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Get the facts. And the help you need.

For more information on Prostate Cancer please view our Localized Prostate Cancer: Patient Guide.

Hormone Therapy for Prostate Cancer

Hormone therapy for prostate cancer is the term used to describe the application of a number of pharmacologic agents (drugs) to reduce testosterone in the male to very low levels. But how can decreasing the activity of natural androgens—sex hormones like testosterone—curb symptoms or even shrink a tumor? The summary below should help explain how hormonal therapy can control localized prostate cancer tumors and even control those that have spread to other parts of the body.

What are androgens?
Androgens is the term used to describe a group of male sex hormones responsible for characteristics such as facial hair, a deepened voice and increased muscle bulk. They come from two sources: the testicles (accounting for 90 to 95 percent of the male hormones) and the adrenal glands that produce several other androgens (accounting for 5 to 10 percent of male hormones).

Testosterone is the most potent of these androgens. It is the product of a controlled process that begins when the hypothalamus, a cherry-sized control mechanism in the brain, releases a substance called luteinizing hormone-releasing hormone (LH-RH). It, in turn, stimulates the pituitary gland, also located in the brain, to manufacture and secrete luteinizing hormone (LH). Lutinizing hormone activates the testicles to produce testosterone.

What causes prostate cancer?
The prostate may be no bigger than a walnut, but it is a major male sex gland. It facilitates reproduction along with another sex gland, the seminal vesicles, by providing the fluid necessary for successful transport of sperm from the testicle to the urethra via a tube system called the ejaculatory duct.

Prostate cancer occurs when abnormal cells, supported by male hormones such as testosterone, begin to grow uncontrollably to form tumors. Since prostate cancer frequently produces no symptoms in its earliest stages, a man may only become aware of the cancer during routine screening. The tumor eventually interferes with normal bladder and sexual function, producing both ejaculatory and urinary problems.

Diagnosis can be made using any or all of a variety of tests: digital rectal examination (DRE), prostate-specific antigen (PSA), biopsy, X-ray and other imaging techniques such as transrectal ultrasound and CT scan. But the most important and productive methods for early detection are the prostate exam (DRE) and the PSA blood test . As men age, the risk for prostate cancer increases. Other known risk factors are African-American ancestry and a family history of prostate cancer.

What is hormone therapy for prostate cancer?
If detected early, prostate cancer is curable. Treatment options are based on the stage and grade of the disease. Surgical removal and radiation treatment are the most frequently applied therapies. The decision for one or the other involves a thorough discussion of the pros and cons of each. When the prostate cancer is more advanced, and has spread to other parts of the body, treatment includes reducing the testosterone (male hormone) that supports the prostate and its tumors. Hormone therapy reduces symptoms and prevents further growth. While hormonal manipulation causes prostate cancer to shrink in 85 to 90 percent of a prostate cancer patients, total and durable eradication of disease is unlikely.

Scientists believe that prostate cancer contains genetically different cells, some of which may respond to hormone deprivation, while others do not. It is those androgen-insensitive cells that scientists believe eventually grow, reproduce and ultimately cause disease progression. The good news is that hormone therapy may control prostate cancer for many years.

Hormone therapy, or as it is sometimes called androgen deprivation is achieved by either surgery or medication. Testosterone can be reduced by removing the testes the operation is called a bilateral orchiectomy. It involves surgically opening the scrotum, and freeing blood vessels and nerves before cutting the testicles away from surrounding tissue. The other commonly used option, however, is chemical castration—injecting synthetic LH-RH analogs every three to four months to suppress the natural production of testosterone.

An additional option focuses on interfering with the effects of both adrenal hormones and testicular testosterone. Referred to as complete androgen blockade (CAB), this treatment choice combines an orchiectomy or LH-RH analogist with anti-androgens. Anti-androgens block the effects of adrenal gland hormones as well as testicular androgens by interfering with a receptor in the nucleus of the prostate cancer cell. These medications include flutamide, bicalutamide and nilutamide. Some urologists add a third drug, finasteride, which blocks the conversion of testosterone to a more potent androgen, dihydrosterstosterone (DHT). In doing so, it deprives the cancer cells of an element needed for growth. Using a number of medications, attempts to nullify as much as possible all male hormone affect on prostate cancer cells.

How effective is hormone therapy for prostate cancer?
While scientists and urologists agree on many aspects of hormone deprivation in the treatment of prostate cancer, there is still controversy concerning when and how to use these options. For instance, research continues in the debate over:

Monotherapy vs. complete androgen blockade (CAB): CAB has not yielded dramatic increases in survival for advanced prostate cancer but there is evidence that it may be more advantageous than monotherapy. This should be discussed between the patient and his urologist.

