Advanced Prostate Cancer

Hormone Therapy

Prostate cancer cells need male hormones called androgens, such as testosterone, to grow. Most testosterone is made in the testicles, but the adrenal glands also make small amounts of androgens. Hormone therapy, also called androgen-deprivation therapy, or ADT, blocks production of androgens, which in turn slows down the growth of the tumor. It is the principal treatment for advanced prostate cancer. Men with metastatic prostate cancer often receive long-term ADT, and some doctors suggest an intermittent schedule of ADT. With an intermittent schedule, treatment is given for 6-12 months to lower the PSA level, and then stopped, and is restarted when the PSA level rises to a predetermined level. If you choose intermittent therapy, your doctor will monitor you every 3-6 months for symptoms and rising PSA values.

ADT Options

ADT treatments include the use of luteinizing hormone-releasing hormone (LHRH) agonists, antiandrogens, other drugs, or surgical castration (Table 1). LHRH agonists are drugs that can prevent the testicles from making testosterone. This treatment is sometimes called medical castration. LHRH agonists are given as injections. Antiandrogens prevent the body from using testosterone and are given as a pill. Another drug, ketoconazole, may be used to prevent the adrenal glands from making testosterone.

Testosterone can also be stopped if the testicles are removed by surgery in a procedure called bilateral orchiectomy. Treatment with an LHRH agonist (medical castration) or with bilateral orchiectomy (surgical castration) is equally effective. Sometimes an antiandrogen drug is combined with either an LHRH agonist drug or surgical castration in a treatment strategy called combined androgen blockade (CAB) or total androgen blockade. CAB is intended to eliminate any androgens that remain in the body, but studies indicate it has no proven benefit over either method of castration alone in patients with metastatic disease, and there may also be an increase in potentially serious side effects.

Table 1. Hormone Therapy Options for Advanced Prostate Cancer

Side Effects of Hormone Therapy

Although ADT causes significant side effects, many are treatable and most go away once treatment is finished. Side effects from an orchiectomy, however, are permanent, including sterility. Men who receive long-term ADT often experience side effects that last more than a year after the drug is discontinued, and for some of these men, side effects may never go away. Be sure to let your doctor know of any symptoms you have during ADT.

Among the most common side effects of ADT are:

• Hot flashes or flushes
• Osteoporosis
• Impotence
• Loss of sex drive
• Weight gain
• Loss of muscle mass
• Fatigue
• Pain
• Mood changes
• Enlargement or tenderness of breasts

Uncommon side effects include diabetes, heart disease, and an increase in the cholesterol level. Tell your doctor immediately if you experience stomach pain, nausea, vomiting, extreme tiredness, loss of appetite, flu-like symptoms, dark yellow or brown urine, or yellowing of the skin or eyes.

Monitoring Response

If you receive ADT, your doctor will monitor how well the treatment is working for you at regular intervals. If the cancer is locally advanced, a yearly DRE is typical and a PSA test is done every 6-12 months. If the cancer has spread to lymph nodes or metastasized to other parts of the body, you will have a physical exam that includes a DRE and a PSA test every 3-6 months. Further studies will be used to determine if the cancer has spread if your PSA level doesn’t go down or even rises. These studies may include a bone scan, CT, MRI, ProstaScint scan, a PSADT test (the time it takes for the PSA to double), or a biopsy. The results of the tests will determine what your options are for further treatment. If you develop symptoms between doctor visits, be sure to let your doctor know immediately.

Questions about Hormone Therapy You May Want to Ask Your Doctor

• What are my options for hormone therapy and what do you recommend?
• What side effects can I expect?
• Will the side effects go away?
• How will treatment affect my sexual well-being and fertility?
• When will I begin treatment? How often will I have treatments? When will I finish treatment?
• How will I know if treatment is working?
• What can I do to take care of myself during treatment?
• How often will I need checkups?