Prostate cancer is a hormonally responsive cancer. In 1966, Charles Huggins was awarded the Nobel Prize in Physiology or Medicine for work that began in the 1940’s with his colleague CV Hodges. Their work was able to establish that if androgens (testosterone) were eliminated in patients with prostate cancer, the cancer cells would atrophy.
The vast majority (95%) of androgen is testosterone and it is predominantly produced by specific cells in the testes known as Leydig cells. 5% of androgen is produced by the adrenal gland. If we are able to eliminate androgens, by creating a castration, then in theory we should be able to control prostate cancer.
Presently there are several means of inducing the castrate state. Surgical castration, the removal of a man’s testicles, had been the gold standard to achieve castration, however over the last decade, numerous medical therapies have evolved that have become the preferred mode of creating a castration, by a medical technique thus eliminating the need for a surgical procedure.
Despite the near immediate castrate level of testosterone brought on by surgical castration, patients tend to opt for non-surgical techniques. Removal of the testicles is a rather psychologically traumatic event for a man. Patients report a negative body image when their testes have been surgically removed. Although castration is associated with a lack of libido, the presence of the gonads does help result in a better sense of well-being.
Hormonal ablative therapy is traditionally utilized as the treatment of choice for patients who have metastatic disease that would otherwise not be curable by other means such as surgery, radiation therapy or cryotherapy. Over the last decade, there has been more widespread use of these treatments in patients who do not have advanced disease but are not candidates for curative therapy for many reasons including advanced age or other coexisting diseases that do not allow for them to undergo curative techniques. Patients may wonder why something as simple as a medication could not be used for the routine treatment of prostate cancer. The main reason is that over time, prostate cancer can become hormonally resistant and patients may no longer respond to the medication, with the cancer progressing. Other side effects such as the development of osteoporosis with long-term androgen ablation is also a concern.
For more information on the choices you have to manage your condition, ask your physician.
Published On: August 15, 2010