Hormone Therapy for Prostate Cancer Patients

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Controlling Hormone Levels to Enhance Your Treatment

Most prostate cancers are hormone-sensitive, meaning they depend on the hormone testosterone to grow. About one-third of prostate cancer patients will require hormone therapy. These men have prostate cancer that has spread beyond the prostate or cancer that has recurred after treatment.

Hormone therapy reduces the levels of testosterone and dihydrotestosterone (DHT or 5 alpha-dihydrotestosterone, a male hormone 5 times more potent than testosterone that is converted from testosterone within the prostate). Physicians may surgically remove the source of male hormones, the testicles (a procedure called an orchiectomy), or -- more commonly -- administer drugs that reduce the body's testosterone production.

Side effects of hormone therapy include reduced or absent feelings of sexual desire, impotence (inability to have an erection), weakness, fatigue, loss of muscle mass, growth of breast tissue, hot flashes and weakening of the bones.

Types of hormone therapy (Androgen Ablation)

There are 4 types of hormone therapy for prostate cancer patients whose doctors recommend it in addition to radiation therapy or surgery.

  1. Reducing the production of testosterone, the primary male hormone. There are two ways to do this:
    • LHRH agonists work by blocking the release of leuteinizing hormone (LH) from the pituitary gland. Normally, LH reaches the testes to stimulate production of testosterone, which in turn promotes tumor growth. By blocking LH release, LHRH agonists reduce testosterone to the same extent if the testes were surgically removed. LHRH agonists may be administered once a month to once a year. The effects of LHRH agonist treatment can be reversible, so if side effects are not tolerable, the patient can stop the drug and testosterone production will resume.
    • Orchiectomy (surgical removal of the testicles) was once the standard way to provide hormone reduction therapy for prostate cancer. For some patients, particularly elderly men, an orchiectomy is an efficient, cost-effective and convenient method of reducing testosterone.
  2. Anti-androgen therapy--Prevents testosterone and dihydrotestosterone from binding, or attaching, to the cancer cell. Examples of anti-androgens are Casodex (bicalutamide), Eulixin (flutamide) and Nilandron (nilutamide). These drugs are taken orally each day, either with a LHRH agonist (total androgen ablation) or alone.
  3. Total androgen ablation--Usually involves the combination of agents, together with LHRH to block the testosterone from binding to the hormone receptor while at the same time inhibiting the release of testosterone.
  4. Intermittent therapy--Hormone therapy that is given for several months to a year to reduce PSA levels. When the PSA is lowered, therapy may stop, allowing the side effects to diminish. Therapy may begin again if the PSA rises above a certain level or if symptoms of the cancer return.

Hormonal therapy for men with advanced prostate cancer

For men with advanced or metastatic prostate cancer, hormone therapies provide relief from pain and other cancer-related symptoms. In patients without symptoms, hormone therapy may delay the symptoms from occurring and delay the cancer from spreading. For most patients, the side effects of hormone therapy are more tolerable than the symptoms of advancing cancer.

Treatments to protect the bones when cancer spreads

If prostate cancer spreads, it often affects the bones. Zoledronic acid is a bisphosphonate, a family of drugs that can slow the growth of cancer in bones and may reduce pain. It may also be used to prevent bone thinning and weakening associated with long-term hormonal therapy.

Clinical trials provide more options

See National Cancer Institute information on Prostate Cancer

Oncologists at Fox Chase are designing and developing new and better drugs through clinical trials. Clinical trials offer medicines that are believed to be more effective with fewer side effects. Through clinical trials, researchers are developing more effective alternatives for patients when hormone therapy stops working. Physicians also work with laboratory researchers to understand how prostate cancers grow so that new therapies can be developed for patients at all stages of prostate cancer.