What should you do? First, let’s make sure that you’re receiving the maximum benefit from hormone therapy—that it’s doing the job it’s supposed to do, and that it’s not making things worse.
If you’ve been castrated, make sure that all the tissue was taken out. This is easier than it sounds; all you need is a blood test to measure your testosterone level. Similarly, if you’re taking estrogen or an LHRH agonist, make sure you’re getting the recommended dosage and taking your pills regularly— taking a pill at six one morning and at midnight the next night, for example, might mean the level of hormones is fluctuating. Again, a blood test can confirm whether your testosterone level is at the crucial castrate range. In either case, if there’s too much testosterone in the blood, dosage regularity is probably the problem, and it can be fixed.
If your testosterone is in the castrate range and you’re not on flutamide, you could try taking it to see whether this makes your PSA levels fall. Some men are helped by this. If, however, you already are taking flutamide in addition to castration, estrogen or an LHRH agonist, try stopping the flutamide.
In a few men, prostate cancer comes back as a kind of tumor called a small-cell carcinoma. This may be the case if there is a large recurrence of cancer in the pelvis or liver—especially if your PSA level is low. A biopsy should find this out. It’s an important fact to know because small-cell prostate cancers have a make-up similar to other small-cell cancers (of the lung, for example), and they respond to the same kinds of chemotherapy drugs used to treat these other small-cell tumors.
If all of these options for hormone therapy have been tried, and the cancer is not a small-cell carcinoma, the next step may be to try and control the cancer and its symptoms with other kinds of drugs—chemotherapy. However, this option is recommended only for men who are strong enough to withstand chemotherapy’s side effects. The other option is to treat specific symptoms as the cancer progresses.
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