- Is my therapy likely to cause impotence?
- What has your success (or failure) been preventing and treating impotence resulting from hormonal therapy?
- What treatments are available if I become impotent?
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Loss of sexual desire - Hormone therapy and surgical castration (removal of the testicles) result in elimination of circulating testosterone in the blood stream. This lack of testosterone will decrease a patient's interest in sexual activities. It is important to realize that a man who has undergone one of these treatments is usually still able to have and sustain an erection, and that lack of interest does not equal lack of ability to perform sexually. However, this change can add to the stress of a diagnosis of cancer and affect a patient's relationships. Other factors can influence sexual desire (libido), including medications, psychological issues, and how well or ill a patient feels, but loss of testosterone most commonly is the main culprit when libido is lacking.
This side effect should be part of any discussion the doctor and patient have when choosing prostate cancer therapy in general. Talk with your doctor or oncology nurse early in your care about the likelihood of loss of libido following therapy. There is no effective treatment yet for loss of sexual desire, but measures can be taken to counteract this effect. |
Discuss with your doctor:
- Is the loss of sexual desire a temporary or permanent condition?
- How is this treated?
- Is there a medication I can take to treat this side effect?
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| Nausea - Nausea is a common side effect of many types of prostate cancer therapy. Nausea is sometimes caused when the lining of the stomach is irritated by treatment for cancer. The patient may decrease intake of food because of severe nausea and subsequently experience weight loss and loss of stamina because of decreased food intake. Nausea can frequently be treated with medication such as trimethobenzamide (Tigan®) and ondansetron (Zofran®), as well as observation for and avoidance of triggers that stimulate nausea. |
Discuss with your doctor:
- How often will I experience this side effect?
- What are the hormonal medications that may cause nausea?
- What has the incidence rate of nausea been for your patients?
- How can nausea be prevented and treated?
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| Weight gain - A common side effect of hormonal therapies that inhibit testosterone production or prevent it from reaching prostate cells and stimulating cancer growth is weight gain. This side effect may be due to water retention, increased appetite, or possibly a difference in the way the body metabolizes fat. The only effective long-term treatment for weight gain is a combination of exercise and a low calorie diet. |
Discuss with your doctor:
- What percentage of your patients experience weight gain after they start hormone treatment?
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| Fatigue - One common side effect of some therapies can be fatigue. Patients experiencing fatigue have a diminished quality of life because they are too tired to take part in normal activities. This can result from therapies causing a decrease in the number of red blood cells carrying oxygen around the body, or it can be a more general result of illness and depression. This is often temporary, and some new medications can be given to help patients who experience extreme fatigue. Fatigue sometimes can be offset by regular exercise with strength training. |
Discuss with your doctor:
- How will fatigue affect my activities of daily living?
- How much fatigue should I expect?
- What measures can be used to minimize fatigue or improve my energy level?
- Would a mild exercise program be beneficial for me during treatment?
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| Risks of surgery - The risks of surgery are much like those of any major surgery, including risks from anesthesia. Among the most serious, there is a small risk of heart attack, stroke, blood clots in the legs that may travel to the lungs as pulmonary emboli, and infection at the incision site. Another risk is bleeding during or after the surgery. Blood transfusions, which carry their own small risk, may be needed. In extremely rare cases, people die due to complications of an operation. Surgical risks depend, in part, upon the individual's age, their general health, and the skill and experience of the surgical team. |
Discuss with your doctor:
- What are the risks of orchiectomy?
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