Hormonal Therapy

Hormonal Therapy:

Hormone therapy works by lowering the body’s natural production of testosterone, a male hormone that stimulates prostate cancer growth.

It can be employed as a long-term treatment to manage prostate cancer or used prior to specific types of radiotherapy to reduce the size of the prostate.

The testicles

The testicles are two small, oval-shaped organs located below the penis, enclosed in a skin pouch called the scrotum.

Image of the testicles (cruk)

Starting from puberty, the testicles begin producing sperm. Inside the testicle, small tubes come together to form the epididymis, a single tube that becomes wider as it exits the testicle. This wider tube is known as the spermatic cord.

The spermatic cord leads to a short passage called the ejaculatory duct, which opens into the urethra, the tube that carries urine and semen out of the body through the penis.

Testosterone:

The testicles produce the hormone testosterone, which is responsible for developing male characteristics such as:

A deeper voice
Facial hair growth
Increased muscle mass
The ability to achieve an erection
Male sexual drive (libido)

Where does testicular cancer start:

The testicles consist of various cell types, and the kind of cancer you have depends on the specific cell where it begins. Most testicular cancers arise from germ cells, which are responsible for producing sperm. Doctors classify germ cell cancers into two main types:

Seminoma
Non-seminoma

Testicular cancer and the lymph nodes: Lymph nodes are a part of the lymphatic system that spans the entire body. They, along with lymph vessels, contain a yellow fluid known as lymph. This fluid circulates through the lymphatic system, collecting waste products and draining into veins for waste removal. Cancer can spread to lymph nodes, causing them to enlarge. In testicular cancer, it’s common for the disease to spread to lymph nodes located at the back of the abdomen, known as retroperitoneal lymph nodes. These retroperitoneal lymph nodes are situated behind the intestines and in front of the spine. They lie next to the main blood vessels in the abdomen, the aorta, and the inferior vena cava. Image of the lymph nodes with testicles Who gets it: Younger men are more likely to get testicular cancer. Trans women can also develop testicular cancer if they haven’t had an operation to remove their testicles (orchidectomy). Men in their early 30s are the most likely to get it. It then becomes less common as men get older.

3.1 How Hormonal Therapy Works:

There are various types of hormone therapy available, commonly administered as injections. The most frequently used medications include Goserelin (Zoladex®), Leuprorelin (Prostap®), and Triptorelin (Decapeptyl® and Gonapeptyl Depot®).

These treatments are typically administered either monthly or every three months, usually by a GP or practice nurse. The injections can be given into the skin of the lower abdomen, arm, or leg.

Before beginning hormone injections, men are prescribed a course of anti-androgen tablets such as Flutamide, Cyproterone Acetate, or Bicalutamide. These tablets are usually taken two weeks before starting hormone therapy and for a short period afterward.

Once hormone therapy commences, it will lower testosterone levels, resulting in a decreased PSA level. This occurs because the therapy effectively ‘starves’ the cancer by depriving it of the hormone it needs to grow.

3.2 : Side Effects:

Hormone therapy is highly effective at diminishing cancer activity, but it can also lead to various side effects due to the reduction in testosterone levels.

Below are some common side effects and strategies to manage them:

Hormonal Therapy Side effects	Symptom Management
Tiredness	Incorporate rest periods into your daily routine. Plan your tasks in advance to avoid rushing. Eliminate any non-essential activities and opt for labour-saving methods.
Weight Gain	Engaging in physical activity and eating a balanced diet can help manage weight.
Hot Flushes	Steer clear of spicy foods. Refrain from smoking, caffeine, and excessive alcohol consumption. opt for natural fabrics such as cotton for your clothing and bedding. Utilize a fan in your bedroom and carry a handheld fan. Keep an insulated water bottle filled with iced water nearby, particularly at night. NICE has suggested medications like medroxyprogesterone and the anti-androgen Cyproterone Acetate to help manage persistent and troublesome hot flushes in men undergoing hormonal therapy.
Breast Swelling (Gynaecomastia)	Tamoxifen can be effective in reducing breast swelling and tenderness. A small dose of radiotherapy to the breast area may also be an option.
Loss of Sex Drive(Libido)	Medications, counselling, or mechanical aids can help address these issues.
Holistic Hormonal Therapy Relief	Practices such as meditation, breathing exercises, and acupuncture may all provide relief.

3.3 ; Intermittent Hormonal Therapy :

Some men undergoing hormone therapy, who respond favourably to treatment, may have the option of intermittent therapy. This involves pausing the therapy when cancer activity is low and resuming it when activity rises. Taking breaks from treatment can help alleviate challenging side effects.

3.4 : Orchidectomy:

Another method to permanently lower testosterone levels is through a surgical procedure called a bilateral orchidectomy, which involves the removal of the testicles.

Confidential Mencan Helpline: 84510 09760