Hormone Therapy for Prostate Cancer

What is Hormone Therapy?

Hormone therapy also known as androgen-deprivation therapy prevents prostate cells being fueled by testosterone. Prostate cancer uses male hormones and tumours don’t usually grow without certain types of hormone. Hormone therapy starves tumours by preventing the release and effects of testosterone within the prostate; it’s important for many advanced prostate cancer patients.

When is Hormone Therapy for Prostate Cancer appropriate?

Patients are ideal candidates for hormone therapy if they have an increased PSA score, have cancer that’s returned following primary radiation treatment/surgery, or whose cancer has breached the prostate. Hormone therapy can also be used to increase the positive outcome of surgery by reducing the size of tumours ahead of scheduled procedures.

Hormone therapy can’t prevent or cure prostate cancer alone and tumours can sometimes develop independently without testosterone. Tumour growth may also be unaffected any effectiveness of the treatment will typically diminish. That said, hormone therapy is a key component in most courses of treatment for advanced prostate cancer and patients whose prostate cancer has returned.

Hormone Therapy
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Hormone Cancer Therapies and techniques

Anti-Androgens

Anti-androgens prevent the effects of testosterone in cancerous prostates, when an increase in testosterone occurs following the use of LHRH agonists. Usually, a combination of anti-androgens and LHRH treatments are used to provide a few years of effective therapy, however the impact decreases over time as cancer cells strengthen and become castrate-resistant.

The rate at which cancer spreads can be slowed despite the short-term effect of anti-androgens. There are also an array of secondary treatments available, including blocker or inhibitor hormone therapies. Metastatic prostate cancer patients should consider the sexual side-effects (less impacting than those of agonist drugs) and alternative cancer treatments.

Inhibitors and Blockers

There is now FDA-approved hormonal medication available to patients with metastatic cancer, which can prevent androgen activity and combat cancer. Treatments for prostate cancer patients who are castrate-resistant are also under development. Best results are achieved when the medication is taken as directed by your doctor; some is taken orally but administration methods vary.

Until complete removal of testosterone is deemed vital few treatments  prevent the adrenal glands from producing testosterone. Treatments can create a tenth of testosterone within the body. Blockers can slow testosterone production by blocking androgen receptors. Inhibitors work in conjunction with steroids by shutting down the adrenal glands.

LHRH Agonists

Prostate cancer patients use LHRH (Luteinizing Hormone-Releasing Hormone) therapy more than any other. LHRH therapy prevents the release of LHRH before testosterone is produced within the body. LHRH agonists involve monthly or annual injections and usually result in a flare or increased testosterone for many weeks following each injection.

LHRH Antagonists

Newer antagonist medications are available that can prevent flares or increases in testosterone and associated PSA scores. LHRH antagonists work by preventing LHRH from acting as a testosterone stimulant. This treatment is only available via injection, although orally administered LHRH antagonists are currently being developed.

Orchiectomy

An orchiectomy is the irreversible and permanent removal of the testicles; this is important and very effective, as the testes produce nine tenths of the body’s testosterone. Understandably, most men are reluctant at best, often choosing the medication route of treatment, but some do see advantages and prefer to undertake this one cost and time-effective procedure.

Side effects of Hormone Therapy

  • belly fat growth
  • breast enlargement or pain
  • cardiovascular issues
  • changes to cholesterol
  • constipation
  • decreased bone density
  • decreased libido or erectile dysfunction
  • diarrhea
  • higher risk of Alzheimer’s disease or osteoporosis
  • hot flushes
  • impacted learning capacity
  • memory and/or focus
  • weight fluctuation

¹Research, Cancer Research UK, Hormone Therapy, Last Reviewed, 02 Jul 2019

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