Counteracting Side Effects from Hormonal Therapy

BY MARK SCHOLZ, MD

Hormonal therapy can slow or even halt prostate cancer growth, but it isn’t without its side effects. Many measures—from medication to exercise—can mitigate these secondary reactions.

Fatigue and Lassitude from Muscle Atrophy

Fatigue mostly comes from muscle loss. To a lesser degree, anemia may be a factor (see below). Fatigue can be combated by lifting weights for one hour three times a week in a program that includes every major muscle group of the body (see our exercise handout).

Weight Gain

Lower muscle mass slows the body’s metabolism and leads to weight gain. Men need to pay careful attention to their diet and reduce caloric intake while on hormonal therapy.

Hot Flashes

Depo Provera dramatically reduces hot flashes. However, it is a chemical precursor to testosterone, and as such introduces the possibility of “feeding” the tumor. Better alternatives are low doses of Effexor or Neurontin. Another approach is acupuncture. Lastly, an estrogen patch (Vivelle Dot) is very effective. However, estrogen can cause breast enlargement.

Breast Enlargement

Breast growth (even without estrogen patches) can occur with any type of hormonal therapy. A preventive measure is a pill called Femara. Alternatively, the breast area can undergo radiation prior to initiating hormone therapy.

Erectile Atrophy

The loss of nocturnal erections causes shrinkage of the penis. Regular use of Cialis or Viagra is essential. If these do not work, a urologist who can teach patients how to do injection therapy should be consulted.

Anemia

Anemia is detected by checking the hematocrit blood level. Levels below 32% cause fatigue. Anemia reverses after hormone therapy is stopped. If anemia is severe, treatment with Procrit or Aranesp helps. Iron is not beneficial.

Liver Changes

Casodex, Flutamide, Nilutamide, and Zytiga occasionally cause liver abnormalities. Therefore, a hepatic panel blood test is routine. The liver problems reverse quickly if the problem is detected early and the medication is stopped.

Mood Swings and Depression

Men occasionally experience more intense feelings or depressive emotions. Low doses of antidepressant medications such as Zoloft, Celexa, or Paxil are very effective at reversing these unpleasant emotions.

Osteoporosis

Bone loss from low testosterone can lead to hip and spine fractures. Prevention consists of exercise and supplementation with calcium and vitamin D.  Treatment with medications such as Fosamax, Boniva or Prolia may be necessary.

Miscellaneous Side Effects

Nilutamide should be stopped if shortness of breath or coughing develops. Xtandi can’t be given to men with a history of seizure. Zytiga lowers potassium, so those levels need to be monitored and supplemented if necessary.

Side effects from hormonal therapy are very common. Some (like hot flashes) are fairly easy to reverse with therapy. Others can be irreversible (penis shrinkage, breast enlargement) or only reverse slowly (osteoporosis) or difficult to reverse (weight gain, muscle loss). Many of the potential side effects of hormonal therapy can be prevented by the sensible means discussed above.  Patients on hormone blockade therapy need to study this brochure diligently and discuss all the potential side effects point by point with their doctors to ensure that these risks are minimized as much as possible.