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A New Treatment for Men with Recurring Prostate Cancer Following Radiotherapy

Radiotherapy is one of the most common treatments currently prescribed for prostate cancer in the UK.  However, following radiotherapy treatment, there is a 1 in 5 chance that prostate cancer will return even if the treatment was initially deemed successful. In the past, men in this unfortunate situation have been treated with a palliative care strategy which involves careful monitoring and hormone therapy.

The hormones used as part of a palliative care strategy suppress testosterone which helps to keep prostate cancer under control for up to 3 years. However, long term use can lead to adverse medical conditions such as heart disease, diabetes, thinning of the bones and weight gain.

The alternative is a prostatectomy (surgical removal of the prostate) which generally causes significant problems and side effects. The tissues within and surrounding the prostate gland become “sticky” with considerable scarring and fusion as a result of the initial radiotherapy. As a result, side effects can include incontinence, bowel damage (which can lead to a colostomy) and a loss of erectile function.

The Alternative: High Intensity Focused Ultrasound (HIFU)

HIFU is a highly effective and minimally invasive treatment option approved by NICE and the NHS which has so far been primarily used to treat early stage treatable prostate cancer.

It is now accepted as an alternative treatment in the setting of radio-recurrent prostate cancer following radiotherapy as a result of highly successful studies over a number of years and has recently become approved for general use, albeit available only in a very limited number of hospitals.

In this form the treatment is known as Salvage HIFU. HIFU treatment (also known as focal therapy) limits the areas it targets by overlaying precision MRI scans and live ultrasound imaging to locate and localise cancerous tissue within the prostate gland. This way, less tissue becomes damaged and side effects occur less often whilst ensuring that the cancer is treated.

The Groundbreaking Study by Imperial College London

A recent study and trial by Imperial College London involved 356 men with recurrent prostate cancer following radiotherapy who were treated using refuge focal therapy. After they received the treatment, 3 in 4 of the men did not experience any disease progression in the following 6 years and did not need any hormones or invasive surgery. Meanwhile, less than 1 in 100 men experienced any significant complications. Only 0.3% suffered some minor rectal injury.

In addition to the 12,000 men each year with early-stage prostate cancer who could be treated with focal therapy, there are at any time a further 10,000 men in the UK with recurrent prostate cancer following radiotherapy who could also be suitable for this treatment.

Currently, there are very few NHS hospitals and private centres that offer HIFU. This is expected to increase in the next couple of years as the benefits of this treatment are better proven, and as men become more aware of it, along with the ongoing campaigning work of the Prost8 UK charity.

How It Works

Roughly two-thirds of men who have localised failure following radiotherapy develop unifocal cancer (one place) or unilateral cancer (one side) and the main location of the recurrence is usually the main (index) lesion prior to radiotherapy.

Localised prostate cancer is quite often multifocal and consisting of an index lesion which drives the cancer. Over time, this can lead to metastatic cancer spreading out from the prostate to other parts of the body. Secondary lesions are usually cancers that lie dormant and are deemed as insignificant.

In fact, more than 89% of recurrent cancer following radiotherapy grows from the cancer remnant in the location of the original index lesion. The majority of the time, secondary lesions are successfully treated by radiotherapy.

What’s Involved During HIFU Treatment?

Before receiving HIFU treatment, patients will have an MRI scan and usually a biopsy taken from the prostate. This helps the medical team to ensure they are only targeting the area of the prostate that’s affected by the cancer.

A single session of HIFU treatment can last up to 3 hours, although, the exact time will depend on the size of the prostate and how much of it is being treated. Once under a general anaesthetic, the surgeon and medical team will place a small hollow tube (known as a catheter into the bladder). The HIFU probe will then be placed in the rectum.

