Course Content
1. Introduction to Prostate Cancer
o Understanding the prostate gland o Overview of prostate cancer o Risk factors and epidemiology
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2. Signs and Symptoms
o Common signs and symptoms o When to seek medical attention o Diagnostic tests and screening guidelines
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3. Diagnosis and Staging
o Biopsy procedures and interpretation o Staging techniques (TNM system) o Imaging modalities for staging
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6. Nutrition and Lifestyle Considerations
o Diet and nutrition recommendations o Exercise and physical activity guidelines o Stress management techniques
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Understanding Prostate Cancer: Online Course for Patients & Caregivers
About Lesson

Introduction:

Hormone therapy, also known as androgen deprivation therapy (ADT), is a cornerstone of systemic treatment for advanced and metastatic prostate cancer. Understanding the mechanisms, indications, treatment modalities, and side effects associated with hormone therapy is essential for comprehensive prostate cancer management.

Mechanisms of Action:

  1. Androgen Deprivation:
    • Prostate cancer is driven by androgens, primarily testosterone and dihydrotestosterone (DHT), which stimulate tumor growth and progression.
    • Hormone therapy aims to suppress androgen production or block androgen receptor signaling to inhibit the growth and spread of prostate cancer cells.

Treatment Modalities:

  1. Medical Castration:

    • Medical castration, achieved through pharmacological suppression of testosterone production or activity, is the mainstay of hormone therapy for prostate cancer.
    • Commonly used medications for medical castration include:
      • Gonadotropin-releasing hormone (GnRH) agonists (e.g., leuprolide, goserelin)
      • GnRH antagonists (e.g., degarelix)
      • Anti-androgens (e.g., bicalutamide, enzalutamide)
  2. Surgical Castration:

    • Surgical castration, or bilateral orchiectomy, involves surgical removal of the testes to eliminate testosterone production.
    • While less commonly performed than medical castration, surgical castration offers a permanent and cost-effective means of androgen deprivation.

Indications:

  1. Advanced Prostate Cancer:

    • Hormone therapy is indicated for patients with advanced prostate cancer, including:
      • Metastatic disease (M1 stage)
      • Locally advanced or recurrent disease not amenable to curative treatment with surgery or radiation therapy
  2. Neoadjuvant and Adjuvant Therapy:

    • Hormone therapy may be used as neoadjuvant therapy before definitive treatment (e.g., radical prostatectomy or radiation therapy) to shrink the tumor and improve treatment outcomes.
    • Adjuvant hormone therapy may be given after definitive treatment to reduce the risk of disease recurrence.

Side Effects and Management:

  1. Sexual Dysfunction:

    • Androgen deprivation therapy can lead to erectile dysfunction, decreased libido, and loss of sexual desire due to reduced testosterone levels.
    • Patient education, counseling, and access to sexual health resources can help address sexual dysfunction and improve quality of life.
  2. Hot Flashes and Sweating:

    • Hormone therapy may cause hot flashes, sweating, and other menopausal-like symptoms due to hormonal changes.
    • Lifestyle modifications (e.g., avoiding triggers, wearing lightweight clothing) and medications (e.g., antidepressants, gabapentin) may help manage hot flashes.

Ongoing Monitoring and Follow-Up:

  1. PSA Monitoring:

    • Prostate-specific antigen (PSA) levels are routinely monitored during hormone therapy to assess treatment response and detect disease progression.
    • Rising PSA levels may indicate resistance to hormone therapy and the need for additional treatment options.
  2. Bone Health:

    • Hormone therapy can increase the risk of osteoporosis and bone fractures due to decreased bone density.
    • Calcium and vitamin D supplementation, weight-bearing exercises, and bone density monitoring help mitigate the risk of bone-related complications.

Online Resources for Further Learning:

Explore the following online resources to learn more about hormone therapy in prostate cancer management:

End of Topic Quiz:

  1. What is the main mechanism of action of hormone therapy in prostate cancer management?

    • A) Induction of apoptosis in cancer cells
    • B) Inhibition of angiogenesis
    • C) Suppression of androgen production or signaling
    • D) Stimulation of the immune system

    Answer: C) Suppression of androgen production or signaling

  2. Which medication class is commonly used for medical castration in hormone therapy for prostate cancer?

    • A) Bisphosphonates
    • B) Nonsteroidal anti-inflammatory drugs (NSAIDs)
    • C) Gonadotropin-releasing hormone (GnRH) agonists
    • D) Selective estrogen receptor modulators (SERMs)

    Answer: C) Gonadotropin-releasing hormone (GnRH) agonists

Takeaway Assignment:

Assign students to develop a patient education brochure or infographic on hormone therapy for prostate cancer. The educational material should cover key information about hormone therapy, including treatment goals, side effects, management strategies, and resources for support. Encourage students to use clear language, engaging visuals, and evidence-based content to enhance patient understanding and empowerment. This assignment will help students refine their communication skills and reinforce their knowledge of hormone therapy principles in prostate cancer management.

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