Two principal kinds of drugs are usually prescribed to fight prostate cancer; some work through the pituitary gland, others block cells in the cancer that are receptive to stimulus from the outside.
Prescription drugs used to treat prostate cancer
The pituitary gland in the brain produces a “luteinising” hormone, also called lutropin, that induces the male testes to make testosterone, the primary androgen that controls and maintains masculine characteristics. Testosterone attached to prostate cancers causes the cells to multiply and grow. If a drug causes the pituitary to produce less lutropin, testosterone levels are reduced. This may cause the prostate cancer to shrink or develop more slowly.
Anti-androgen drugs block these testosterone receptors so they can’t instruct cancer cells to grow and multiply. Anti-androgens do not cure prostate cancer, but they can improve some of the disease's symptoms and help the patient live longer.
Bitcalutimide and Cyproterone acetate
Marketed as Casodex, bitcalutimide is an anti-androgen. It comes as a tablet taken once a day by mouth, with or without food, and is ordinarily prescribed with leuprorelin, goserelin or triptorelin. Those drugs prevent your pituitary gland from secreting luteinising hormones that instruct the testicles to make testosterone. It can also be used with anti-androgens like bicalutamide, flutamide, and cyproterone acetate.
Bicalutamide, along with the luteinizing hormone-releasing hormone, may help stop the growth and spread of cancer cells, but it does not cure prostate cancer. Continue to take both bicalutamide and the luteinizing hormone-releasing hormone even if you feel better. Do not stop taking these medications without talking to your doctor.
You should tell your doctor what other medications you are using and if you have ever had liver disease in the past.
The side effects of taking bitcalutimide are numerous, ranging from stomach problems and nausea, constipation, diarrhoea, vomiting, gas, dizziness, blood in your urine, painful urination, sexual problems, joint pains, sweating, feeling anxious, and many more. Make sure that you watch for yellowing of your skin or eyes or anything else that suggests liver problems or chest pains, exhaustion, and unusual bleeding. Go to www.drugs.com/casodex.html to get a full list of the complications of using this drug.
Cyproterone, structurally similar to testosterone, attaches itself to the receptors on the surface of cancer cells. Testosterone can’t then attach itself to these cells, slowing the growth of cancer cells. It can be given for months to years, depending on its effectiveness.
Take cyprostate as a tablet evenly spaced two or three times daily, after meals and with water.
Cyprostate may be used to treat prostate cancer if surgery and other treatments are not suitable. It can be prescribed to prevent flare-ups when anti-androgen drugs are used, causing a temporary rise in levels of testosterone—with side effects including pain in bones or problems urinating.
You should not father children while taking Cyprostate, as it can affect the developing foetus.
Some people have side effects using Cyrpostate. Side effects include breast tenderness, reduced sex drive, nausea, vomiting, diarrhoea, blood clots, high or low blood sugar levels and liver problems.
Euxelin and Flutamide
The generic name for anti-androgen drug Eulexin is Flutamine. The anti-cancer drug Leuprolide is sometimes prescribed to accompany Euxelin. The two drugs should be taken together, exactly in the amount prescribed, without interruption.
You can’t anticipate the side effects of Euxelin, but they can include, nausea, vomiting, diarrhoea, loss of sex drive, and impotence. In combination with radiation therapy, you may experience stomach problems, blood in your urine, or bleeding from your rectum.
Eulexin has caused some patients to suffer fatal liver failure. This is rare. Have your liver tested before taking Eulexin. If you experience liver problems, reduce your dosage or stop taking the drug. If you think you’re having liver problems, tell your doctor immediately. Look for itching, flu-like symptoms, yellowing skin or eyes, loss of appetite and tenderness on the upper right side of your abdomen.
If you are taking Warfarin, an anti-coagulent drug, your doctor will have to watch you closely after you begin treatment of Eulexin, and he might lower your dosage of Warfarin.
