Prostate cancer occurs when cells in the prostate start to grow out of control. The prostate is a gland found in males’ reproductive system. It is shaped and sized like a walnut, and located below the bladder, near the rectum and around the urethra. The size of the prostate changes with age, growing fast during puberty and again as men get older. The function of the prostate is to produce a fluid that protects and nourishes sperm cells in semen, making the semen more liquid.
After being diagnosed, the physician determines the stage of the prostate cancer and defines a treatment plan. The treatment depends on the patient’s age and expected life span, additional severe health conditions, stage and grade of the cancer, patient’s and physician’s feeling and opinions on the treatment and potential side effects, as well as likelihood that each type of treatment will cure the cancer. The treatment options for prostate cancer patients include expectant management (watchful waiting) or active surveillance, surgery, radiation therapy, cryosurgery (cryotherapy), hormone therapy, chemotherapy, vaccine treatment, and bone-directed treatment.
Hormone Therapy for the Treatment of Prostate Cancer Patients
Hormone therapy, also known as androgen deprivation therapy (ADT) or androgen suppression therapy, is one of the treatment options for patients with prostate cancer. “The goal is to reduce levels of male hormones, called androgens, in the body, or to stop them from affecting prostate cancer cells,” explains the American Cancer Society. It is particularly indicated in patients whose cancer has spread too far to be cured by surgery or radiation, or when patients can’t undergo these treatments for some reason, in patients whose cancer is resistant to or returns after previous treatments, as well as in combination or before radiation therapy to increase the probabilities of success.
“The main androgens are testosterone and dihydrotestosterone (DHT). Most of the body’s androgens come from the testicles, but the adrenal glands also make a small amount. Androgens stimulate prostate cancer cells to grow. Lowering androgen levels or stopping them from getting into prostate cancer cells often makes prostate cancers shrink or grow more slowly for a time. But hormone therapy alone does not cure prostate cancer.”
There are different approaches included in the class of hormone therapy such as orchiectomy (surgical castration), luteinizing hormone-releasing hormone (LHRH) analogs, Degarelix (Firmagon®), Abiraterone (Zytiga®), which are used to decrease the androgen levels. Anti-androgens like flutamide (Eulexin®), bicalutamide (Casodex®), nilutamide (Nilandron®), Enzalutamide (Xtandi®), Estrogens (female hormones), and Ketoconazole (Nizoral®) are used to block the function of androgens.
Risks and Side Effects of Hormone Therapy for Prostate Cancer
Hormone therapy may be used as adjuvant hormone therapy, which has been proven effective in increasing life span, as neoadjuvant hormone therapy, which is administered before other treatments in early-stage prostate cancer patients who have an intermediate or high risk of recurrence, or alone as palliative care. The length of the treatment depends on each patient’s risk of recurrence, defined according to the amount or spread of cancer in the body, Gleason score, and PSA level. Patients with intermediate-risk prostate cancer usually need four to six months of hormone therapy, while patients with high-risk disease generally need it for two to three years.
“Doctors cannot predict how long hormone therapy will be effective in suppressing the growth of any individual man’s prostate cancer. Therefore, men who take hormone therapy for more than a few months will be regularly tested to determine the level of PSA in their blood. An increase in PSA level may indicate that a man’s cancer has started growing again. A PSA level that continues to increase while hormone therapy is successfully keeping androgen levels extremely low is an indicator that a man’s prostate cancer has become resistant to the hormone therapy that is currently being used,” adds the American Cancer Society.
Since there are numerous risks associated with hormone therapy, its use is not always preferable. The main risk is that its effects are limited. In addition, both medical castration and surgical castration decrease the amount of androgens produced by the body, causing side effects like decreased libido and loss of interest in sex, erectile dysfunction, hot flashes, loss of bone density, bone fractures, loss of muscle mass and physical strength, alterations in blood lipids, insulin resistance, weight gain, mood swings, fatigue, and growth of breast tissue, which is known as gynecomastia. In addition, side effects specifically associated with antiandrogens are diarrhea, breast tenderness, nausea, hot flashes, loss of libido, erectile dysfunction, and liver damage.
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