This probe will then release highly controlled ultrasound waves that generate pinpoints of heat accurately targeting just the cancerous tissue and a small margin around it within the prostate. During the treatment, the surgeon will use the ultrasound scanning to ensure that the probe is correctly positioned. The probe only treats small areas at a time (about the size of a small grain of rice) so the treatment will be staged and energy redirected until all the cancerous cells have been targeted and destroyed.

Recurrent Prostate Cancer and Why We’re Campaigning

Prost8 UK is the only prostate cancer charity working solely to promote awareness of the enhanced lifestyle outcomes provided by focal ablation for men with early-stage or recurrent prostate cancer.

Currently, more than 95% of men with a new prostate cancer diagnosis will not even be told about this treatment option, let alone offered it. Too many GP’s and clinicians involved in prescribing treatments for this disease are unaware of this less invasive treatment pathway and its efficacy. But, Prost8 UK are working hard with forward thinking urology specialists nationwide to change this as soon as possible.

In addition, the charity is actively fundraising to buy and deploy focal therapy equipment into strategic NHS hospitals across the UK to create focal therapy centres of excellence and so accelerate access to the treatment.

To support the campaign and help Prost8 UK to help up to 20,000 men each year in the UK, then please donate today via the website (www.prost8.org.uk), or by calling 0203 858 0848.

The Importance of Conversation Following a Prostate Cancer Diagnosis

If you have been recently diagnosed with prostate cancer, there will be many emotionally challenging conversations that you will need to have. They will range from speaking to your doctor about the symptoms and available treatments to telling your family and loved ones about your diagnosis. Opening up and talking about your diagnosis can be scary, but these extremely important conversations can make a big difference to the way your prostate cancer is managed, the way you live your daily life and the long-term outcome of your disease.

The information that we provide throughout this resource gives you some important guidance on the different conversations and decisions that you might need to have following your prostate cancer diagnosis. But, because no two diagnosis are identical and each man is different, it’s important that you have conversations and make decisions based on what personally feels right for you. Always remember, there are no rules on how to do things when faced with prostate cancer.

How Prostate Cancer Can Affect You Mentally 

Receiving a prostate cancer diagnosis is a life-changing experience for yourself and your family. During and after your treatment you are likely to experience a whole range of emotions. Common emotions include sadness, anxiety, fear and anger. It’s natural to feel overwhelmed and frightened when finding out about a prostate cancer diagnosis. It can have a huge impact on the way you live your life during treatment and beyond as well as the lives of the people that care about you.

There is no set way for you to feel and your emotions may fluctuate to extremes. Some days you might feel very positive and others very anxious. Some less well informed people might actually tell you to remain positive following prostate cancer diagnosis and that your mood can affect the effectiveness of your treatment. This is completely not true, and some men can find this extremely hurtful. It might make you feel even more anxious and frightened but don’t worry; it isn’t going to affect the efficacy of your treatment.

How to Deal With The Various Emotions

Just as prostate cancer affects your physical health, it can bring up a range of emotions you’re not used to dealing with. It can also make existing emotions seem more intense. They may change daily, hourly, or even every minute. This is true whether you’re currently undergoing treatment or have finished your course of treatment. But, the most important thing to remember is that these feelings are all to be expected.

Worry and Anxiety 

When you receive a prostate cancer diagnosis, you are likely to worry about the impact it will have on you, your loved ones, and what the future might hold. Prostate cancer can affect your entire family and talking to each other openly can help you all cope together. You may get anxious and worry about appointments for treatment or tests. These feelings might come and go, or you may experience them a great deal of the time. If worry and anxiety gets out of control, then it may affect your everyday life, and you may feel tired (but not able to sleep), unable to concentrate and irritable. The physical symptoms of worry and anxiety can include:

  • Heart palpitations
  • Feeling nauseous
  • Difficulty focusing
  • Heavy sweating
  • Restlessness

Part of coping with prostate cancer is looking after your mental health. So, it’s very important to speak to your doctor if you are having problems with worry and anxiety. Some GPs and hospitals have in-house counsellors that you can talk to. Just discussing how you feel and what’s making you anxious can help you put things into perspective.

