Other Treatments

Other Treatments

Androgen Suppression Guidelines

Male hormones (called androgens), particularly testosterone and dihydrotestosterone, determine male secondary sex characteristics and stimulate prostate cell growth. When prostate cells, both healthy and cancerous, are deprived of androgens, they no longer proliferate and eventually die.

Hormonal treatment in prostate cancer uses drugs or surgery (orchiectomy) to suppress or block male hormones (androgen), particularly testosterone and dihydrotestosterone. Hormone therapy is used for advanced and metastatic cancer and may be used if treatment for localized prostate cancer has failed and cancer recurs (as indicated by rising PSA levels). Side effects can include decreased bone density, decreased muscle mass, hot flashes, and enlargement of breasts.

Therapies that suppress male hormones (called androgens) are the mainstay treatment for advanced and metastasized cancer (Stage IV). Such therapies may be in the form of hormonal drugs, orchiectomy (surgical removal of the testicles) surgery, or both. Cure is possible in late-stage prostate cancer, but it is rare. Even without cure, however, treatments can produce striking subjective or objective responses in most patients.

Androgen-suppression treatments include:

Hormonal Drugs. The primary drugs used for suppressing androgens are called luteinizing hormone-releasing hormone (LH-RH) agonists.

Orchiectomy. Orchiectomy is the surgical removal of the testicles. It is the single most effective method of reducing androgen hormones, but it is considered an extreme procedure. Studies do not indicate that it significantly improves survival rates. Orchiectomy plus radical prostatectomy may delay progression in patients with cancers that have spread only to the pelvic lymph nodes. Combining orchiectomy with antiandrogen drug therapy adds a modest benefit.

The median survival rate after the operation is about 55% over a 40-month period. An estimated 25% of patients survive 5 years or more. Nevertheless, orchiectomy, although irreversible, may produce fewer adverse effects than hormonal drugs, and interestingly, patients report significantly higher quality of life after orchiectomy than patients who opt for hormonal treatment, particularly total androgen ablation. Because orchiectomy is irreversible, about 75% of patients with advanced prostate cancer choose hormonal therapy to block androgens. Like all androgen deprivation therapies, orchiectomy increases the risk for osteoporosis.