By R. Morgan Griffin
Reviewed By Charlotte Grayson
Hormone therapy can make a big difference for men with recurrent or metastatic prostate cancer. But it isn't a cure. Its effects are limited and the side effects can be difficult to cope with. Deciding on a therapy -- which drugs, alone or in combination, and what dosing schedule -- can be difficult.
It's key that you understand the benefits and risks. You need to be informed. So WebMD turned to some experts for advice. If they were patients, we asked, what would they ask their doctors about hormone treatments?
Do I really need hormone therapy?
You shouldn't assume that more therapy is always better, says Durado Brooks, MD, MPH, director of prostate cancer programs at the American Cancer Society. If there's proof that the cancer has returned or spread throughout the body, hormone therapy makes sense. But if your case is not so clear-cut, you should carefully weigh the benefits and risks of hormone therapy -- especially the side effects. As of yet, we don't have good evidence that getting very early treatment helps more than the standard approach.
What kind of treatment do you think I need?
You should think about what kind of treatment makes sense for you, Brooks says. Would you prefer to have injections every few months, or get an implant once a year? Is surgery something you would like to consider? Talk over the options with your doctor.
What are the side effects?
"The side effects of these drugs aren't inconsequential," says Stuart Holden, MD, medical director of the Prostate Cancer Foundation and director of the Warschaw Prostate Cancer Center at Cedar Sinai Medical Center in Los Angeles. LHRH agonists (and orchiectomies) essentially knock out a man's sexual drive. "Since every drug causes different side effects," he says, "make sure that your doctor tells you the specific consequences of the drugs you might take."
Why do you think this type of hormone therapy is the best choice?
"Your doctor should be able to tell you all the options, and the pros and cons of each approach," says Holden. "That's the key." Some doctors prefer to use the most powerful treatments early. Others prefer less aggressive treatment, keeping some treatments in reserve, Holden says. The best approach depends on your particular case.
What will happen if this treatment fails?
Unfortunately, hormone treatments don't always help. So it's important that your doctor have a plan for what to do if that happens, Holden says. "When one type of hormone therapy fails, there are back-up remedies that may work," says Holden. He suggests that you get details. Find out exactly what your doctor would do at each stage if your treatment doesn't work.
You don't necessarily need to get a second (or a third) opinion when you're deciding on treatment, say the experts. "But if you're not comfortable with the advice that your doctor gives you, or you have questions that he's not really answering, then it's a good idea to talk to someone else," Brooks tells WebMD.
Published May 2005.
SOURCES: Durado Brooks, MD, MPH, director, prostate cancer programs, American Cancer Society. Stuart Holden, MD, medical director of the Prostate Cancer Foundation; and director, Warschaw Prostate Cancer Center at Cedar Sinai Medical Center, Los Angeles.
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