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.

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