Anger 

Having prostate cancer can sometimes make you feel angry because you might not be able to do the things you used to before your diagnosis. But, feeling angry is a natural response, and you shouldn’t feel guilty about having these emotions. However, anger does become a problem is starts to affect the relationships you have with your family and friends. This is because they might feel that you are angry with them rather than because you have prostate cancer. They might also feel angry that you have to deal with the cancer or that it has also affected the way they live their daily lives. Your family and friends might find that it helps to speak to someone about how they are feeling too.

Depression

Feeling sad isn’t unusual when living with prostate cancer. However, an on-going low mood that doesn’t go away after a couple of weeks can be a sign of depression. If you have suffered from depression in the past, then you may be more likely to get depression following a prostate cancer diagnosis. But, don’t worry, depression is common and can be treated. If you are depressed, you may suffer from low moods all the time and no longer enjoy the things you used to before your diagnosis. Some symptoms can include difficulty getting to sleep, feeling restless and having no appetite. You might not even realise that you are suffering from depression because it comes on gradually, and the people around you might notice it first. They might try to approach and talk to you about it and then suggest that you get some help.

If you think you have depression, the first you need to do is book an appointment to see your GP or consultant. There are a range of treatments they may recommend including cognitive behavioural therapy (CBT), counselling and antidepressant medication. Your doctor might suggest one or more of these, but there are also ways that you can help yourself.

The First Conversation Is With Yourself

Receiving a prostate cancer diagnosis can be a huge shock. That is why the first conversation you need to have is with yourself. As you try to process all the information you have been provided, it can take weeks or months for all of it to fully sink in. But, please remember that this is completely fine. Take all the time you need (within the parameters of the urgency of treatment pathway) and don’t be afraid to ask for support from others.

The Conversation With Your Loved Ones

Spend some time thinking about who you want to tell about your diagnosis and how much detail you want to go into. This is likely to differ across the range of people that you have in your life, such as a partner or spouse, children, brothers (who may be at higher risk of prostate cancer), friends and co-workers.

You might be nervous about having a conversation about your diagnosis with the people you care about for a few reasons, such as not wanting to upset them, not wanting to show them that you are upset, or you’re worried about how they might react. All people respond differently to bad news and can become upset or angry together with being supportive and sympathetic, and it can be very difficult to deal with unexpected responses. But, remember that there is always someone who is completely unconnected to you who can help you in these difficult situations.

Healthcare organisations and patient helplines offer the chance to speak to doctors, cancer specialists and other men living with prostate cancer.

Talking to Your Partner About The Sexual Effects

Prostate cancer and the treatment you receive can affect you sexually, and the majority of men find that their sex life changes. Some men question their masculinity when they cannot get an erection or find that they have no libido. If you experience this, then you might find it upsetting. Even if you use medication to help, having sex with your partner may take some getting used to as it may well be different to before your diagnosis. But, you can talk to your doctor about these feelings and counselling may also help. You might think that this is unnecessary if you are in a long term relationship and presume that you know everything about your partner, but this isn’t always the case.

Many men return to a level of acceptable functionality following treatment but be able to find satisfying ways to have a sex life even though your erectile function may not be optimal. Your partner may also have concerns about the way you feel about your sex life as well as concerns about your health. So, talking about your feelings is extremely important during this time. You need to remember that you can’t guess or assume what your partners wants. You need to have an open and honest discussion with each other.

Remember, You’re Not Alone

Talking about prostate cancer isn’t easy because it’s hard to know what to say. And, it’s difficult to know how family and friends are going to react. You might avoid talking about it because you don’t want people to get upset, but it’s important to talk and remember that you are not alone. It can help you understand the way you are feeling and help you feel more in control. It can help make your relationships stronger and help others understand what you’re going through. Once they know what you’re going through, they will want to help in any way they can.

