Treating prostate cancer with hormone therapy has been in practice for long enough for most medical experts to know that it has limited functionability as a cure for the disease. However, it has been found that certain forms of hormonal therapy such as the pamidronate may prevent bone loss during androgen-deprivation therapy for the disease. A test was carried out by several professionals, which included Matthew R. Smith, M.D., Ph.D., Francis J. McGovern, M.D., Anthony L. Zietman, M.D., and five others with a purpose to determine whether gonadotropin-releasing hormone (GnRH) agonists prevent osteoporosis in men with prostate cancer.
In their test, it was found that patients treated to leuprolide (lupron) only lost bone mineral density of about 3.3%, while patient treated to leuprolide and pamidronate experienced no significant bone mineral density changes at any skeletal site – an interesting fact that suggests that lupron might is great help in treating the disease.
Other tests were carried out, for instance the use of alternative antiandrogens to treat prostate cancer relapse after initial hormone therapy, and hormone therapy for locally advanced prostate cancer. In the latter study, 208 students were evaluated with locally advanced prostate cancer and treated with gonadal androgen ablation or gonadal androgen ablation and an antiandrogen.
Published in the Journal of Urology, August 2002, the study determined that fourteen patients died of causes related to cancer and 71 patients died of associative diseases. Complications from the primary tumor developed in 13 patients and included obstructive symptoms, which required a transurethral prostate resection (TURP), a ureteral obstruction, or persistent hematuria.
Generally those who survived appeared to be those with a Gleason score less than 8. At five years all cause survival was 59 percent and at eight years it was 41 percent. Complications from treatment developed in four patients and included flutamide hepatotocicity and a hip fracture.
From the studies, what was found all in all is that prostate cancer hormone therapy still does not cure the disease, and that survival rates from the treatment, although apparently fair, are still insufficient for jubilation. To that end, the treatments would either have to be improved upon, or ditched in favor of other procedures that are being realized all of the time.
Prostate cancer hormone therapy, or hormonal therapy for prostate cancer, uses various techniques, notably medications and/or surgery, to compromise the ability of the cancer cells to grow. The most common types of prostate cancer – the adenocarcinoma, which account for about 95% of all prostate cancers diagnosed in the United States – are hormone dependent, not as causal factors, but as factors that contribute to the growth and development of the tumor. This was discovered by Nobel laureate Charles Brenton Huggins in the early 1900s, which was what won him the price.
By using surgery, the testicles of a man can be removed – castration – which produce most of the body’s testosterone. Without sufficient testosterone, the prostate gland is unable to produce the needed dihydrotestosterone (DHT) to fuel the growth of all prostate cells, including prostate cancer cells. There are some medications that achieve pretty much the same thing by blocking the body’s ability to produce DHT from testosterone through various techniques.
Some examples are antiandrogens – such as flutamide, bicalutamide, nilutamide, and cyproterone acetate; medications that block the production of dehydroepiandrosterone (DHEA) and other adrenal androgens – such as ketoconazole and aminoglutethimide; and gonadotropine releasing hormone (GnRH) action suppressors – such as GnRH antagonists, e.g. aberelix, or GnRH, e.g. leuprolide, goserelin, triptorelin, and buserelin.
The side effects prostate cancer androgen hormone therapy can be the same for all of these treatment approaches or as varied as they come. It would appear for one as though the most singular successful approaches to hormonal therapy are surgery and GnRH agonists, although total androgen blockage (TAB) may be necessary by combining treatments to achieve the best results.
Surgery (orchiectomy) for one, in addition to the actual problems that come with the loss of testosterone by the body, may have a psychological impact on the patient. That aside, loss of testosterone may cause all of some of hot flashes, weight gain, loss of libido, gynecomastia, impotence, and osteoporosis. GnRH agonists have similar side effects on the long run, but because they often start their action with an increase in the level of the androgens in the body, they may be worse symptoms at the beginning of treatment, such as increased bone pain due to metastasis of the disease.
Antiandrogen medications usually reduce these sad side effects but cause their own set of symptoms as well. Abarelix, a GnRH antagonist, may in fact cause less loss of bone and muscle mass. Medications blocking DHEA action and production, such as Ketoconazole and aminoglutethimide, result in liver damage and skin rashes respectively with prolonged use.
Antiandrogens are medications such as flutamide, bicalutamide, nilutamide, and cyproterone acetate which directly block the actions of testosterone and DHT within prostate cancer cells. They are a form of hormonal therapy which, in the treatment of prostate cancer, makes use of such medications (otherwise orchiectomy) to block prostate cancer cells from getting the dihydrotestosterone (DHT) hormone that is required for their growth and spread.
This way these androgen treatments cause the tumor to stop growing and even shrink. Although they rarely cure the disease (since the cancers generally become resistant after a while), they are a good way to slow the disease down, especially when it is metastasizing.
Prostate cancer hormone therapy is also called androgen deprivation therapy (ADT) or androgen suppression therapy because of this. The androgens, produced mainly in the testicles, stimulate prostate cancer cells to grow; and as stated in the previous chapter, lowering their levels in the patient often causes the cancer shrink or grow more slowly.
The side effects prostate cancer androgen hormone therapy are pretty much the same as those that are experienced if the patient had to undergo an orchiectomy (surgical removal of the testicles to hinder testosterone production). There isn’t as much of the psychological impact of surgery, but the hot flashes are there just the same. It is common for such a patient to begin to experience weight gain and loss of libido within a year or more of the treatment, while in some people it doesn’t even take that long.
One of the most common side effects of androgen deprivation therapy is the enlargement of the breasts (gynecomastia), a source of considerable embarrassment to most men. Also, perhaps the most devastating complication, impotence can make a man desire not to want to continue living; and osteoporosis, a bone condition characterized by a decrease in density, which also results in the bones being porous and more easily fractured than normal bones.
GnRH (gonadotropine releasing hormone) agonists may also cause increased bone pain from metastatic cancer, and certain estrogens may even increase the risk for cardiovascular disease and blood clots. Ketoconazole specifically has been known to bear with it a certain risk of liver damage to the patient, especially with prolonged use; and another drug, aminoglutethimide, has been known to cause skin rashes. For this reason, the doctor has to be fully apprised of the patient’s medical history before administering such treatments.