Hormone Therapy Basics for Advanced Prostate Cancer

New options in hormone therapy mean you and your doctor can better tailor your prostate cancer treatment and even combine it with other therapies. Find out about the different forms of hormone therapy and their potential side effects.

Hormone therapy is often the first line of treatment for advanced prostate cancer — and it’s often used in conjunction with other types of prostate cancer treatment. All forms of hormone therapy work to lower the levels of testosterone in the body, but they do so in different ways. That’s why it’s essential to understand the different types available and how they work with other prostate cancer treatments. Understanding the options puts you in a better position to make the right health care decisions for your prostate cancer.

Hormone Therapy’s Role in Treating Advanced Prostate Cancer

Hormone therapy for prostate cancer — also known as androgen deprivation therapy (ADT) or androgen suppression therapy — reduces the level of androgens, which are male hormones, or blocks their activity. The main androgens are testosterone and dihydrotestosterone (DHT). About 90 percent of testosterone is produced by the testicles, and a small amount is produced by the adrenal glands. The pituitary gland controls how much testosterone the testicles produce. That’s why hormone therapy often targets the pituitary gland as well as the adrenal glands.

Hormone therapy can be an effective treatment because androgens are like fuel for prostate cancer. “If the body is deprived of testosterone, the cancer can regress, symptoms improve, and the person goes into remission,” says Michael Cookson, MD, MMHC, professor and chairman of the department of urology at the University of Oklahoma College of Medicine in Oklahoma City. “But this doesn’t cure the cancer. It just slows it down.” Used in combination with other treatments, hormone therapy can improve control over the cancer and help men live longer.

When Hormone Therapy Is Appropriate Prostate Cancer Treatment

Hormone therapy is often the treatment given for advanced prostate cancer, known as stage 3 or 4 of the disease. At these stages, the tumor extends throughout the prostate (stage 3) or is intruding on nearby tissue (stage 4).

It is commonly used to treat prostate cancers that have come back after initial treatment with surgery or radiation. Hormone therapy can also treat physical symptoms of the cancer, such as painful urination, impotence, and lower back pain.

Hormone therapy may also be used before, during, and for up to two years after radiation treatment to help shrink the cancer and make radiation therapy more effective, says Michael J. Zelefsky MD, professor of radiation oncology and chief of the brachytherapy service at Memorial Sloan-Kettering Cancer Center in New York City.

Additionally, your doctor may recommend hormone therapy if you’re unable to have surgery or radiation to treat your prostate cancer, or if your prostate-specific antigen (PSA) level — an indicator of inflammation in the prostate — continues to rise without other evidence that the disease is spreading.

Dr. Cookson says the timing of hormone therapy is an individual decision based on many factors that should be discussed with your doctor, including side effects. These can include hot flushes and sweating, osteoporosis, fatigue, loss of muscle mass or strength, decreased libido, and weight gain.

Hormone Therapy Options for Advanced Prostate Cancer

Here are the current hormone therapy options you and your doctor may consider:

Luteinizing hormone-releasing hormone (LHRH) analogs/agonists. These drugs are synthetic proteins designed to resemble the hormone LHRH, which stimulates production of androgens in the body when levels are low. The medication causes an initial surge of luteinizing hormone and testosterone, but then the pituitary gland stops producing luteinizing hormone and testosterone production halts. Once treatment is stopped, testosterone production resumes. LHRH analogs are delivered by injection or implanted under the skin. They include leuprolide, triptorelin, goserelin, and buserelin.

Luteinizing hormone-releasing hormone (LHRH) antagonists. LHRH antagonists prevent LHRH from binding to receptors in the body. They work much like LHRH agonists except that they have the benefit of not causing an initial surge of testosterone. An example is degarelix, which is given by monthly injection.

Anti-androgens. These drugs block androgens from working within prostate cells by binding to the receptors they need to function. Anti-androgens are given as daily pills and include flutamide, bicalutamide, and nilutamide. They are often given with other types of hormone therapy to increase their effectiveness. For example, used in combination with LHRH analogs, Cookson says anti-androgens can completely block off androgen. The LHRH analogs shut down androgen production in the pituitary gland, while anti-androgens block the androgens produced by the adrenal glands.

Orchiectomy. This is the surgical removal of the testicles to reduce androgen production. It has been used as a successful form of hormone therapy for advanced prostate cancer since the 1940s. Orchiectomy is performed as a simple outpatient procedure in a urologist’s office. However, unlike non-surgical methods to lower androgen levels, it is permanent. That’s why many men may now opt for newer forms of drug therapy, whose effects are reversible.

Estrogen. The female sex hormone estrogen was the primary alternative to orchiectomy for men with advanced prostate cancer until LHRH analogs and anti-androgens were developed. Estrogen may still be used if other means of androgen deprivation no longer work, but they come with side effects like risk of blood clots and breast enlargement.

Hormone therapy may be a good initial treatment for advanced prostate cancer. Talk to your doctor about which form might be best for you, and don’t be afraid to get a second opinion before making your final decision.

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