Hormone Therapy Procedure for Prostate Cancer
Overview
Hormone therapy for prostate cancer works by blocking androgens like testosterone from reaching cancer cells. Lowering these hormones can slow cancer growth or kill the cells. Treatments may involve medications or surgical removal of the testicles. Other approaches may include:
- Medicine to block androgen effects.
- Surgical intervention aimed at reducing hormone levels.
- Combination with radiation treatment or chemotherapy.
Doctors use diagnostic tools—such as prostate-specific antigen (PSA) tests, biopsies, and Gleason scores—to help guide these treatment options.
Reasons for Hormone Therapy Use
Doctors use hormone therapy, also called androgen deprivation therapy (ADT), to lower male hormones such as testosterone and dihydrotestosterone (DHT). Prostate cancer cells rely on these hormones to grow and spread. Blocking them can help slow or stop cancer growth. Common uses include:
- Treating metastatic prostate cancer to shrink tumors and manage symptoms.
- When prostate-specific antigen (PSA) levels stay high or rise after other treatments.
- Alongside radiation for locally advanced or high-risk prostate cancer to lessen the chances of the cancer returning.
Doctors may also recommend hormone therapy if a person is in a higher risk group or is being closely monitored through observation or watchful waiting. In cases where the cancer is castration-resistant prostate cancer (CRPC) or advanced, doctors may use other forms of hormone therapy to control the disease for as long as possible.
| Purpose | Details |
|---|---|
| Slow or stop cancer growth | Decreases the fuel for cancer by reducing male hormone levels. |
| Treat advanced cases | Used when cancer has spread or become resistant. |
| Support other treatments | Helps boost results of radiation and reduce recurrence risk. |
Potential Complications
Periodic Use of Medicines
Some people with prostate cancer use hormone therapy in cycles, starting and stopping treatment based on specific factors like PSA levels. This method, called periodic dosing, helps reduce unwanted effects linked to long-term hormone therapy. Possible side effects include:
- Fatigue and tiredness
- Hot flashes
- Increased body fat and weight gain
- Loss of muscle mass
- Reduced sexual desire and erectile dysfunction
- Bone thinning (osteoporosis), which can raise the risk of fractures
- Mood changes, such as depression or mood swings
- Higher risk of diabetes and heart disease
- Breast tissue growth (gynecomastia) and breast enlargement
- Muscle and bone pain
- Changes to blood pressure
- Anemia and liver problems
Switching between periods of treatment and no treatment may help lessen some of these issues.
Getting Ready for Treatment
Before starting hormone therapy for prostate cancer, patients should talk with their doctor to review all possible treatment options and what each one could mean for their health. This is also a good time to ask questions and discuss any worries. Common types of hormone therapy include:
- Medicines that block the body from making testosterone.
- Anti-androgens that keep testosterone from affecting cancer cells.
- Surgery to remove the testicles (called an orchiectomy), which lowers testosterone quickly.
Each method has different risks and benefits, so careful thought is needed. It may be helpful to get a second medical opinion before making a final choice. Staying active can also support overall health—gentle exercise is often recommended if approved by a doctor.
Checklist Before Starting Therapy
| Step | Action |
|---|---|
| Meet with healthcare team. | Discuss all therapy options. |
| Consider a second opinion. | Confirm the best treatment plan. |
| Review lifestyle adjustments. | Plan for a healthy diet and exercise. |
What You Can Expect
Medicines that Suppress Testosterone
Doctors give medicines that reduce the body’s testosterone as injections or small implants under the skin. These treatments can be scheduled monthly, every three months, or every six months. Some implants slowly release medication over time.
Luteinizing hormone-releasing hormone (LHRH) agonists are commonly used to lower testosterone but may cause a short-term rise in testosterone levels at the start of treatment. This rise, known as a “flare,” can temporarily make cancer symptoms worse.
To help reduce this risk, doctors sometimes prescribe anti-androgen tablets before starting treatment with an LHRH agonist. Luteinizing hormone-releasing hormone (LHRH) antagonists work in a similar way but do not trigger a flare, making them a useful alternative in some cases.
| Type | How Given | Flare Risk |
|---|---|---|
| LHRH Agonists | Injection/Implant | Yes |
| LHRH Antagonists | Injection/Tablet | No |
Medicines Blocking the Effects of Testosterone
Patients take anti-androgens as pills that stop testosterone from reaching the cancer cells. Doctors often use them along with LHRH agonists or start them just before to help prevent a testosterone flare.
Doctors may use these medicines as part of a combined approach known as combined androgen blockade, or CAB, to further lower the effects of male hormones on prostate cancer.
Other Treatments Lowering Hormone Levels
Even after the main hormone therapy, some cancer cells may still receive testosterone produced by other parts of the body. In such cases, doctors may use hormone synthesis inhibitors to block these additional hormone sources.
Doctors most commonly use these hormone synthesis blockers for advanced or treatment-resistant prostate cancer. These medications are often combined with a corticosteroid to help manage side effects and improve effectiveness. This approach is typically used when prostate cancer continues to grow or returns after standard hormone treatments.
Surgical Removal of the Testicles (Orchiectomy)
A surgeon removes the testicles through a small cut in the groin during orchiectomy. Numbing medicine is used, and both testicles are taken out during the same procedure.
This surgery is not common, but it quickly drops testosterone levels. Most people can go home the same day. As with other surgeries, patients may experience pain, bleeding, or infection.
Outcomes
Regular checkups are important during hormone therapy for prostate cancer. Doctors use blood tests and health checks to monitor progress and adjust treatment as needed. These visits help address side effects that may affect quality of life, such as loss of energy or changes in sexual health.
Key Points
- Lab tests track how well the cancer responds.
- Doctors review quality of life at each visit.
- Doctors change treatment if there are problems.