There is no right or wrong way to talk about prostate cancer. Who you talk to may differ and depend on the type of relationship you have with each person. However, some of these tips can give you some ideas.

Prepare Yourself

First, you need to decide who you want to tell and how you want to tell them (that being maybe over the phone or in-person). Think about what you want to say and how much detail you want to go into. Try to also think of the questions that people might ask and come up with some simple answers.

Be As Honest As You Can About Your Feelings

You don’t need to protect people by hiding behind your emotions; it’s healthy to express them. If you are not sure how you feel, then say so. Once you start talking, you might find that it comes naturally.

Ease Yourself Into The Conversation

It’s important to ease into the conversation slowly by letting the person know that you have something serious that you need to tell them.

Give Information in Small Chunks

People will find it easier to understand if you give them information in small chunks by using a few sentences at a time. Also, check that the person you are talking to understands what you are saying.

Don’t Force Your Words

Most men find that are times when they want to share information and times when they don’t feel comfortable doing so. Be completely honest if there are times when you don’t want to talk but also respect others who are not ready to talk either.

Choose Someone To Speak on Your Behalf

It can get exhausting to keep talking about your diagnosis or provide people with updates when you are receiving treatment. And, you don’t have to tell everyone personally. You can ask a close friend or family member to share the news with as many people as you are comfortable with.

Patient Support Groups 

Many men with prostate cancer find that attending a support group really helps them. People often imagine that these types of support groups consist of sitting together in a circle and telling each other about yourself. But, this simply isn’t the case. Patient support groups often involve talks and activities that have nothing to do with prostate cancer. Information and advice is also provided by other patients and healthcare professionals on the management of prostate cancer. Many men like the fact that people in these support groups are not linked to their personal life so they can be more honest about their mental health and how they feel about living with prostate cancer.

Most importantly, attending a patient support group is a chance to meet other men that are living with prostate cancer. Never underestimate how much of a positive impact this can have or how much you can help other men just by having an honest conversation with them. Many support groups also welcome the families of men who have prostate cancer, so if you want to bring your loved ones with you for further support, then this is possible.

We Are Here If You Need Guidance 

Prost8 UK as a charity is working with forward-looking hospitals and clinicians (and you the public) to raise funds to deploy better equipment to accelerate access to minimally invasive treatments as the least impact the treatment has on your lifestyle after cancer then the less impact it will have on your mental health too. Prost8 UK is also lobbying the NHS to roll better treatments out faster than currently planned. However, we are also here for all men who need guidance about talking to their loved ones about a prostate cancer diagnosis. We are often able to help direct you to the best sources of help and/or resources.  If you would like help then please do not hesitate to get in touch today by visiting our contact page. We want to help men feel as comfortable as they can when speaking about their prostate cancer diagnosis.

Everything You Need to Know About Hormone Therapy For Prostate Cancer

This reference material is aimed at men who are receiving, or about to receive, hormone therapy as a treatment on its own or as part of a combination treatment plan for prostate cancer. It contains information to help you understand the important factors surrounding hormone therapy for prostate cancer. It may also benefit partners, family members or support networks so they may better understand what can be a confusing area of medical practice. The content herein can provide points to discuss with your healthcare team when you feel comfortable and ready to do so. Your team will consist of a number of health professionals with different expertise, and they work together to make sure you are supported. Each member brings specialist skills that are important in managing your care and making decisions around your treatment needs.

The way you experience prostate cancer is entirely personal. It’s not the same for every man, even if it’s the same type of cancer. Depending on the stage of your prostate cancer (and other conditions), your experience might actually be very different to somebody else’s. When it comes to dealing with prostate cancer, it’s important to take each stage as it comes. It means that you can breakdown an overwhelming situation in smaller (and more manageable) steps. For some, prostate cancer and the impact of treatment might be minimal and quickly resolved. But, for others, the impact can be more difficult to deal with, which may require more support.

