Hormone Therapy Prostate Cancer
When the prostate cancer is has become advanced, and has spread to other parts of the body, treatment includes reducing the HYPERLINK “Javascript:OnClick=openGlossary(’/glossary/popup.cfm?id=65′,’300′,’200′,’glossary’)” testosterone (male hormone) in the body. Prostate cancer can be exacerbated by male hormones like testosterone and dihydrotestosterone. This means that the male hormones make prostate cancer grow bigger more quickly; in other words, they stimulate the cancer cells to grow. Conversely, if there are fewer male hormones in a man’s body, prostate cancer grows more slowly and sometimes even stops growing altogether. Hormone therapy is used to decrease the male hormones, called androgens, in a patient’s body. It reduces symptoms and prevents further growth. Hormone therapy can cause prostate cancer to shrink in 85 to 90 percent of prostate cancer patients, but a total and durable eradication of disease is unlikely with this therapy.
There are several different forms of hormone therapy used to treat prostate cancer. Because 90% of male hormones are produced in the testicles, orchiectomy is an effective treatment. Orchiectomy is when the doctor surgically removes the testicles from inside the scrotum. The scrotum and the penis remain intact, and orchiectomy is probably the least expensive and simplest way to reduce hormone levels in the body. However, unlike some other treatments, it is permanent; men who are concerned about the disfigurement can get small silicone sacks inserted into the scrotum. Side effects of orchiectomy can include sterility, loss of sexual interest, erectile dysfunction, hot flashes, an increase in the size of breast tissue, weight gain, loss of muscle mass, and thin or brittle bones.
Another treatment of prostate cancer is the prescription of luteinizing hormone-releasing hormone analogs called LHRH. These drugs block the action of male hormones and lower the amount of testosterone made by the testicles, so their use is sometimes referred to as chemical castration. LHRH drugs are injected or placed as small implants under the skin. Depending on the drug used, they are injected once a month, or every 3-4 months, or once a year. When LHRH drugs are given, they cause a temporary increase in the production of male hormones which can cause the tumor to grow, too; this is called a flare. Tumor flare can be avoided by taking anti-androgen drugs for the first few weeks along with the LHRH drugs. Side effects can include hot flashes, loss of sexual desire, erectile dysfunction, weight gain, loss of muscle mass, loss of penile volume, loss of bone density, loss of hair, fatigue, and anemia.
Other drugs used in the treatment of prostate cancer are called anti-androgens; they block the body’s ability to use the hormones. Even after an orchiectomy or drug treatment with LHRH analogs, a small amount of hormones are still secreted by the adrenal glands. These anti-androgen drugs are generally given in pull from and are often used with other treatments like orchiectomy or LHRH treatments.
In both the LHRH drug treatment as well and the anti-androgen drug treatment, a patient’s body occasionally becomes resistant to the drugs, in other words, they stop working. So some doctors suggest an on-again/off-again treatment schedule where the patient will take the drugs for some months and then have rest periods when no drugs are taken for some months.
Many of the side effects experienced by men undergoing hormone therapy can be treated or prevented. For example, hot flashes can be minimized by taking certain antidepressants, and brief radiation treatment to the breast tissues can help prevent their enlargement. There are several drugs available to treat bone density loss and depression. Fatigue, muscle mass loss, and weight gain can be treated with simple exercise. If anemia occurs, it is usually very mild and can be treated with vitamin and electrolyte supplements.
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