Your Treatment Options for Metastatic Hormone-Sensitive Prostate Cancer (mHSPC)

This article is for people who are living with mHSPC and their caregivers, or anyone who wants to learn more about mHSPC. The goal of this activity is to help patients and their caregivers talk to and work with their doctor about treatment options for mHSPC as part of their treatment plan.

You will learn about:

• What prostate cancer is and what metastatic hormone-sensitive means

• Treatments for mHSPC, including hormone therapy medicines and their possible side effects

• Making a treatment plan with your doctor and healthcare team

• Questions to ask

Medicines listed in this activity may not be approved by the US Food and Drug Administration (FDA) for metastatic hormone-sensitive prostate cancer (mHSPC) but are recommended by the National Comprehensive Cancer Network (NCCN).

Prostate cancer is cancer that starts in the cells of the prostate, a small walnut-shaped gland in men and boys that forms a ring around the urethra (the tube that carries urine from the bladder to outside the body).

Androgens are a type of male hormone made in the testicles that help your prostate grow and function. But with most prostate cancers, androgens can cause both normal cells and cancer cells in the prostate to grow. The 2 main androgens are testosterone and dihydrotestosterone (DHT), which is made from testosterone.

Metastatic is when cancer spreads, or metastasizes, from where it started to other parts of your body. When prostate cancer spreads, it is often to the bones, lymph nodes, liver, or lungs.

Hormone-sensitive cancer needs hormones to grow. With prostate cancer, this means it needs androgens to grow and will often stop when androgens are not there or are blocked.

Metastatic hormone-sensitive prostate cancer, or mHSPC, is prostate cancer that has spread and may respond to a type of treatment called hormone therapy that stops or blocks androgens.

There is no one treatment for mHSPC that's for everyone. Which treatment, or combination of treatments, your doctor recommends will depend on where cancer has spread, any treatment you had before and how well it worked, and your overall health and wishes.

Treatment will be used to help stop or slow cancer growth, shrink cancer, manage your symptoms, and improve your quality of life. Before treatment, ask about the goals of each treatment, what you can expect during treatment, and what side effects may happen with which treatments.

Treatments that your doctor may recommend, alone or in combination, can include:

• Hormone therapy to stop your body from making androgens or block what they do. This can be:

  • Local, such as surgery to remove the testicles (orchiectomy)

  • Systemic (affects the whole body), such as medicines

• Chemotherapy (or "chemo")

• Surgery to remove tumors (groups of cancer cells), including those in other parts of your body

• Radiation therapy to help treat pain

• Joining a clinical trial

• Supportive care to improve your quality of life

Hormone therapy may be recommended to lower your amount of androgens and help slow prostate cancer growth or shrink it.

Types of medicines that your doctor may recommend, alone or in combination, can include:

• Androgen deprivation therapy (ADT) such as:

  • Luteinizing hormone-releasing hormone (LHRH) antagonists or LHRH agonists to help stop the androgen testosterone

• Androgen pathway-directed therapy such as:

  • Antiandrogen medicines that block receptors on prostate cancer cells to stop them from receiving testosterone

  • Androgen synthesis inhibitors that help block androgens from being made

All treatments can have side effects, and different medicines can have different ones. Some that may happen with hormone therapy medicines for mHSPC can include:

• Fatigue (tiredness)

• Mood changes

• A lowered libido (sex drive) or erectile dysfunction (problems with your erection)

• Osteoporosis (thin or weak bones) and bone fractures

• Weight gain and muscle loss

• Hot flashes

• Chest or breast tenderness and growth

• Increased risk for diabetes and heart disease

Before treatment, ask your doctor and healthcare team about which side effects can happen with the medicines you're taking and when you should contact them or seek emergency medical care. Not all possible side effects are listed here, so be sure to ask for a complete list.

You and your doctor will make a treatment plan together that best fits your individual needs, so be sure to share your personal preferences and wishes. It's important to feel comfortable so open communication is key. It's also not uncommon to seek a second opinion so you can feel confident about your treatment decisions.

During treatment, be sure to mention any side effects. Some may go away on their own, while others may last longer. But side effects will be managed differently depending on which treatment caused them, so together you can discuss how. Tracking and recording your symptoms and side effects in a journal can help.

Taking treatment as directed is also important. Don't skip doses, stop, or change treatment without talking to your doctor first.

Questions you can ask about mHSPC can include:

• What treatments are available, and what are the treatment goals?

• What side effects can happen with what treatments, and how can we manage them?

• How will we know if treatment is working?

• Are there any lifestyle changes I should make?

• How can I make sure I have the best quality of life possible?

• What should I do if I feel stressed or depressed?

• Is there a clinical trial I might be eligible for?

• Is there a support group I can join?

• Where can I find more information and resources?

Congratulations!

You have successfully completed the program Your Treatment Options for Metastatic Hormone-Sensitive Prostate Cancer (mHSPC).

View Additional Materials on this topic that you may find useful:

Prostate Cancer

Hormone-Sensitive Prostate Cancer

Hormone Therapy for Prostate Cancer

ZERO -- Advanced Prostate Cancer

ZERO -- Questions for Your Doctor: Advanced Prostate Cancer

ZERO -- Prostate Cancer Support

ZERO Us TOO Support Groups

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