This video is about hormone therapy (ADT) and your bones.
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This video is the fourth of five short videos on bones and prostate cancer.
I'm not a doctor.
I'm just a man with locally advanced, recurrent, prostate cancer.
I ask the questions.
An expert medical oncologist answers the questions.
And when you occasionally hear this sound,
[swish],
our resident artist attempts to illustrate.
Meet the doctor.
My name is Alicia Morgans, and I'm the Assistant Professor of Medicine at the Vanderbilt University
in Nashville, Tennessee, in the United States.
Why is Testosterone important to prostate cancer cells?
Testosterone is the food or the fuel that those
prostate cancer cells needs to grow,
spread and survive.
How does hormone therapy (ADT) Help?
So, hormone therapy or ADT keeps testosterone levels down so well that it starves those
cells
and hopefully causes many of them to die or even shrivel up or hibernate so they are not
going to cause a problem.
Are there side effects when hormone therapy lowers a man's testosterone?
When we lower testosterone with hormonal therapy or ADT men do experience side effects.
What might some of these side effects be?
This is the main male hormone, and when we lower it, you can see things like
hot flashes or changes in sex drive that can be very disturbing for men.
Is hormone therapy for men like the menopause for Women?
Some men think of it as the male version of menopause, what women experience
as they get older.
In some ways it's similar.
But is it the same thing?
But it is truly its own thing, particularly the sexual side effects that men can experience
can be somewhat troubling.
Are there any other side effects when hormone therapy lowers a man's testosterone?
Bones can thin and be at risk for fracture.
There can be an increased risk of heart disease and an increased risk of things like diabetes.
So, with those possible problems, why is hormone therapy so widely used?
Despite all that, hormone therapy or ADT is actually the best medicine that we have
for treating prostate cancer, and it's the backbone of the treatments that we give.
What goes on in normal bones?
Normal bones are continuously being rebuilt and
broken down. That's the normal lifecycle of the bone.
What is the main mineral used to make bones?
Calcium is the main mineral that's used to build
up bones, and vitamin D is sort of like a mortar
that lets calcium enter into the bones and be
incorporated into the bones themselves.
How does hormone therapy affect this normal recycling of bones?
Hormone therapy can affect the normal cycling of bone build up and breakdown because this
whole process is controlled by hormones.
Which hormone is very important for normal bone
recycling, and how does hormone therapy affect this?
In particular, oestrogen controls that build up and
breakdown, and when we lower testosterone with
hormonal therapy to treat prostate cancer, we're also lowering oestrogen levels.
What is the effect of lower oestrogen levels?
This causes the bones to break down more than they build up, and it causes them to thin
over time.
How do we measure the strength of bones?
We can measure the thickness, which really reflects the strength of the bone, with something
called a DEXA, or a bone density scan.
It's generally just an x-ray that looks at how
thick or dense the bones are
and it can relate to the doctor a number that tells the doctor
how likely that bone is to fracture or to break.
When might a doctor recommend the bone mineral density scan – the BMD or DEXA scan?
The doctor might recommend the first DEXA Scan early on in treatment when
starting hormonal therapy, sometime within the first year or so of starting hormonal
therapy.
Why might the bone mineral density scan be ordered before hormone therapy begins?
If the doctor is concerned that the individual may be at higher risk of having a break or
or a fracture or thin bones,
even before the hormonal therapy is started, he or she might order
that DEXA scan or bone density scan just as the hormonal therapy is beginning.
If the bones are thinning from the cancer, or from the treatment, how can the doctor
lower the risk of bones breaking?
If the doctor thinks that the bones have already become thin, or are thinning, during hormonal
treatment for prostate cancer, the doctor can
prescribe medicines like Zometa, or Denosumab,
to thicken the bones and strengthen them, so that they are at lower risk of breaking.
Is there a role for exercise when a man
is on hormone therapy?
When men have prostate cancer and are on hormonal therapy, there is always a role for using
bodily activity like exercise and being active to strengthen the bones.
We always encourage men to be as active as possible, because even walking, which is
a weight bearing activity strengthens the bones.
Believe it or not, even if you spend the day in bed, whether you have prostate cancer or not
or you're on hormonal therapy, ADT or not, your bones start to break down.
So just getting up and walking
strengthens the bones and helps to keep them stronger.
>> JIM: Thank you.
Thank you.
This video is the fourth of five short videos
on bones and advanced prostate cancer.
Look for the other four videos which deal with
why bones are important in advanced prostate cancer,
the special case of prostate cancer in the spine,
treatment for prostate cancer in the bones,
and a special message on pain.
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