Hormone therapy for prostate cancer, also called hormone or androgen deprivation or androgen ablation, is any type of treatment that prevents prostate cancer cells from using testosterone to grow. The intent of hormonal therapy for prostate cancer is to reduce the size or slow down the growth of the prostate cancer. Hormone therapy, unlike surgery or radiation, eliminates the body’s production of testosterone, a major stimulant of prostate cancer. Hormonal therapy has the advantage reaching prostate cancer cells in all parts of the body, even if they have spread to other areas and cannot be detected.
Hormone therapy alone, typically, does not completely rid the body of prostate cancer. A disadvantage to hormone therapy is that it does not stop hormone-insensitive cells, which can continue to grow silently. However, hormone therapy for prostate cancer can be a very effective control measure for some men. Hormonal therapy sets out to accomplish two things: Stop prostate cells from making prostate-specific antigen (PSA), and shrink the population of hormone-sensitive cells.
Hormonal therapy for prostate cancer has traditionally been used for men with metastatic prostate cancer. Hormone therapy is considered the appropriate course of treatment if prostate cancer has gone to the lymph nodes or to the bones. However, doctors are now exploring the benefits of using it earlier in the course of prostate cancer treatment. Hormone therapy is now often used to shrink tumors before, during, and sometimes, after other prostate cancer treatment, such as surgery or radiation.
The main options for hormone therapy for prostate cancer are:
- Orchiectomy- This prostate cancer hormone therapy, also known as castration, involves the surgical removal of the testicles, and ensures no testosterone will be available to stimulate the growth of prostate cancer. This hormone therapy is so effective that within 3 to 12 hours of surgery, testosterone levels drop to almost zero. Men who undergo this option do not have to worry about daily pills or monthly injections, as other hormonal therapy. Prostate cancer patients with pain from cancer in the bone may experience the disappearance of their pain within a few days of their prostate cancer treatment. This hormone therapy, however, is permanent, and although men get to keep their scrotum intact (only the testicles within the scrotum are removed), some men find this hormone treatment option emotionally challenging.
- LHRH analog – This medication, consisting of LHRH antagonists or LHRH agonists, is a copy of a naturally occurring hormone in the body which stimulates the production of testosterone. Monthly injections of the LHRH analog stimulate a burst of testosterone for the next two weeks. The body interprets this burst as a signal of having too much testosterone. It then essentially shuts down hormone production, resulting in the same low level of hormone as if the testicles had been removed. However, to maintain the benefits of this hormonal therapy, prostate cancer patients have to continue with the injections of this medication for the rest of their lives. The main advantage to this type of hormone therapy is prostate cancer patients are able to keep their testicles intact, and if later this treatment proves intolerable or ineffective, orchiectomy is still an option. Also, these injections are effective if opting for intermittent therapy.
- Total Androgen Blockade – This prostate cancer hormone therapy works by blocking the ability for prostate cancer cells to absorb testosterone made by the testicles and the adrenal glands, producing what is called total androgen blockade. Some experts believe antiandrogens keep the cancer in control longer than orchiectomy or LHRH analog alone. An advantage to this hormone therapy is prostate cancer patients can include it later in their treatment plan. For example, if you chose initially not to take the antiandrogen and then your PSA level begins to rise, antiandrogen can be added, and usually, with good results. There is debate as to whether waiting to start the medication is less effective than if you start taking antiandrogens at the onset of your prostate cancer treatment. Some doctors believe you should be add it only if necessary. This hormone therapy for prostate cancer is intended to be the rest of your life. For some unknown reason, if you are taking antiandrogens and the prostate cancer returns, when you stop taking the medication, your PSA level may drop.
- Combination Hormonal Therapy - For prostate cancer treatment, a combination of an LHRH agonist or an orchiectomy plus daily antiandrogens is used.
- Intermittent Hormonal Therapy – This prostate cancer hormone therapy practices an on-and-off treatment pattern. Before signs or symptoms of advanced cancer become apparent, men begin taking hormones when there is a rise in their PSA levels, then stop treatment when their PSA levels drops down to their lowest levels and stabilizes. The advantages to this method are the recovery of sexual function and better quality of life during the time between their treatments. However, men who undergo this hormone therapy need to be monitored closely for the any growth of prostate cancer, so hormone therapy can be restarted right away.
Good Candidates for Hormone Therapy for Prostate Cancer
Men with low and intermediate grade prostate cancer are not thought to be viable candidates for hormone therapy. Prostate cancer patients who may be treated with hormonal therapy include men with metastatic prostate cancer; men with locally spread prostate cancer, and men with early recurrence of prostate cancer after initial treatments such as surgery or radiation. Hormonal therapy can also be very effective for elderly men with early stage prostate cancer or for men in poor overall health who are not candidates for surgery or radiation. Good candidates for hormonal therapy for prostate cancer include men whose:
- Prostate is large or whose cancer has spread locally, beyond the prostate gland
- Cancer has spread distantly to bones
- Cancer has spread locally to the lymph nodes near the prostate
- High-grade cancers (Gleason scores of 8, 9 and 10) are likely to spread
- Advanced age or poor overall health precludes them from surgical or radiation treatment
The Side Effects of Hormone Therapy
Like most treatment therapies for prostate cancer, hormone therapy has side effects. While undergoing hormone therapy, some prostate cancer patients may experience the following:
- Hot flashes
- Erectile dysfunction
- Decreased sexual desire
- Breast enlargement or nipple tenderness
- Osteoporosis and other side effects
- Weight gain
It important to understand that hormone therapy for prostate cancer cannot definitively cure cancer, not like radiation or surgery. When hormone therapy for prostate cancer works, it works very well. As with all treatments for prostate cancer treatments, men respond differently. For some men, they will have no evidence of cancer growth for many years following their hormone therapy. Some prostate cancer patients experience substantial prostate cancer regression and shrinkage. In some men, who have undergone hormone therapy, prostate cancer cells remain dormant for many years, sometimes ten years or more. Other men will have only good results for a short period of time. Hormone therapy for prostate cancer, therefore, is not so much a cure as it is an effective method of control.
