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Hormone therapy for treating and recovering from prostate cancer

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It may sound strange, but there is increasing evidence that hormone therapy, which would normally be taken to boost the levels of testosterone in the blood after prostate surgery or chemotherapy for prostate cancer, can also work directly as a way of treating prostate cancer itself.

In a case where prostate cancer has been detected, hormone therapy aims to reduce the production of hormones that can stimulate cancer growth. The target of using hormones as a cancer treatment is to slow or halt the growth of prostate cancer cells. Hormone therapy may be the preferred alternative to surgery or radiation treatments.

Considering male hormones’ role in prostate cancer

Essential male hormones are required for normal growth and function of the prostate gland

The relationship between male hormones and prostate cancer has been known for more than fifty years. Dr. Charles B. Huggins, the first scientist to discover and investigate this, won a Nobel Prize in 1966 for his finding of “Endocrine-Induced Regression of Cancers.”

According to the National Cancer Institute’s information page about prostate cancer, the essential male hormones are required for normal growth and function of the prostate gland itself. (The gland is responsible for producing semen in mature men.) These hormones (grouped together as androgens) are triggers that cause both normal and cancerous prostate cells to multiply and grow. Androgens act by binding to and activating the androgen receptor in prostate cells which then will cause prostate cells to grow.

The role of the therapy is to suppress the output mainly of the primary male hormones (androgens like testosterone and androstenedione). Many studies show that these hormones play a significant role in causing prostate cancer. They can lead to prostate gland inflammation, which is more likely to react by growing cancerous cells.

Primary therapies suitable for controlling androgen output

Two main types of hormone replacement therapies are used: androgen deprivation therapy (ADT) and antiandrogen therapy. ADT is typically done if the cancer was found in a man’s testes, or they have had their testicles removed. In men not doing well on ADT, antiandrogen therapy may be used in place of ADT. Still, it is only appropriate for those with a low risk of testosterone-producing tumors after three cycles of ADT.

Another type of hormone therapy is called luteinizing hormone-releasing hormone (LHRH) agonists. These medications are given as injections or implanted pellets under the skin every few months. They work by stopping the production of luteinizing hormones and follicle-stimulating hormones in men with advanced prostate cancer that has spread outside their prostate gland.

ADT therapy may also be given before surgery or radiation to shrink the tumor size so that it can be removed more easily. There is also sometimes a combination of surgery, radiation, and medications. The goal here is to stop the production of testosterone, which can cause prostate cancer cells to grow.

Considering hormone therapy as a treatment for the after-effects of prostate cancer treatments.

Once the progression of prostate cancer is considered to be sufficiently under control, thoughts turn to restoring the normal sexual functionality that is so dependent on the levels of male hormones like testosterone.

Hormone therapy is a treatment for the after-effects of prostate cancer treatments. It is an option for men who have had their testosterone level lowered during treatment for prostate cancer, or who have been castrated.

The type of hormone therapy offered depends on the stage of the cancer. The treatment will vary based on whether or not hormone therapy was done prior to diagnosis, if the patient has had his testicles removed, or if they are still producing sperm. 

The primary hormone therapy after prostate cancer is testosterone replacement therapy (TRT). TRT replaces testosterone in the body that has been lost. TRT may be used to treat other symptoms of androgen deprivation therapy (ADT), such as fatigue, loss of libido, weight gain and hot flashes. 

TRT is available in many different forms, such as topical gels, patches and injections. 

Testosterone can also be delivered in a patch or gel under the arm. The patient’s doctor will decide which treatment is the best for the patient.

Gonadotropin-releasing hormone agonists are a commonly prescribed form of HRT (hormone replacement therapy) that helps boost sex drive in men with low testosterone levels. It may also be helpful in relieving symptoms of sexual dysfunction associated post-prostate cancer, such as erectile dysfunction or trouble achieving an orgasm.

Which drugs are available in the fight against prostate cancer?

Some of the drugs commonly prescribed during prostate cancer treatment are based primarily on producing additional levels of androgen hormones, or blocking the effect of the hormone. These include:

Lupron (active ingredient: leuprolide) achieves and maintains concentrations of testosterone in men with prostate cancer, producing an increase in levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

Zoladex (active ingredient: goserelin) is a luteinizing hormone blocker. This means it stops the release of luteinizing hormone (LH) from the pituitary gland. This prevents the testicles from producing the male sex hormone testosterone.

Casodex (active ingredient: bicalutamide) is indicated for treating stage D2 metastatic prostate cancer in combination with a luteinizing hormone-releasing hormone analog or as a monotherapy. It has also been used in combination with castration

Zytiga (active ingredient: abiraterone acetate) is a treatment in combination with prednisone for metastatic high-risk castration-sensitive prostate cancer (CSPC). 

Which drugs will help restore normal sexual virility after prostate cancer treatment?

Since the main effects of boosted androgens will wear off once the prostate cancer is under control, there could be a steep fall in testosterone levels, which will immediately reduce virility, lower the libido, and could directly induce erectile dysfunction. It’s advisable to consult with your physician thoroughly after the prostate cancer is cured or in remission, in order to avoid these effects.

Androgel (active ingredient: testosterone) is used for hormone replacement therapy in men with low levels or an absence of the hormone testosterone (officially termed hypogonadism but commonly termed low T). The hormone is applied to the upper chest area every morning.

What are the alternative treatments for prostate cancer?

Besides hormone replacement therapy, according to the National Cancer Institute’s prostate cancer treatment website, there  are three main possibilities:

Orchiectomy, a permanent and irreversible surgical procedure to remove one or both testicles. Removal of the testicles, called surgical castration, can reduce the level of testosterone in the blood by 90% to 95%. There is a possibility (subcapsular orchiectomy) to remove only the tissue in the testicles that produces androgens, rather than the entire testicle. 

Surgery – patients in good health whose tumor is in the prostate gland only may be treated with surgery to remove the cancer. The primary type of surgery is a radical prostatectomy, which removes the prostate, surrounding tissue, and seminal vesicles.

Pelvic lymphadenectomy – a surgical procedure to remove the lymph nodes in the pelvis. If the lymph nodes contain a cancer, the doctor will not remove the prostate and may recommend other treatments.

Transurethral resection of the prostate (TURP) – removes tissue from the prostate using a cutting tool inserted through the urethra. It is done to treat benign prostatic hypertrophy, and it is sometimes done to relieve symptoms caused by a tumor before another cancer treatment is given. TURP may also be done for men who cannot have a radical prostatectomy.

What are the primary responses to hormone therapy?

According to the American Cancer Society’s categorization of how well a man’s prostate cancer is responding to hormone therapy, there are three main groupings:

Castration-sensitive prostate cancer (CSPC), or hormone-sensitive prostate cancer (HSPC), means the cancer is being controlled by keeping the testosterone level as low as expected if the testicles were removed by castration. 

It means the cancer continued growing even when the testosterone levels are at or below the level that would be expected with castration. Some of these cancers might still be helped by other forms of hormone therapy, such as abiraterone or one of the newer antiandrogens.

Hormone-refractory prostate cancer (HRPC) refers to prostate cancer that is no longer helped by any type of hormone therapy, including newer medicines.

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