Androgens encourage the growth of prostate cancer cells. Dihydrotestosterone (DHT) and testosterone are the body's primary androgens. The testicles produce the majority of androgen, but the adrenal glands and prostate cancer itself can also produce some. When androgen levels are decreased or prevented from entering prostate cancer cells, prostate cancer frequently grows more slowly for a time. But prostate cancer cannot be cured without hormone therapy. Â Children with Cancer
When does hormone therapy take place?
If your cancer has progressed to the point where surgery or radioactivity cannot cure it, or if you are unable to receive these treatments for any other reason.
if the cancer returns or remains after surgery or radiation therapy treatment.
In addition to radiation therapy as the initial treatment, if you are more likely to get cancer again after treatment.
Prior to using radiation to try to shrink cancer so that the type of treatment is more effective.
Prostate cancer can be treated with a few different kinds of hormone therapy.
Treatment for low androgen levels in the testicles Androgen deprivation therapy, also known as ADT, uses surgery or pills to lower all androgen levels in the testicles.
Orchiectomy, also known as surgical castration, is a type of surgery that primarily serves as hormone therapy. The surgeon removes the testicles, which are where the majority of androgens are produced, during this procedure. This causes the majority of prostate cancers to temporarily stop growing or shrink.
As a casualty procedure, this is done. It is probably the simplest and least expensive method of hormone therapy. However, unlike some of the other treatments, it is permanent, and many men find it difficult to accept having their testicles removed. As a result, they might choose a treatment that lowers hormone levels instead.
Some men who are undergoing this procedure are concerned about how it will look in the future. False testicles that resemble normal testicles can be implanted into the scrotum if desired.
LHRH agonists Drugs that reduce the amount of testosterone produced by the testicles are known as luteinizing hormone-releasing hormone (LHRH) agonists. Because they independently reduce androgen levels and perform orchiectomy, treatment with these medications is sometimes referred to as medical castration.
The testicles remain in place while taking these medications, but they will shrink over time and may even become insignificant to feel.
LHRH agonists can be injected or placed in the skin as small implants. They might be given once a month or once a year, depending on the medication. The following LHRH agonists are available in the United States:
Leuprolide (Lupron, Eligard); Zoladex; Trelstar; Histrelin (Vantas); Triptorelin (Trelstar); Histrelin (Vantas). When LHRH agonists are first prescribed, testosterone levels briefly rise before dropping to extremely low levels. This side effect, known as a flash, is caused by the complicated way these medicines work. Bone pain may occur in men with cancer that eats at the bones. It may be difficult for men whose prostate gland has not been removed to urinate. Even a brief increase in tumor growth as a result of the flare could mediate on the spinal cord and cause pain or paralysis if cancer has spread to the spine. After beginning treatment with LHRH agonists, philanthropic medications known as anti-androgens can prevent a flare for a few weeks.
LHRH antagonists Progressive prostate cancer can be treated with LHRH antagonists. The way these drugs work differs slightly from that of LHRH agonists, but they lower testosterone levels more quickly and do not flare tumors like LHRH agonists do. A medical castration can also be used to measure these drugs' treatment.
Degarelix (Firmagon) is injected under the skin once a month. There might be issues at the injection site for particular men.
Because Relugolix (Orgovyx) is taken as pills once daily, fewer visits to the doctor are necessary.
LHRH agonists and antagonists can stop the testicles from making androgens, but cells in other parts of the body, like the adrenal glands and prostate cancer cells, can still make male hormones that can fuel cancer growth. Treatment to lower androgen levels from the adrenal glands There are drugs available that prevent these cells from making androgens.
Abiraterone (Zytiga) prevents these cells from producing androgens by inhibiting an enzyme known as CYP17.
Abiraterone can be used to treat advanced prostate cancer in men who have one of two types:
Castrate-resistant (cancer that is still increasing despite low testosterone stages from an LHRH agonist, LHRH antagonist, or otherwise orchiectomy) This medication is taken as pills throughout the day. High risk (cancer with a high Gleason score, feast to several spots in the frames, or spread to additional organs). Men who have not had an orchiectomy must continue treatment with an LHRH agonist or antagonist because it does not stop the testicles from making testosterone. Prednisone, a corticosteroid, must be taken during treatment to avoid certain side effects because abiraterone also lowers the level of certain other hormones in the body.
Ketoconazole (Nizoral), which was first used to treat fungal infections, also stops the adrenal glands from making androgens like abiraterone. Because it offers a quick way to lower testosterone levels, it is most commonly used to treat men recently diagnosed with advanced prostate cancer who have a lot of cancer in their bodies. If no other hormone therapy is used, it may also be stretched out.
Men treated with ketoconazole frequently need to take a corticosteroid because it can also stop the body from making important steroid hormones like cortisol.
Effects that could occur: High blood pressure, cooperative or muscle pain, fluid retention, hot flashes, upset stomach, and diarrhea are all possible side effects of abiraterone. Ketoconazole can cause gynecomastia, nausea, vomiting, skin rash, and elevated liver blood tests.