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Prostate cancer: how to control the side effects of treatment?

Prostate cancer: how to control the side effects of treatment?

Chemical castration or androgen deprivation therapy (ADT) is the name given to treatment for prostate cancer using agents with direct action on the hypothalamic-pituitary-gonadal axis, the final outcome of which is the suppression of testosterone levels in the body.

A pulsatile secretion by the hypothalamus stimulates the production of luteinizing hormone (GnRH) by the pituitary gland and this, in turn, stimulates the production of testosterone by the Leydig cells in the testicle. > Behavioral changes, loss of libido and lack of energy are the most frequent changes, and should be treated promptly in order not to compromise quality of life.

Agents such as leuprolide and goserelin are drugs whose continuous use inhibits the pulsatile secretion of GnRH , which culminates in the suppression of testosterone levels. In addition, degarelix has been made available more recently.

TDA is used primarily in two distinct scenarios for prostate cancer patients (CaP): in patients with localized disease associated with radiotherapy for a period of 4 to 36 months or as the first line of hormonal treatment in the patient with metastatic disease, for an indeterminate period.

In patients with localized prostate cancer, the addition of ADT to radiotherapy is associated with better outcomes, even increasing the chances of cure in some cases . The duration of ADD in this context varies according to some criteria that classify the tumor at intermediate or high risk (PSA level, tumor extension, Gleason score). In those with intermediate risk, the duration varies from 4 to 6 months, while in those with high risk is indicated the chemical castration for 3 years.

Patients with metastatic disease, whose intention of the treatment is palliative, should remain in state of indeterminate androgenic deprivation. In these cases, this goal can be obtained by means of the GnRH agonist agents mentioned above, or by means of the surgical removal of both testicles (bilateral orchiectomy).

The castration state leaves the patient subject to a series of behavioral changes , physiological and body composition that are proportional to the duration of the treatment:

- Loss of lean mass, increase of body fat and decrease of muscular strength, Loss of libido and / or erectile dysfunction, Loss of bone mass and osteoporosis; ; Gynecomastia; Behavioral changes; Fatigue and feeling of lack of energy; Increased cholesterol and triglycerides Possible increased risk of cardiovascular diseases.

Those men undergoing chemical or surgical castration should be encouraged to practice physical activity and to do program of active diabetes screening and dyslipidemia. The propensity for these two problems may warrant a higher cardiovascular risk in these patients, which is still debatable in the medical literature.

Before the onset of ADD, every patient should undergo an evaluation of their bone health, since the Hypoandrogenism environment may induce loss of bone mass. Therefore, every patient should perform a bone densitometry before starting treatment and use calcium 1,200 mg / day and vitamin D 1,000 U / day prophylactically. If osteoporosis is already present, bisphosphonates may help (alendronate, zoledronate).

Behavioral changes, loss of libido and lack of energy are the most frequent changes, and should be treated promptly in order not to compromise quality of life. life. Psychotherapy can help to understand this time when so many changes are occurring in the body and thereby facilitate tolerance and management of these symptoms.Hot flashes can occur in up to 80% of patients undergoing TDA and are described as a sudden sensation of heat in the head and upper body segment, which may or may not be accompanied by profuse sweating. Serotinin reuptake inhibitor drugs have some activity in this condition, and venlafloxine is the best studied. In a randomized phase III study, low doses of medroxyprogesterone or cyproterone acetate were shown to be superior in the control of these symptoms. Thus, castration, whether chemical or surgical, continues to play a crucial role in the treatment of patients with prostate cancer, and the management of their prostate gland. side effects are of paramount importance in order not to lose quality of life.


Using Headphones and Exposure to Noise May Clogged Ear

Using Headphones and Exposure to Noise May Clogged Ear

The clogged ear sensation, known as atrial fullness, usually occurs when we are in a situation of rapid altitude change, such as in a flight or dive. The ear is filled with air and its internal pressure must be equalized with atmospheric pressure to function properly. When the ambient pressure changes, as in flight, the auditory tube, which communicates the ear with the nose, is opened to do the equalization.

(Health)

Frozen packaging is related to heart disease

Frozen packaging is related to heart disease

Diet full of fat and sugar, lack of physical exercise and family history are the main cause of cardiovascular disease. Turning the routine on behalf of healthy habits is still the best way to prevent problems like high cholesterol, high blood pressure and heart attack. Recognizing the importance of such care, researchers now turn to other factors that may interfere with heart health, and the latest finding is related to the packaging of many products, including food.

(Health)