Numerous factors go into the decision process for the treatment of prostate cancer. A patient’s age and his or her co-existing medical conditions must be taken into consideration when determining the ideal treatment for a patient. The stage and grade of the tumor must also be utilized to make the best decision for the newly diagnosed patient. When all this information is considered there are numerous options available for the patient. These options include surveillance, radical surgery, radiation therapy, Cryotherapy, high intensity focused ultrasound, Cyberknife and androgen deprivation therapy (ADT).
Androgen deprivation therapy currently involves the use of medications that eliminate the male androgens testosterone and dihydrotestosterone, which are predominantly produced by the testicles. Elimination of these hormones creates a castrate state. When prostate cancer is not exposed to androgens, the cancer tends to slow its growth and the tumor shrinks in size. Although beneficial to many, this treatment does not cure the disease.
ADT was first identified as a means to treat prostate cancer, by the Nobel Prize winner in Medicine in 1966, Charles Huggins, who was able to identify that prostate cancer is a hormonally sensitive cancer. Castration can either be performed surgically or more commonly with medications that can eliminate the hormones. This group of medications includes drugs such as Lupron, Trelstar or Vantas. They can be administered by either an injection or with a pellet of medication that is inserted beneath the skin. The advantage of the skin insert is that the medication is intended to last for one year.
Traditionally androgen deprivation therapy is reserved for those patients with advanced disease. When prostate cancer is metastatic to bone, this is the most common means of treating the cancer. Most patients with bone disease experience a rapid and drastic improvement in their symptoms shortly after initiating therapy with androgen deprivation therapy. Unfortunately not all patients experience permanent relief with the use of these agents, as some will develop hormonally resistant disease. In this group of patients, despite the lack of measurable androgens, the prostate cancer continues to spread. Over the last several years there have been a series of medications that have become available to treat this group of difficult patients.
ADT is traditionally utilized in patients who have metastatic disease. Despite these obvious indications for the use of ADT, patients commonly undergo ADT for other reasons. Many of these patients are older patients who are not suitable candidates for local treatments with curative intent and need to undergo treatment.
A recent study authored by Yao from Rutgers reported on survival following primary ADT with men localized prostate cancer. The results of this study demonstrated that primary ADT was associated with lower 10-year prostate cancer-specific survival but no increase in 10-year overall survival compared with conservative management. Those patients with poorly differentiated cancer showed an improved prostate cancer-specific survival but no overall survival advantage.
Although primary ADT sounds like an easy approach to the treatment of this disease, problems arise with its use long term. Some of these problems include diabetes, coronary disease, myocardial infarction, cardiac death, increased fracture risk, effects on fat mass, and an adverse effect on quality of life. These medications are definitely associated with a loss of libido and many patients experience severe hot flashes with their use.
Prior to embarking on a course of treatments with these medications, it is important to understand what they are truly intended for. You should have a thorough discussion with your Urologist to determine what the intent of the treatment is. Lastly you need to determine whether you need treatment or if you are a candidate for any other treatments that may be curative.
Published On: August 23, 2014