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Hormone therapy for prostate cancer
By Mayo Clinic staffMale sex hormones (androgens) stimulate the growth of prostate cancer cells. The main type of androgen is testosterone. Hormone therapy may stop your body from producing testosterone or block testosterone from entering cancer cells. Hormone therapy on its own doesn't get rid of cancer. That is, simply depriving prostate cancer of testosterone usually doesn't kill all of the cancer cells.
Three methods of hormone therapy are:
- Luteinizing hormone-releasing hormone (LH-RH) agonists
- Anti-androgens
- Testicle removal (also called orchiectomy and castration)
The first two options are temporary. The surgical removal of the testicles is permanent and irreversible.
Luteinizing hormone-releasing hormone (LH-RH) agonists
LH-RH agonists stop the testicles from producing testosterone. They do this by preventing the pituitary gland from releasing hormones that stimulate the production of testosterone from the testicles. Drugs typically used in this type of hormone therapy include leuprolide (Lupron, Eligard), goserelin (Zoladex) and triptorelin (Trelstar). These medications are injected into your buttocks (leuprolide) or abdomen (goserelin) monthly, every three or four months or once a year, depending on the type of injection you get.
Anti-androgens
These drugs block the prostate cancer cells' ability to use testosterone and are given in pill form. A small amount of testosterone comes from the adrenal glands and won't be suppressed by LH-RH agonists, and these drugs are useful to block this adrenal testosterone. Drugs typically used for this type of therapy include bicalutamide (Casodex) and nilutamide (Nilandron). These drugs are usually used to treat cancer that has spread beyond the prostate.
Testicle removal
In this procedure, testicles are removed and the scrotum is left intact. Men sometimes opt for surgery to insert testicle-shaped prostheses. This procedure permanently removes the source of about 90 percent of testosterone production in the body, which comes from the testicles (about 10 percent of testosterone comes from the adrenal glands).
Surgical removal of the testicles may be the best treatment for men who want a permanent procedure to reduce their testosterone level. It is much less expensive than LH-RH or anti-androgen therapy.
Specialized approaches to hormone therapy
- Intermittent therapy. Within a few years, your cancer may become resistant to androgen deprivation therapy. Once this happens, your doctor may suggest other forms of treatment. In some people, intermittent hormonal drug therapy may be considered. During this type of therapy, the hormonal drugs are stopped after your PSA drops to a low level and remains steady. The drugs are resumed if and when your PSA level rises again. This allows a break from the side effects of hormone treatment. Studies are being done to compare how well intermittent hormonal treatment works vs. continuous treatment.
- Combined therapy. In men with more aggressive prostate cancer (higher stage or higher grade), temporary hormone therapy using injections or oral drugs may be used in combination with radical prostatectomy or radiation. One type of hormone therapy (neoadjuvant) shrinks large tumors so that surgery or radiation can remove or destroy them more easily. And after these treatments, adjuvant hormone therapy can reduce or stop the growth of any cells left behind at the tumor site.