Early vs. late hormonal deprivation: Research has not provided a clear indication that early, compared to delayed, hormonal therapy improves survival. There is little argument, however, that a person with prostate cancer that has distant spread (e.g. to their bones) should be treated promptly to prevent potentially crippling effects like bone fractures and spinal cord paralysis. There is also evidence that prostate cancer patients whose disease has spread to the lymph nodes will encounter prolonged progressive-free survival and a better quality of life with early hormonal therapy. In fact, research suggests that men suffering from prostate cancer that has spread without symptoms experience fewer serious complications if they undergo hormonal therapy earlier, rather than later.

Continuous vs. intermittent androgen deprivation: The current hormonal therapy standard of care is, once initiated, to continue hormone therapy for life. In fact, most physicians prescribe testosterone-suppressing therapy even after other second-line hormonal agents or chemotherapies are introduced. Recent research has focused on intermittent androgen deprivation (IAD). Alternating cycles of hormone therapy possibly inhibit the molecular pathways that allow cells to escape or modal control. The idea is that by stopping and starting therapy, IAD delays that transformation and may improve quality of life. But until a large current randomized National Cancer Institute trial yields its findings, scientists will not know which method of administration offers patients the best survival with the least complications—IAD or continuous hormonal therapy.

What can be expected after hormone therapy for prostate cancer?
While hormonal therapy can put your cancer in check, there are unpleasant side effects: nausea and vomiting, hot flashes, anemia, lethargy, osteoporosis, swollen and tender breasts and erectile dysfunction.

Also, if your cancer is resistant to hormonal treatments, your doctor may order chemotherapy, which consists of single drugs or a cocktail of several medications aimed at killing the cancer cells, even though this regimen causes numerous side effects.

Evidence indicates that hormonal treatment when combined with radiation increases survival duration.

Frequently asked question:

Can prostate cancer be cured with hormonal therapy?

The future is bright with regard to new agents that can deliver hormone therapy more effectively. A number of agents are now being tested in clinical trials and soon will be positioned for FDA approval. They are more reliable and reducing the effect of androgens in the blood and tissue and do so with few added side effects.

Where can I get more information?

Know Your Stats About Prostate Cancer Treatment Options: Hormonal Therapy

Hormone Health Network's Osteoporosis and Men's Health Fact Sheet

Reviewed January 2011

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Prostate Cancer: Hormone Therapy Glossary
  • adrenal: Glands that reside above the kidneys composed of an inner medulla and an outer cortex.

  • adrenal gland: One of a pair of small glands, each of which sits on top of one of the kidneys. These glands produce hormones that help control heart rate, blood pressure, the way the body uses food and other vital functions.

  • androgen: Male sex hormone.

  • anemia: The condition of having too few red blood cells to carry oxygen throughout the body. People with anemia may be tired and pale, experience shortness of breath and/or may feel their heartbeat change. Anemia is common in people with chronic renal failure or those on dialysis.

  • anti-androgen: Hormonal therapy drug that works by attaching itself to proteins on the surface of the cancer cell and blocking testosterone from entering the cancer cell.

  • bilateral: Term describing a condition that affects both sides of the body or two paired organs.

  • biopsy: A procedure in which a tiny piece of a body part (tissue sample), such as the kidney or bladder, is removed (with a needle or during surgery) for examination under a microscope; to determine if cancer or other abnormal cells are present.

  • bladder: The bladder is a thick muscular balloon-shaped pouch in which urine is stored before being discharged through the urethra.

  • cancer: An abnormal growth that can invade nearby structures and spread to other parts of the body and may be a threat to life.

  • chemotherapies: Treatments with medication that kills cancer cells or stops them from spreading.

  • chemotherapy: Treatment with medications that kill cancer cells or stop them from spreading.

  • clinical trials: Clinical trials are researcher studies that test how well new medical approaches work in people. Each study answers scientific questions and tries to find better ways to prevent, screen for, diagnose or treat a disease. Clinical trials may also compare a new treatment to a treatment that is already available. www.clinicaltrials.gov

  • CT scan: Also known as computerized tomography, computerized axial tomography or CT scan. A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images of the body. Shows detailed images of any part of the body, including bones, muscles, fat and organs. CT scans are more detailed than general X-rays.

  • digital rectal examination: Also known as DRE. Insertion of a gloved, lubricated finger into the rectum to feel the prostate and check for any abnormalities.

  • DRE: Also known as digital rectal examination. Insertion of a gloved, lubricated finger into the rectum to feel the prostate and check for any abnormalities.

  • ejaculatory: Involved in or related to the structure involved in the release of semen from the penis during orgasm.

  • ejaculatory duct: The passage through which semen enters the urethra.

  • erectile: Capable of filling with blood under pressure, swelling and becoming stiff.

  • erectile dysfunction: Also known as ED or impotence. The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence.

  • erectile dysfunction: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence.

  • FDA: Food and Drug Administration.

  • gene: The basic unit capable of transmitting characteristics from one generation to the next.

  • genetic: Relating to the origin of something.

  • gland: A mass of cells or an organ that removes substances from the bloodstream and excretes them or secretes them back into the blood with a specific physiological purpose.

  • hormonal therapy: Treatments that add, block or remove hormones.

