The Role of Testosterone in Prostate Cancer Disease Behavior and Course of Treatment

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Topics include: Treatments and Understanding

Prostate cancer experts Dr. Maha Hussain and Brenda Martone, both from the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, explain the connection between testosterone and prostate cancer, how hormone therapy works to suppress cancer growth, some common treatment side effects and recommendations for side effect management. Prostate cancer patient Gary Andrus also shares his experience with hormone therapy and how he copes with being, as he says, “chemically castrated” from treatment.  Watch now to hear their expert knowledge and experience.

This is a Patient Empowerment Network program produced by Patient Power in partnership with Robert H. Lurie Comprehensive Cancer Center of Northwestern University. We thank Astellas, Clovis Oncology and Pfizer for their support.

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Okay, let’s talk about hormones for a minute. Is prostate cancer, Dr. Hussain, fueled by testosterone? Is that like throwing gasoline on the fire? Is that what it is? Then, where does controlling hormone with medicine come in?

Dr. Hussain:                

As it turns out, testosterone is the feeder for the cancer, and essentially, potentially even the instigator, so to speak, of causing, potentially, the cancer, and therefore, starving the cells from the male hormone is essentially the backbone of treatment when we get to the level where systemic therapy is necessary. In the old days, this was accomplished by removing the testis, and subsequent to that, medical therapy hit the clinic and there are many choices right now that we have, primarily injections to try to suppress the testosterone production and shut down the testis. 

By starving the cancer, that causes the cancer to first arrest and it doesn’t grow, and then, ultimately, the cancer cells will die. Then, depending on the setting and how much cancer there is, and how resistant or how smart are the cancer cells, the downstream outcomes can vary by individuals. There are people who continue in a good response for a long period of time, and there are patients who, unfortunately, literally, I say, respond for five minutes and their cancer ends up progressing, but the majority is not like that. 

The majority is, you can buy a lot of time and hormone treatment has gravitated now to the earlier stages of the disease because that is where, when you have lesser cancer, you have a better chance of eradicating it from the system with the hope that you can cure the patient, and so, consequently, that is part of the operation when we have patients choosingradiation treatment, but let’s say they have borderline bulky disease in their prostate, a finite duration of hormonal treatment is added to the radiation and that ends up prolonging life.

Andrew Schorr:          

Gary, you had hormonal therapy for quite a while. It worked for a quite a while for you, didn’t it?

Gary Andrus:              

Yes, I still am on hormonal therapy.

Andrew Schorr:          

Okay, so that’s part of it. Let’s talk, Brenda, about side effects. You’re shutting down, as best you can, the testosterone, so it’s not a free lunch, there are some side effects with that, right? 

Brenda Martone:         

Yes, there are. The most frequent side effects with androgen deprivation therapy is hot flashes, men can get hot flashes. They can be infrequent, or they can hop into hourly, and they can be distressing. They can also gain weight. We are altering their metabolism by taking away their testosterone. Men often gain weight in the same—kind of the midsection where women gain weight during menopause, there can be muscle mass wasting, so their muscle mass can go down, and then probably the most—or more distressing would be the lack of libido because it’s testosterone that kind of drives that sex drive, as well as having erectile dysfunction or not being able to get an erection.

Andrew Schorr:          

Okay, so we see on TV, there are pills for things like that. I think, do they work in men who are going through prostate cancer treatment?

Brenda Martone:         

There are times where men can get erections with medications such as sildenafil (Viagra), I’m not advertising, but those sorts of medications that help with that. What we don’t want men to do is pay attention to those commercials that talk about low T and what you should do for that because that’s exactly what we want to avoid, is supplementing the prostate cancer with additional testosterone.  

Andrew Schorr:          

Yeah, gas on the fires.

Brenda Martone:         

Absolutely. 

Andrew Schorr:          

Don’t want to do that.Gary, what side effects have you had with hormonal therapy and how have you coped?

Gary Andrus:              

All the ones that Brenda has mentioned. The hot flashes, I think the doctor was saying, we’ll probably use the right word, but I guess I would say I’ve been chemically castrated for years, the hot flashes, but you cope. I always looked at the hot flashes as, it’s no different than what hundreds of thousands—every woman has to go through at some point in time, and actually, sometimes in the winter, they kind of warm me up. 

Andrew Schorr:          

Living in Michigan, yeah.

Gary Andrus:              

Yeah, living in Michigan, but you just deal with it. I still get hot flashes. I mean, the drugs I’m on now, everything—you still get hot flashes, they’ve never stopped. At different times, they’re pretty intense, but that’s better than any other times. 

As far as the sexual nature, Dr. Hussain and I talked years ago and I’m like, you’ve got to be kidding me. I mean, I don’t really care. At this point in my life, whether I was 48, 50, and now 61, it’s about living. I don’t hold that side of my male character as being what makes me male, and I’ve tried to explain this to other men, it’s—that is not what makes you a man, and I’m a pretty strong alpha male, and I’m on the board of directors at Oakland Hills and I’m—and guys see me as extremely strong alpha male and they follow me, and it has nothing to do with whether or not I have a strong libido or not. It doesn’t come into play. It’s all in your head. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on March 21, 2019