The recommended dosage for Eulexin in an adult, with or without food, is two 250-milligram capsules three times a day at eight-hour intervals. If you stop taking your medications, your cancer can grow more rapidly. If your symptoms get worse, tell your doctor.
Stopping your medications could allow the cancer to spread more rapidly. Inform your doctor if your condition persists or worsens (e.g., urination becomes more difficult or bone pain increases).
Another anti-androgen used to fight prostate cancer is Flutamide. Like Euxelin, it is taken three times a day. The same warning applies as to the other anti-androgen drugs, don’t stop taking them. If you do, your cancer might spread more quickly. If you miss a dose, make it up as quickly as possible. Don’t take twice as much.
Don’t drink alcohol while taking Flutamide. Anti-androgens can affect your liver. Flutamide is no exception. Your liver should be tested before you take this drug and while you are taking it. Watch for symptoms of a liver gone bad: dark urine, exhaustion, yellow skin and eyes, pains in your abdomen, loss of appetite, vomiting. Liver problems most often happen sometime in the first three months you use Flutamide.
Along with nausea and vomiting, you may experience diarrhoea. If you develop diarrhoea, stop taking dairy products, and drink lots of water and eat more fruits and vegetables. Don’t be alarmed if your urine becomes yellow-green or light orange-brown.
Many people using Flutamide have no serious side effects. But if your legs or hands begin to swell, if you have lung problems, depression, or mood changes, see your doctor.
Goserelin and Leuprorelin acetate
Groserelin, a generic name, works on your pituitary gland; it comes in the form of an implant that slowly releases hormones into your body. A health care professional injects the implant under the skin of your lower abdomen below the navel. A 3.6-millimetre or 10.8-millimetre syringe is used; the smaller size is implanted every month; the larger size is put in place every three months. Your body will absorb the implant over weeks or months. Your testosterone will increase before it declines, resulting in making your symptoms worse.
You may experience nausea, trouble sleeping, mood swings, headache, dizziness, and a decreased interest in sex. Tell your doctor if your ankles or feet begin to swell, if you have to urinate frequently, if you have an irregular heartbeat, or if you have bone pain or a broken bone. If you have serious side effects, your doctor can remove your implant.
Although serious reactions are uncommon, see a doctor if you have pain in your jaw, chest or left arm or if you are confused, experience slurred speech, have trouble breathing, or feel weak in one side of your body.
In the first two weeks after having an implant of Goserelin, you may experience a rare, but serious problem with your pituitary gland. Pituitary apoplexy is signalled by confusion, a sudden severe headache, changes in your vision, vomiting, and fainting.
In the first month of treatment, you can experience serious blockage of your urine or a compression of your spinal cord. This is signalled by a numbness or weakness of your legs and arms, severe back pain, painful urination, blood in the urine, and an inability to move.
Leuprorelin acetate, marketed as Prostap SR and Prostap 3, is used to treat advanced cancer of the prostate. Prostap causes the pituitary to make more leuteinising hormones, thus lowering levels of testosterone. The prostate cancer may shrink or grow more slowly. As in most prescription anti-cancer drugs acting on the prostate, testosterone levels may increase in the first few days or weeks.
A physician or nurse injects Prostap under the skin of your abdomen or arm or into your thigh or buttocks. Prostap SR is injected monthly. Prostap 3 is injected every three months. You can learn how to inject yourself. If you find the injection painful, you can apply a small amount of local anesthetic to numb the area.
You may be required to continue these injections for months or even years.
People react to leuprorelin differently. With most there are few side effects. One thing that can happen is that the symptoms of your cancer will temporary get worse; this is called tumour flare. To prevent this cyproterone acetate, bicalutamide, or flutamide, is sometimes prescribed. Hot flushes and sweats subside over time, but you can help by cutting down on coffee, tea, alcohol and nicotine. You might also experience loss of sex drive, bone thinning, fatigue, nausea, change in levels of your blood sugar, and headaches.