You can use the information we provide as a guide for further discussions with your healthcare team. Being informed about hormone therapy for prostate cancer treatment will enable you to participate in decisions that will lead to improved experiences and better care.

What Are Male Sex Hormones?

Hormones are substances that are produced by glands in the body which function as chemical signals. They travel through the bloodstream and affect actions of cells and tissues all around the body. Androgens (male sex hormones) control the maintenance and development of male characteristics and sex drive. Testosterone and dihydrotestosterone (DHT in short) are the most abundant androgens in men. The majority of testosterone is produced in the testicles, but a small amount is also produced by the adrenal glands (small glands found above each kidney).

How Do Hormones Stimulate Prostate Cancer Growth?

Androgens are needed for the normal function and growth of the prostate. They are also necessary for cancer to grow in the prostate. Androgens promote the growth of both healthy and cancerous cells by activating the androgen receptor. Once activated, the receptor stimulates the expression of particular genes that contribute to the growth of prostate cells. Early-stage prostate cancer needs a high level of androgens in order to grow. Such prostate cancers are known as androgen sensitive (also referred to as androgen dependent or castration sensitive) because treatments that block androgen activity or decrease androgen levels can suppress the cancers growth. Prostate cancers that are treated with surgery or drugs that block androgens will eventually become castration resistant. What this means is that they can continue to grow even when androgen levels are low. Historically, these types of tumours were also called androgen independent, hormone resistant or hormone refractory. However, these terms are not really used in the modern-day because tumours that they become castration resistant may respond to newer antiandrogen treatments.

How Does Hormone Therapy Treat Prostate Cancer

Hormone therapy might be used in several different ways to treat prostate cancer, including early-stage prostate cancer, relapsed/recurrent prostate cancer and advanced or metastatic prostate cancer.

Early Stage Prostate Cancer

Men with early stage prostate cancer (localised prostate cancer) will often receive hormone therapy before, during and after radiation therapy. Or, in rare circumstances they might receive hormone therapy following a prostatectomy (surgery to remove the entire prostate gland). When it comes to early stage prostate cancer, factors are used to determine the risk of it returning following treatment. These factors include the tumour’s grade (which is measured using a grading system called the Gleason score), the extent to which the tumour has spread, and whether the cells are found close to the lymph nodes. The length of treatment with hormone therapy for a man with early stage prostate cancer depends on the risk of recurrence. Hormone therapy for intermediate-risk prostate cancer is usually given for a period of 6 months. But, when prostate cancer is graded as high-risk, it may be prescribed for 18-24 months, or longer.  Men who receive hormone therapy after having a prostatectomy may have less likelihood of recurrence than with a prostatectomy alone. However, there is no substantive evidence that they will live longer overall. Men who receive hormone therapy after having radiotherapy for intermediate or high-risk prostate cancer live longer overall without recurrence than men who just have radiotherapy.

The use of hormone therapy in early-stage prostate cancer is to essentially shrink the tumour to a size where treatment can be more effective and cause fewer side effects. Its use in surgery and radiotherapy is well established, and studies are also being carried out to see if it would be useful for patients undergoing ablation treatments such as HIFU (High intensity Focused Ultrasound) and Cryotherapy.

Relapsed/Recurrent Prostate Cancer

Hormone therapy is a standard treatment for men who have a prostate cancer recurrence after having radiotherapy or a prostatectomy. It is sometimes also recommended for men who have a biochemical recurrence or an increase in the prostate-specific antigen (PSA) level following surgery or radiotherapy (especially if the PSA level doubles in less than 3 months).

Advanced or Metastatic Prostate Cancer 

Essentially prostate cancer when it spreads to other parts of the body remains a prostate cancer; in other words, it does not transform into another type of cancer. Hormone therapy therefore is used as a standard treatment for men who have metastatic prostate cancer (the cancer has spread to other areas of the body) when it is first diagnosed. It is used to shrink the cancer even if it has spread to other tissue, bones or organs. At this point it is not used as an aid to treat the cancer, but it can help to keep it under control (sometimes for a number of years). It can also help manage the symptoms of advanced or metastatic prostate cancer such a bone pain. How long hormone therapy controls for this grade of prostate cancer for varies from case and to case. It depends on how far the cancer has spread and how aggressive it is when treatment begins.

