Cancer Studies > cancer > Prostate Hormone Therapy

Prostate Hormone TherapyProstate hormonal therapy is the main option for the treatment of cancer has already spread outside the prostate region, or has recurred after initial treatment with surgery or radiotherapy. It is sometimes also used for short periods in combination with radiotherapy. This fact describes what are prostate hormonal therapy, the effects, and the long-term results.

Male hormones (called androgens) are important for prostate growth – a fact that is known for more than 50 years. Indeed the normal development of the prostate to its adult form is very dependent on testosterone; the main male hormone is released from the testicles. Men rely on a normal level of male hormones to have adult sexual function and fertility. The level of male hormone in the body is carefully controlled by several factors, but the main one is the normal secretion of hormones from stimulating the hypothalamus and pituitary gland in the brains.

Both normal and benign cells in the prostate and prostate cancer cells are stimulated to grow by male hormones. Prostate cancer cells that have left the prostate and grow in other parts of the body (metastases) are also stimulated to grow by male hormones. So a relatively common treatment for prostate cancer that has spread outside the prostate region the level of male hormones in the body and thus reduces the growth of cancer cells stops. This happens regardless of whether the cells in the prostate or in other areas of the body. Indeed, prostate cancer cells typically respond to the withdrawal of male hormones by dying. Unfortunately, not all prostate cancer cells die, and with time, often several years later, the cancer recurrence. However, a good control of cancer and a symptom-free lifestyle are achieved for many years by men on prostate hormonal therapy. This factsheet is intended to help those with prostate cancer for whom hormone therapy is an option.

Using Prostate Hormone Therapy

This is not an easy question to answer; many factors must, before choosing this treatment option should be considered. In general, prostate hormonal therapy as there are indications that the cancer is no longer confined to the prostate (and sometimes shrink the gland before disposal or radiotherapy).

Hormone therapy is often used for men in whom radical treatment is not successful in curing the disease, that is, after radical surgery or radiotherapy. Often our best indicator of recurrent prostate cancer growth is a rising PSA level (PSA is a blood test, after surgery or radiotherapy, indicates the amount of the remaining cancer activity in the body). The exact timing of hormone treatments in response to a rising PSA level is variable and based to some extent the rate of tumor growth and the sites of the tumor.

Prostate hormonal therapy is the main therapy for metastatic prostate cancer and prostate cancer cells have escaped from the prostate to grow in other parts of the body. In this case, treatment can be started soon after the diagnosis, although sometimes a delay in starting no serious danger to the patient.

Prostate hormonal therapy can also be used for the tumor prior to or in combination with other treatments shrink. There are indications that it might be useful in combination with radiotherapy, but their use in combination with surgery is controversial (as proposed, this should be discussed with a specialist). Once the prostate treatment is completed, the hormone therapy is usually stopped and the response observed by following the PSA levels.

Prostate Hormone Treatment

Essentially there are two ways of reducing male hormones by an operation in which the testicles are removed (orchiectomy) and through medication, either in the form of regular injections or tablets. Both are effective.

Since the testes provide more than 95% of the male hormones, it is clear that the removal of the levels will decrease. This happens very quickly after surgery, which is sometimes performed as day surgery, but often with an overnight stay in hospital. An advantage of this form of hormone therapy is the inconvenience and cost of regular medication is avoided.

Medicines are available as an alternative to orchiectomy. The injectable drugs work on the brains for the production of male hormones in the testes and, to date 1 to 3 months per injection. This means that monthly or 3-monthly injections needed to control the growth of cancer cells, and must be stopped; the prostate cells begin to grow.

Tablets are also available to control the cancer, though not often recommended by itself as a first choice method for combating cancer. In the past, both injectables and tablets are often used in combination control prostate cancer cell growth (the so-called total androgen ablation). We are currently unsure of the additional effectiveness of taking a tablet, while an injectable drug or in combination with orchiectomy (removal of the testicles). Sometimes hormone therapy may be given in cycles ie started and stopped repeatedly.

This type of treatment is intermittent prostate hormonal therapy. Usually hormonal treatment continued for several months to a low PSA level reached, and then stopped. Once the PSA level in blood increases to a certain level again (and this can take many months), hormone therapy is started again. The advantages of this approach are a reduction of side effects, and possibly extending the effectiveness of hormone therapy.

Side Effects of Hormone Therapy

Much of the side effects of hormone therapy in the absence of normal levels of male hormone in your body and out if you choose surgery or drugs. These are summarized in Table 2 below. Typically, most people suffer from poor or absent erections (impotence) and there is also a lack of interest in sexual activity (decreased libido). Your voice will not change, but some men notice a change in their body hair, as a different structure and may grow back on earlier rather bare areas. Fatigue is a common complaint, and is related to the main male fuel suppressed.

Hot flashes are very common in the early stages of treatment, but may decline spontaneously after several months of treatment. There are medicines available to the intensity of this sometimes disabling symptom if necessary, reduce. For many months or years may be a decrease in muscle strength and some tenderness or enlargement in the chest area.

Prior to prostate hormonal therapy, it is useful to the possibility of side effects with your wife or partner to discuss. Good communication is important in dealing successfully with these changes and maintaining your close relationship.

The nature of this treatment, the removal of male hormone or the impact the changes mean that a man in the way he feels will experience, his attitude, and of course his sex life. While this can be painful, and it means that the communication with your partner is extremely important, it is not change that you are. It does not change your identity as a human being and ability to direct your own life. Some men feel the need for a change in focus in their lives at this stage, however, and they can take actions more meaningful to them. Under these men, the years that follow can be rewarding and productive.

Hormone Resistance

The ability of hormone treatment to fight your cancer is very variable. Some men (about one in five) are returned within one years of starting growth hormone therapy while others show no evidence of recurrent disease after 10 years of treatment. The median time to PSA evidence of re-growth (hormone resistance) is 2.5 years. The delivery of hormone therapy is in bursts (i.e., intermittent rather than continuous) as a way of delaying the start of the resistance is possible with medication, but not after removal of the testicles with surgery. Although this approach has some theoretical advantages, the benefits have not been established, and continuous prostate hormonal therapy is still considered by most physicians as the best option.

When the resistance to prostate hormonal therapy occurs (usually indicated by rising PSA in the blood), treatment is often tailored to individual symptoms. The symptoms usually occur several months to years after evidence of cancer re-growth and are either related to the growth of the cancer in the pelvis (blood in the urine, a reduced ability to urinate) or progress in remote places like the bones (pelvic pain, back, etc.).

Treatment Options for Hormone-Resistant Cancer

Options available for this stage of the disease:

  1. Radiotherapy, pain and fight cancer growth in locations outside the prostate. Radiation is usually delivered by external beam (meaning from outside the body) in this setting, although sometimes used agents injected.
  2. Additional hormone treatments, most tablets. Not many men have a lasting beneficial effect of second-line prostate hormonal therapy, but a downward trend in the PSA action for several months. Stopping the use of a tablet and another is sometimes useful.
  3. Steroids such as prednisolone to control pain and reduce tumor growth.
  4. Non-specific pain medications, including arthritis-type tablets and morphine.

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