Gonadotrophin and Nilandron
Gonadotrophin, also called Lupron, is a naturally occurring substance that releases hormones in the body. Lupron is widely used to treat endremetriosis, the shredding of the lining of the uterus. Three synthetic versions of gonadotrophin—Lupron Depot 7.7, Lupron Depot 22.5 and Lupron Depot 30--are sometimes prescribed to relieve symptoms of prostate cancer in advanced stages.
Since Lupron lowers oestrogen levels, the resulting decrease in bone density can increase your risk of osteoporosis later in life. For that reason, doctors do not ordinarily prescribe Lupron for longer than six consecutive months.
As with other drugs that suppress hormones, symptoms may get worse in the beginning. You may experience a temporary increase in bone pain; rarely, you may have a blocked urinary passage or experienced pressure on your spinal cord.
Doctors prescribe Nilandron for prostate cancers that have begun to spread beyond the prostate. Nilandron, an anti-androgen drug that blocks the effects of testosterone, is ordinarily coupled with the removal of the testicles. The testes are a major source of testosterone. Treatment is begun the same day as the testes are removed or the next day.
You can take Nilandron with or without meals. If you miss a dose, which is ordinarily 300 milligrams daily for 30 days, don’t take an extra dose; just wait for your next scheduled dosage. Do not stop taking this medicine without consulting your doctor.
If you have an allergic reaction to Nilandron, stop taking it. Don’t take it if you have breathing problems or liver disease. Tell you doctor if you have these conditions.
Nilandron will sometimes inflame your lungs. If you think you might have a lung problem, tell your doctor. Symptoms include difficulty breathing, fever, cough, and chest pain. Your doctor will check your liver before you take Nilandron and will continue checking it. Watch for a yellowing of your eyes and skin, dark urine, loss of appetite, vomiting, tenderness in the upper right part of your abdomen, and abdominal pain.
Your eyes may be slow to adjust to entering darkness from a lighted area, so be alert when you drive at night or through tunnels.
If after drinking alcohol your face flushes, you experience flu-like symptoms, or your blood pressure drops, stop drinking while taking Nilandron. You should ask your doctor about combining Nilandron with Phenytoin (Dilantin), Theophylline (Theo-Dur), or Vitamin K antagonists (Coumadin).
Triptorelin and Zoladex
Triptorelin, marketed as Decapeptyl SR and Gonapeptyl Depot, is another drug that acts on the luteinising hormones to reduce the levels of testosterone coming from the testes.
As with other anti-cancer drugs working on the pituitary gland, Triptorelin is injected under the skin or into a muscle. It can be injected monthly. A longer-action dose can be injected every three months. Missing a scheduled injection by two or three days is not critical, but you should keep on schedule as much as possible. You can learn to inject yourself and there are local anesthetics that you can apply to numb the area of injection.
Some people don’t experience side effects. But like users of Leuprorelin acetate, you may experience flushes and sweats which subside over time, but you can help by cutting down on coffee, tea, alcohol and nicotine. You might also experience loss of sex drive, bone thinning, fatigue, nausea, change in levels of your blood sugar, and headaches.
Zoladex reduces the levels of testosterone. It is sometimes used to treat early prostate cancer and can relieve the symptoms of advanced prostate cancer. You might feel worse for a few weeks then feel better as hormone levels subside.
A physician or nurse will implant Zoladex under the skin of your abdomen every month to three months. Make up a missed dose as soon as possible.
Patients can expect a large range of side effects from urinary problems, flu-like symptoms and lethargy to depression, loss of sex drive and weight gain.
Zoladex can cause osteoporosis, bone pains, brittle bones and fractures. If the tube from your kidneys to your bladder is blocked or you have suffered compression of your spinal cord, get these treated before you use Zoladex. Make sure your doctor knows if you have been taking steroids or anticonvulsant drugs. Using Zoladex has been known to give patients hives and cause their lips and throats to swell. If that happens, call your doctor.
The doctor will ordinary treat prostate cancer with a implant of 10.8 milligrams every three months. When given with Flutamide, a 3.6-milligram implant is followed by a 10.8-milligram implant a month later.
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