The Different Types of Hormone Therapy

The type of hormone therapy that men receive will depend on whether their cancer has spread, other treatments they are currently having, and their personal preference. It is possible to receive more than one type of hormone therapy simultaneously.

Implants or Injections

This type of hormone therapy is medically known as androgen deprivation therapy (ADT in short). It works by stopping the brain from telling the body to produce testosterone and is just as effective at controlling prostate cancer as surgically removing the testicles. Both implants and injections are administered via a needle. Injections are given in a way that is similar to a vaccination where liquid is injected into the muscle or under the skin. Men that receive injections will typically have them in their abdomen (stomach area), arm(s), thigh(s) or buttock, but it does depend on type of injections they are receiving. Implants, however, are administered via a larger needle that places a tiny tube that sits under the skin which releases the drug slower than an injection would.

LHRH Agonists

LHRH (Luteinizing Hormone-Releasing Hormone) agonists are the most common type of implant or injection. They are used to effectively chemically castrate men.

When androgen levels are low, this causes the pituitary gland (a gland in the brain that controls hormones) to produce luteinizing hormones which stimulates the testes to produce androgens.

There are several different types of LHRH agonists that used in the UK, including:

GnRH Antagonists

GnRH (Gonadotrophin Releasing Hormone) antagonists are used less than LHRH agonists. GnRH antagonists can also be known as GnRH blockers. In the UK, there is one type currently available which is called Degarelix (Firmagon). It can be used as a first treatment for advanced or metastatic prostate cancer that has spread to the bones. It can also prevent metastatic spinal cord compression (MSCC for short), which can occur if cancerous cells grow in or near the spine.

Antiandrogens 

This type of hormone therapy is used to reduce the ability of androgens to stimulate the growth of cancerous prostate cancer cells. It doesn’t lower the overall androgen level in the body and is usually used in combination with LHRH agonists. There are a few different types of antiandrogens that are used in the UK, which are:

Orchidectomy 

Before we explain this type of hormone therapy, please note that even though it is medically classed as a type of hormone therapy, it is in fact, surgery. An orchidectomy is radical surgery to remove the testicles, or parts of the testicles that produce testosterone. It is not used as often as other types of hormone therapy. It is very effective at reducing testosterone levels which normally drop to their lowest very quickly. However, an orchidectomy can’t be reversed, so it is only offered as an option to men who require long-term hormone therapy.

How Will I Know That Hormone Therapy Is Working?

Unfortunately, doctors predict how long hormone therapy will be effective for in suppressing the growth of prostate cancer. Because of this, men who receive hormone therapy for more than a couple of months are tested on a regular basis to determine the level of PSA in their blood. An increase in PSA may indicate a man’s prostate cancer has started growing again. A PSA level that continues to increase while hormone therapy keeping androgen levels low is an indicator that a man’s prostate cancer may have become resistant to hormone therapy.

Intermittent Hormone Therapy

If a man is receiving life-long hormone therapy and experiencing problems with the side effects, they may be able to have intermittent hormone therapy instead. This involves halting the hormone therapy when their PSA level is low enough, and then starting it again if the PSA level rises or if the symptoms get worse.

Potential Side Effects Of Hormone Therapy

Like all hormone therapy for prostate cancer there can be side effects. Not all men experience side effects in the same way. Side effects are also not an indicator that treatment isn’t working. Some men find that their side effects get easier to cope with the longer they’re on hormone therapy. Sides effects can include:

  • Depression and Anxiety

Some men experience depression and anxiety while on hormone therapy. The therapy itself can cause this, or because they have prostate cancer (or a combination of both). Another contributing factor can also be the impact that the cancer and hormone therapy might be having on their personal relationships.

