Testosterone serves as the main fuel for prostate cancer cells to grow and survive. That’s why it’s a common target for therapeutic intervention.
Hormone therapy, also known as androgen-deprivation therapy (ADT), is designed to stop testosterone from being released or to prevent it from acting on the prostate cells.
Although ADT plays an important role in men with advancing prostate cancer, it is increasingly being used before, during or after local treatment as well. It will likely be a part of every man’s therapeutic regimen at some point during his fight against recurrent or advanced prostate cancer.
Because some cells grow independently of testosterone, ADT is not a foolproof strategy. It often must be used in concert with other treatments.
The Most Common Types of Hormone Therapy
About 90 percent of testosterone is produced by the testicles. Orchiectomy — the surgical removal of the testicles — is effective for blocking testosterone release.
The procedure is typically done on an outpatient basis in the urologist’s office. Recovery tends to be rather quick with no further hormone therapy needed, which is good for a man who prefers a low-cost, one-time procedure.
Because this approach is permanent and irreversible, most men opt for drug therapy instead.
Treatment courses for radiation therapy usually run five days a week for about seven or eight weeks and are typically done on an outpatient basis.
Luteinizing hormone-releasing hormone (LHRH) is one of the key hormones released by the body before testosterone is produced. Blocking its release is the most common hormone therapy option.
This is done with drugs administered through regular shots either once a month, once every three, four or six months, or once per year.
However, these drugs can create a testosterone surge or flare reaction because of an initial transient rise in testosterone over the first three weeks after the shot. This can result in a variety of symptoms, ranging from bone pain to urinary frequency or difficulty. This flare reaction can be prevented with the addition of antiandrogens, which can help block the action of testosterone in prostate cancer cells.
A newer class of medications can block LHRH from stimulating testosterone production without causing an initial testosterone surge. This class includes degarelix, which is given monthly to men as an alternative to orchiectomy or LHRH agonists.
Side Effects of Hormone Therapy
Testosterone is the primary male hormone, and it plays an important role in establishing and maintaining the typical male characteristic and a host of other normal physiologic processes in the body.
The potential effects of testosterone loss include:
Erectile dysfunction and decreased sexual desire
Loss of bone density and increased fracture risk (osteoporosis)
Increased risk of diabetes and heart attacks/strokes
Weight gain and decreased muscle mass
Rise in cholesterol (especially LDL cholesterol)
Most men on hormone therapy experience at least some of these effects, but the degree is impossible to predict.
Before beginning hormone therapy, every man should discuss the effects of testosterone loss with his doctors to help minimize them. Exercise is probably the best thing a man can do to prevent many of these side effects.
Over the years, researchers have explored different ways to minimize the side effects of testosterone loss while maximizing the therapeutic effect of hormone therapy. The most commonly explored strategy is known as intermittent therapy.
This strategy takes advantage of the fact that it takes a while for testosterone to begin circulating again after LHRH agonists are removed. With intermittent hormone therapy, the LHRH agonist is used for six to 12 months, during which time a low prostate-specific antigen (PSA) level is maintained. The drug is stopped until the PSA rises to a predetermined level, at which point the drug is restarted.
The time between cycles allows men to return to nearly normal levels of testosterone, potentially enabling sexual function and other important quality-of-life measures.
However, the true benefits of this approach remain unclear, and large clinical trials are currently underway to evaluate its use in men with advanced prostate cancer.
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