Prostate Cancer and Hormone Therapy

Hormones are found in your body naturally and are responsible for controlling the growth and activity of normal cells. Testosterone is a hormone that is significantly found in men as the testicles make it.

Androgens are mainly responsible for the stimulation of prostate cancer cells to grow. The most common androgens in the body are testosterone and dihydrotestosterone (DHT). The testicles make most androgens, but the adrenal glands and prostate cancer also produce a fair amount of it.

Hormone therapy can be used to lower or completely block the amount of testosterone produced in the body. But it can reduce the risk of prostate cancer coming back when you have it combined with other treatments. Also, it can slow the growth of advanced prostate cancer or shrink it. Hormone therapy is also known as androgen suppression therapy when its goal is to reduce the production of androgens in the body or inhibit them from triggering prostate cancer cells. However, hormone therapy alone doesn't cure prostate cancer completely. It has to be used with other treatments for effectiveness.

Types of Hormone Therapy

Hormone therapy can be taken in three different ways, such as mentioned below:

Injections

LHRH injections work by blocking messages from a brain gland that tells the testicles to produce testosterone. These include:

● Leuprorelin (Prostap)

● Goserelin acetate (Zoladex)

● Buserelin (Suprefact)

● Triptorelin (Decapeptyl)

Buserelin is taken for a few days, followed by a nasal spray. At first, the injections can worsen your symptoms. This is called tumor flare. Your doctor will give you anti-androgen tablets to stop the tumor flare for a few weeks.

Drugs

These anti-androgen tablets stop your testicles making testosterone from getting to the cancer cells. Examples of these drugs include:

● Bicalutamide (Casodex)

● Flutamide (Drogenil)

● Enzalutamide (Xtandi)

● Cyproterone acetate (Cyprostat)

Bicalutamide and flutamide are less likely to cause erection problems are more likely to cause increased breast and tenderness. Enzalutamide is a treatment for men who already have had other types of hormone therapy and chemotherapy that are no longer working.

Surgery

Orchidectomy is a surgery that is done to remove the testicles as they make most of the androgens. It helps to stop the growth or shrink most prostate cancers. It is the least expensive and simplest type of hormone therapy but problematic for some men. However, is not a commonly used way to lower the amount of testosterone in a man. A doctor usually recommends orchidectomy when you require to reduce your testosterone levels right away. For example, if your cancer has spread to your bones and is now pressing against your spinal cord, your doctors might want you to go for it to reduce testosterone quickly. Also, if you want to avoid injections or tablets, your doctor may want you to have an orchidectomy.

When is Hormone Therapy Used?

Hormone therapy should be taken if:

● You can't have treatments like radiation or surgery for some reason

● Your cancer has spread too far to be cured by these treatments

● Your cancer remains or comes back after these treatments

● Along with radiation therapy, if your risk of developing cancer again after treatment is higher

● Before getting radiation to try to shrink cancer to make treatment more effective

Hormone Therapy with Radiotherapy

Doctors usually recommend having hormone therapy before, during, or after radiotherapy between 3 months and three years. The duration of this treatment should depend on the intensity of your cancer's risk of coming back and your side effects. You may have hormone therapy with radiotherapy only if:

● Your cancer has not spread to other parts of the body.

● Your cancer has a high risk of coming back.

● Your prostatic specific antigen (PSA) and Gleason score are very high.

Hormone Therapy Alone

Your doctor might tell you to have intermittent therapy. Intermittent therapy involves breaks from the treatment and has 3 monthly tests to check your PSA. You have to restart treatment in case your PSA rises above a certain level. With this, it is possible to have fewer side effects.

You can have hormone treatment alone if:

● The cancer is grown too much to be entirely cured with treatment

● You can't have treatments like radiation or surgery for some reason

● You don't want to have radiotherapy or surgery

● It is working completely fine.