  • Weight Gain

Some men find that they put on weight while on hormone therapy, particularly around their waistline. Hormone therapy affects the way the body metabolises food which can cause this. Physical changes can be difficult to deal with, particularly if a man has never had any problems with their weight in the past.

  • Breast Tenderness and Swelling

Hormone therapy can cause tenderness and swelling (gynaecomastia) in a man’s breasts. It is caused when testosterone and oestrogen levels change. Tenderness can affect one or both breasts and can sometimes cause long-lasting pain. Enlargement that is entirely due to adipose (fatty) tissue is called pseudogynaecomastia.

  • Hot Flushes

Hot flushes are one of the most common sides effects of men on antiandrogens or LHRH agonists. They can differ from a few seconds of feeling overheated to hours of sweating, which can be uncomfortable to experience. Hot flushes can be similar to the ones that women get when they are going through the menopause.

  • Fatigue 

Hormone therapy for prostate cancer can cause various levels of tiredness (fatigue) from mild to severe. Some men find that this effects the way they live their day-to-day life. It can affect energy levels, motivation and emotions. Some men find that tiredness can come on quite suddenly, which means that there needs to be caution in some situations; for example, when driving.

  • Loss of Bone Mass

Long-term hormone therapy can cause bones to lose their bulk because testosterone helps to keep them strong. GnRH antagonists, LHRH agonists and an orchidectomy (surgery to remove the testicles) can all have this effect. Antiandrogens as less likely to cause a loss of bone mass.

  • Erectile Dysfunction 

Lower amounts of testosterone can cause issues with getting and maintaining an erection which is known as erectile dysfunction. Other prostate cancer treatments, such as radiotherapy and surgery, can also cause erection problems.

  • Muscle Mass Loss 

Testosterone plays a major role in how men’s bodies are physically made up. Hormone therapy can cause a decrease in muscle mass and an increase in body fat. This can change the way the body looks. Some men can also experience aches and pains in their muscles while they are on hormone therapy.

  • Loss of Body Hair 

Some men lose body hair while on hormone therapy. This is because testosterone plays a key role in the growth of hair. It is less common for men to lose hair from their head, but if this does happen, it normally grows back once they stop their hormone therapy.

  • Lack of Libido 

A lack of libido (reduced interest in sex) is common for men on hormone therapy for prostate cancer. However, it is often caused by anxiety and fatigue rather than the therapy itself (although, it can contribute to it). Most men notice their sex drive returns when their hormone therapy ends, but for some, it’s an on-going problem.

  • Problems Concentrating

Men who are currently on hormone therapy might find it difficult to concentrate or focus on specific tasks. However, there isn’t much evidence to suggest that this is directly caused by hormone therapy. For example, feeling depressed and stressed is normal for men with prostate cancer and can affect concentration levels and memory.

Side effects normally last for as long as a man is on hormone therapy. They normally improve once testosterone levels start to rise again. Depending on the type of therapy, this could take months or several years, and for some, the side effects may never go away completely. But, this ultimately depends on the type of hormone therapy, how long a man has it for, and what other treatment they are receiving at the same time.

What Can Be Done to Reduce the Side Effects?

Men who experience loss of bone mass during long term hormone therapy might be prescribed medication to slow down or reverse it. Exercise may also help to reduce side effects, including loss of bone mass, weight gain and fatigue. The sexual side effects of hormone therapy can be some of the hardest to deal with. Medication such as Viagra doesn’t normally work for men who are undergoing hormone therapy because it does not address the loss of libido that is caused by a lack of androgens. When men stop taking hormone therapy, the loss of libido will eventually go away. However, if hormone therapy has been used for a number of years, then these side effects may not completely disappear.

Does Hormone Therapy Help With HIFU?

