Hormone Therapy for Prostrate Cancer – How Effective Is It?

Hormonal therapy is one of two prostate cancer treatments that are often reserved for when the disease has spread beyond the prostate gland and may no longer be curable. The other one is chemotherapy, although radiotherapy applies for some advanced tumors, and hormonal therapy may also be used for some early stage tumors, and sometimes offered if initial treatment fails and the cancer progresses.

Hormonal therapy for prostrate cancer aims at blocking prostate cancer cells from getting dihydrotestosterone (DHT) for their growth and progression. This is done either with the aid of medications or by surgery (orchiectomy).

DHT is a hormone that is produced in the prostate and required for the growth and spread of most forms of prostate cancer. By blocking DHT, prostate cancer generally stops growing and may even shrink. But the reason why hormonal therapy is usually reserved for late stage disease when it is hardly curable at all is because it rarely cures the adenocarcinoma in the first place. In fact, malignant cells that initially respond to hormonal therapy characteristically become resistant to the therapy after just a couple of years, sometimes not even lasting so long.

As stated earlier, hormone treatments aim for the pathways the body uses to produce DHT, which is a feedback loop that involves the testicles, the hypothalamus, and the pituitary, adrenal, and prostate glands. The hormones involved in this process are several as well, namely the gonadotropin releasing hormone (GnRH), the luteinizing hormone (LH), testosterone, dehydroepiandrosterone (DHEA), and DHT, all generally from different sources in the body. Very simply hormonal therapy decreases levels of DHT by interrupting the loop at any point.

An orchiectomy is a surgical castration to remove the ability of the body to produce testosterone. Although there are other sources of the hormone, there isn’t enough to produce DHT or transform into it. Antiandrogens work in a different manner, using medications like flutamide, bicalutamide, nilutamide, and cyproterone acetate to directly block the actions of testosterone and DHT within prostate cancer cells. Other medications block the production of adrenal androgens like DHEA, only applicable in combination with other methods to achieve total androgen blockage (TAB). These drugs are ketoconazole and aminoglutethimide.

Finally GnRH agonists and antagonists help to interrupt GnRH action. The agonists (e.g., leuprolide, goserelin, triptorelin, and buserelin) suppress LH by downregulation after an initial increase in its production, but the production crashes sooner than later; the GnRH antagonists (e.g., abarelix) however suppress the production of LH directly.

Prostate Cancer Hormone Therapy Treatment

It is unfortunate but true that the efficacy of hormonal treatment in prostate cancer intervention is riddled with controversies, especially with respect to early or delayed treatment. Other factors that relate to how precisely the treatments should be administered to the patients are also being hotly debated, and everyone is offering their views based on research findings, intuition, and sometimes actual experiences in dealing Hormone Therapy to live patients.

This article looks at some of the more prominent issues that surround hormone therapy that not all doctors or specialists appear to agree on. The best time to start and stop the treatment, the best way to give it, and so on, are explored below.

Hormone Treatments for prostate cancer Patients ? Early or Delayed ? There are about as many oncologists who believe that hormone therapy works better if it is started as soon as possible even for cancers that have reached an advanced stage as there are those who think otherwise. When an adenoma has spread to the lymph nodes, it does constitute a bigger problem. It the cancer tumor is T3 large, or if it has a high Gleason score, or if after an initial treatment the PSA level of the patient starts to rise again in spite of the fact that the patient feels perfectly alright.

Especially because of the side effects of treatment, several oncologists believe that is it wiser in such instances to wait for more evidence of benefit, while others think that treatment should resume right away. There are studies, which prove that hormone treatments tend to slow down the disease and lengthen the patient’s survival, although maybe not in all cases, but the risk to the patient needs to be taken into account. As a result of these, studies are underway to answer the questions.

Hormone Treatments for prostate cancer Patients ? Intermittent or Continuous ? It is a fact that cancers that initially respond to hormonal therapy typically become resistant after one to two years. To that end, some specialists consider the possibility of constant androgen suppression being more harmful to the patient than an intermittent, on-again-off-again administration of the treatment. Again there are those who believe and there are those who veto, so that clinical trials of intermittent hormonal therapy are currently still in progress to determine whether it is better or worse than continuous hormonal therapy. Intermittent hormonal treatment however seems to afford the chance of avoiding the worst side effects of hormonal therapy like impotence, hot flashes, and loss of sex drive.

Certain other arguments focus on combined androgen blockade (CAB) and triple androgen blockage (TAB). Some treat patients with both androgen deprivation and an anti-androgen, and some have suggested that taking combined therapy by adding 5-alpha reductase inhibitor to CAB should improve the curative results of the therapy. However, there are doctors who believe that there is not enough evidence to prove that, as such, research is again enforced to prove the point.

Hormone Therapy 26 Prostate Cancer

Hormone therapy for prostate cancer requires the manipulation of the hormones in the male body that have been implicated, not as causal factors for the disease, but in the progression and growth of the adenocarcinoma. It has been long established that some forms of cancer depend in hormones in the body to fuel their growth. prostate type of cancer in particular relies on the male endocrines testosterone, dehydroepiandrosterone, and dihydrotestosterone (DHT) in order to progress.

More specifically, testosterone produced in the testicles works with dehydroepiandrosterone secreted by the adrenal glands and causes the prostate gland to produce DHT. In the presence of DHT, certain forms of prostate cancer are able to grow faster. It was Nobel laureate Charles Brenton Huggins who first castrated a dog to determine that prostate carcinoma tumors in the dog mostly ceased to grow within a few days, and some actually started to shrink. The castration stopped the body’s production of testosterone, thereby compromising the synthesis of DHT.

Hormonal therapy seeks to interrupt the production of DHT at any point during the cycle of its manufacture. By surgically removing a man’s testicles (process called orchiectomy), testosterone production is hampered. However, sometimes there is need for other medications to further inhibit DHT production in the body. Also, there are instances in which men prefer taking oral and topical treatments to undergoing the surgery because of the invasiveness of the latter procedure. To that end, there are several treatments also that can function well enough in that category.

To mention a few, there are drugs like leuprolide (sold as Lupron, Eligard, or Viadur in the United States) or goserelin (Zoladex). These are called GnRH (gonadotropine releasing hormone). But there are also antiandrogens such as bicalutamide (Casodex) or flutamide (Eulexin). They either block the production of the hormone testosterone, or interfere with the process that makes DHT production possible anywhere along the line.

Hormone treatments are indeed favored because of their ability to slow the progression of prostate cancer cells; however they are limited in the regard that they do not actually cure the disease. As a matter of fact, a patient who has been on hormone treatments for over a year is at risk of the cancer becoming resistant to the therapy and resuming its growth. For such reasons as these, hormonal therapy not used quite as often to treat early stage prostate type of cancer, but instead on advanced metastatic disease to aid palliation.

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