One in three American men with prostate cancer is treated with hormonal therapy – medications to suppress the testosterone that drives prostate cancer growth. These therapies represent a marvelous advance in prostate cancer treatment, increasing 5-year survival from 68% to 99% over the past 25 years. Still, they are not without possible problems — from bone loss to hot flashes. But a good-news University of Michigan article, published just in time for Prostate Cancer Awareness Month, reports specific integrative therapies that can be especially helpful to counter possible side effects of hormonal therapy. Here are the findings:
Bone loss – In women, hormonal therapy can combat bone loss, associated with menopause. In men, it’s just the opposite. However, excellent research has demonstrated that high-intensity aerobic and resistance exercise (strength training) are key to stopping bone loss. Individualized guidance by a physical therapist or trainer, experienced in working with patients under medical treatment, is a must. In addition, taking 1000 to 1200 mg of calcium and 800-1000 IU of vitamin D – from food and/or supplements — should be a daily routine. If you don’t spend a lot of time outdoors, do get your vitamin D level checked to ensure you’re not deficient.
Fatigue – Like many cancer therapies, hormonal treatment can cause long-lasting fatigue. For prostate cancer, most studies show that resistance exercise improves fatigue from hormonal therapy. A recent randomized study also found that 2000 mg daily of American ginseng, a dietary supplement, reduces fatigue in cancer patients during treatment. Plus, beverages like green or black tea and coffee may help if you don’t have trouble tolerating caffeine.
Hot flashes – Hormonal therapy can cause hot flashes in men, while it relieves them in women. While there are some medications that can combat hot flashes, the best integrative strategy seems to be maintaining a healthy weight with an integrative regimen. Moderate, routine aerobic exercise may also be helpful.
Cardiovascular disease risk – Men on hormonal therapy are prone to metabolic syndrome, which shows up as weight gain, elevated blood sugar and triglycerides, insulin resistance and risk for diabetes. Metabolic syndrome can raise cardiovascular risk, and studies link hormonal therapy to higher risks for heart attack and stroke.
This is a complicated set of symptoms and risks, and demands a comprehensive intervention. We do know that exercise reduces risk factors for cardiovascular disease, by reducing atherosclerosis, dilating blood vessels for smoother blood flow, decreasing blood pressure and lowering the tendency of blood platelets to clump together and stick to vessel walls (which also raises risks for metastasis). Thus, an exercise program is a sensible intervention. So are a low-glycemic diet, like the one recommended at the Block Center, omega-3 fatty acids to lower triglycerides, and certain prescriptions (for example, statin drugs or metformin where appropriate.) Weight gain can be combatted with a healthful, calorically appropriate diet, as well as combined resistance and aerobic exercise. Finally, the inflammatory marker C-reactive protein (CRP) is elevated in metabolic syndrome. Exercise, appropriate diet and anti-inflammatory supplements can bring it back within normal range in many patients, as we commonly see at the Block Center
Muscle loss – Muscle loss is a discouraging aspect of hormonal therapy, making daily life more challenging. Resistance exercise is a clear winner here, producing greater muscle. Whey protein supplements along with resistance exercise have been found to increase muscle and decrease abdominal fat in 14 randomized studies. Creatine monohydrate, a dietary supplement, may help as well.
Sexual health – While there is no evidence of supplements being helpful for men on hormonal therapy, in spite of what you may read on the internet, there is evidence that exercise is linked to better sexual health, including data from randomized trials in prostate cancer patients. The effect appears to be a general one: Men who exercise have more energy and self-confidence, which is associated with better maintenance of sexual activity.
In summary, exercise seems to be the number one integrative medicine recommendation for prostate cancer patients on hormonal therapy. If you are experiencing bone loss or bone metastases, it’s especially important to consult with a physical therapist before starting an exercise program. But a routine physical regimen is just one part of a comprehensive program of diet, lifestyle and supplements.
Integrative medicine here truly shines in its role as a support to conventional medicine, and we urge you to take advantage of these powerful therapies to help you continue to enjoy the benefits of these hormonal medications.