Hormone therapy is used when prostate cancer has spread to other parts of the body or returned after treatment. The goal is to eliminate the testosterone produced by the testicles that causes the cancer to grow.
How does hormone therapy for prostate cancer work?
Prostate cancer cells can be hormone-sensitive, hormone-insensitive or hormone-resistant. Cancer cells that are hormone-sensitive need androgens to grow. Testosterone is an androgen. Hormone therapy can eliminate the androgens and slow the cancer cells' growth. Though not curative, this can be effective for several years. Prostate cancer cells that are hormone-resistant will not respond to hormone therapy.
When is hormone therapy for prostate cancer recommended?
- As an initial treatment for metastatic disease.
- For an elevated PSA or recurrence of prostate cancer following radical prostatectomy, radiation therapy or cryotherapy.
- For men who are not candidates for surgery or radiation therapy and are not interested in active surveillance.
- To shrink the prostate gland before having a radical prostatectomy or radiation therapy to make the procedure easier. (Therapy performed prior to treatment is called neoadjuvant therapy.)
How is hormone therapy administered?
- Medical Therapy - The medication, which is delivered through a series of injections, is used to stop production of testosterone by the testicles and other adrogens from the adrenal glands. There are several types of medical therapy: luteinizing hormone-releasing hormone (LHRH) analogues, antiandrogens, and gonadotropin-releasing hormone (GnRH) antagonists. LHRH/GnRH therapy comes in a variety of types, made by different manufacturers, including goserelin (Zoladex), leuprolide (Lupron), triptorelin (Trelstar), and degarelix (Firmagon). These medications are administered as a subcutaneous or intramuscular injection, or placed as a slow-release capsule under the skin.
- Surgical Therapy - Also called bilateral orchietomy, this surgery is to remove both testicles, which are the main source of androgen production. Surgical removal results in a fast drop in testosterone levels that slows the growth of prostate cancer. The surgery may be performed via one or two incisions, depending on what your surgeon decides. For men who are bothered by the change of scrotal appearance (empty scrotum), prosthetic testes can be placed as implants.