Hormone therapy is sometimes given to men for about 2 to 3 months prior to HIFU (high-intensity focused ultrasound). It can make the prostate gland smaller and ultimately easier to treat. Some men may also be offered an operation called transurethral resection of the prostate (TURP) which removes prostate tissue to improve urine flow. It is sometimes used before a man receives HIFU to reduce the risk of urinary issues following the treatment. However, please note that if a man has a large prostate, they might be offered alternative treatments before receiving HIFU. The grade of the prostate cancer and Gleason score will also be used to determine the best course of treatment.

How Does HIFU Treat Prostate Cancer?

High-intensity focused ultrasound (HIFU) is a non-invasive procedure that uses high-frequency ultrasound energy to heat and destroy cancerous prostate cells. Ultrasound energy travels into the prostate gland from a transducer (transrectal probe) that enters through the back passage (rectum). The basic concept of how HIFU works is that it targets, burns and destroys cancerous prostate tissue similar to the way a magnifying glass can use the sun’s rays to burn a hole in a leaf. However, instead of using light as a source of energy, HIFU uses sound. When the sound waves are aimed at the prostate, they increase tissue temperature, only destroy cancerous cells and protect the surrounding healthy tissue.

HIFU can be suitable for men whose cancer is still within their prostate (localised prostate cancer). It can sometimes also be an option if the cancer has started to break out of the prostate or has spread to the tissue that surrounds the prostate (locally advanced prostate cancer). It is not an option if the cancer spread outside of the prostate and to other areas of the body (advanced prostate cancer). HIFU can also be used to treat prostate cancer that has returned after a man receives radiotherapy (recurrent prostate cancer). This is known as salvage HIFU but is only a treatment option for men with localised or locally advanced prostate cancer.

What Happens During the HIFU Procedure?

A typical HIFU procedure takes about 1 to 1 and a half hours. However, it does depend on the size of a man’s prostate and how much of it is being treated. Some HIFU procedures can take up to 3 hours. Once under anaesthetic, a surgeon will place a thin, hollow tube called a catheter into the bladder. This will be placed either through the penis (urethra) or through the wall of the abdomen (stomach area). The surgeon will then place the transducer (transrectal probe) into the man’s back passage. The transducer will then give out beams of ultrasound waves that will kill the cancerous prostate cells. The surgeon will use ultrasound scanning throughout the procedure to ensure that the transducer is in the right position and targeting the right area of the prostate. The transducer only treats a very small area at a time (but with pinpoint accuracy), so the surgeon will move it until all cancerous tissue has been destroyed. Most men are able to go home on the same day that they receive HIFU. A doctor or nurse will check that they have recovered from the anaesthetic and that they are fit enough to go home. Before leaving the hospital, they will also be shown how to look after their catheter, which will remain in place (usually for a week) to help with passing urine.

What Happens Following HIFU?

Following HIFU, men will have regular check-ups with their doctor or nurse at the hospital to begin with, and then with their GP. The purpose of these check-ups is to:

  • Monitor how the cancer has responded to HIFU
  • Deal with any side effects that men might be experiencing
  • Allow men to ask questions or raise concerns.

A PSA test will also be carried out every 3 to 6 months for the first couple of years following HIFU to determine how well it has worked. A PSA level is most likely to reach its lowest within a few months following the treatment. A steady rise in a PSA level can be a sign that the prostate cancer has come back. If it does come back, then a doctor or nurse will discuss further treatment options. Some men may also need to have other tests such as an MRI scan, CT scan or bone scan. These are to determine whether the prostate cancer has spread to other parts of the body.

Why Prost8 UK Are Campaigning For HIFU

At Prost8 UK, we strongly believe in campaigning for less invasive treatments for prostate cancer like HIFU (and cryotherapy) for men with early-stage prostate cancer. We also campaign for earlier awareness of the symptoms of prostate cancer through newer, simpler and more accurate cancer screening. If you would like to support our cause and help us help all men in the UK, then please make a donation today via the website, or by calling 0203 858 0848.