  • hormone: A natural chemical produced in one part of the body and released into the blood to trigger or regulate particular functions of the body. Antidiuretic hormone tells the kidneys to slow down urine production.

  • hormone therapy: Treatment that adds, blocks or removes hormones.

  • hypothalamus: The area of the brain that controls body temperature, hunger and thirst.

  • IAD: Also known as intermittent androgen deprivation. Irregular hormone therapy as a treatment for prostate cancer.

  • intermittent androgen deprivation: Also known as IAD. Irregular hormone therapy as a treatment for prostate cancer.

  • ions: Electrically charged atoms.

  • LH-RH: Luteinizing Hormone Releasing Hormone. A drug that blocks the production of testosterone by the testicles.

  • liver: A large, vital organ that secretes bile, stores and filters blood, and takes part in many metabolic functions, for example, the conversion of sugars into glycogen. The liver is reddish-brown, multilobed, and in humans is located in the upper right part of the abdominal cavity.

  • lymph: Fluid containing white cells. It can transport bacteria, viruses and cancer cells.

  • lymph nodes: Small rounded masses of tissue distributed along the lymphatic system most prominently in the armpit, neck and groin areas. Lymph nodes produce special cells that help fight off foreign agents invading the body. Lymph nodes also act as traps for infectious agents.

  • nucleus: Central part of a living cell.

  • orchiectomy: The surgical removal of one or both testicles.

  • osteoporosis: A disease occurring among women after menopause or in men on hormonal therapy for prostate cancer in which the bones become very porous, break easily and heal slowly. Found in patients with Cushing's syndrome.

  • pharmacologic: Reaction to drugs.

  • pituitary: Relating to or produced by the pituitary gland.

  • pituitary gland: The main endocrine gland. It is a small oval shaped structure in the head and it regulates growth, sexual maturing and metabolism.

  • prostate: A walnut-shaped gland in men that surrounds the urethra at the neck of the bladder. The prostate supplies fluid that goes into semen.

  • prostate-specific antigen: Also referred to as PSA. A protein made only by the prostate gland. High levels of PSA in the blood may be a sign of prostate cancer.

  • PSA: Also referred to as prostate-specific antigen. A protein made only by the prostate gland. High levels of PSA in the blood may be a sign of prostate cancer.

  • radiation: Also referred to as radiotherapy. X-rays or radioactive substances used in treatment of cancer.

  • receptor: A nerve ending that is sensitive to stimuli and can convert them into nerve impulses.

  • rectal: Relating to, involving or in the rectum.

  • rectal ultrasound: A diagnostic test that uses very high frequency sound waves to produce an image of the rectum.

  • renal: Pertaining to the kidneys.

  • scrotum: Also referred to as the scrotal sac. The sac of tissue that hangs below the penis and contains the testicles.

  • seminal vesicle: Two pouch-like glands behind the bladder. They produce a sugar-rich fluid called fructose that provides sperm with a source of energy that helps sperm move. The fluid of the seminal vesicles makes up most of the volume of a man's ejaculatory fluid, or ejaculate.

  • sperm: Also referred to as spermatozoa. Male germ cells (gametes or reproductive cells) that are produced by the testicles and that are capable of fertilizing the female partner's eggs. Cells resemble tadpoles if seen by the naked eye.

  • stage: Classification of the progress of a disease.

  • testes: Also known as testicles. Paired, egg-shaped glands contained in a pouch (scrotum) below the penis. They produce sperm and the male hormone testosterone.

  • testicle: Also known as testis. Either of the paired, egg-shaped glands contained in a pouch (scrotum) below the penis. They produce sperm and the male hormone testosterone.

  • testicular: Relating to the testicle (testis).

  • testosterone: Male hormone responsible for sexual desire and for regulating a number of body functions.

  • tissue: Group of cells in an organism that are similar in form and function.

  • transrectal ultrasound: Also referred to as TRUS. This is a special kind of ultrasound test in which the sound waves are produced by a probe inserted into the rectum. In men, the structures most commonly examined with this test are the prostate, bladder, seminal vesicles and ejaculatory ducts.

  • tumor: An abnormal mass of tissue or growth of cells.

  • ultrasound: Also referred to as a sonogram. A technique that bounces painless sound waves off organs to create an image of their structure to detect abnormalities.

  • urethra: A tube that carries urine from the bladder to the outside of the body. In males, the urethra serves as the channel through which semen is ejaculated and it extends from the bladder to the tip of the penis. In females, the urethra is much shorter than in males.

  • urge: Strong desire to urinate.

  • urinary: Relating to urine.

  • urinary problems: Abnormal urination patterns or bladder habits, including wetting, dribbling and other urination control problems.

  • urologist: A doctor who specializes in diseases of the male and female urinary systems and the male reproductive system. Click here to learn more about urologists. (Download the free Acrobat reader.)

  • urology: Branch of medicine concerned with the urinary tract in males and females and with the genital tract and reproductive system of males.

Prostate Cancer: Hormone Therapy Anatomical Drawings

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