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Patients who want to pursue any type of hormone therapy
should take the following into account:
- Not all hormone therapies are
the same; there are different side effects that occur
with each
- Patients with bone metastasis
should not take LHRH agonists
- Hormone therapy does not destroy
prostate
cancer, but controls the growth for a period of
time
Patients who want to consider hormone
therapy as adjuvant
or neoadjuvant therapy
should speak with their doctors about which
one is right for them. Patients with recurrent prostate
cancer who want to pursue monotherapy
alone should also speak with their doctors. Read on
to see when hormone therapy is most often used.
Neoadjuvant
Hormone Therapy
Hormone therapy does not cure prostate cancer, but androgen
ablation can be a useful way to augment
another therapy or to control the growth of prostate
cancer. When hormone therapy is given as primary treatment,
hormone therapy is usually referred to as a neoadjuvant
prostate cancer treatment. Neoadjuvant refers to a “pre-therapy”
that is given before the main therapy. Before most other
prostate cancer treatments, hormone therapy is given
to shrink the prostate gland and make the main therapy
more effective.
Noninvasive procedures such as brachytherapy
and cryotherapy
are not as effective when administered to a prostate
gland that has a high volume. In most cases, implanting
seeds or creating effective ice balls may not be feasible
due to the size of the gland. An enlarged prostate gland
increases the likelihood of the pubic
arch interfering with the needles.
During prostatectomy,
an enlarged prostate gland may cause a surgeon to miss
a piece of the prostate gland, which increases the likelihood
of recurrence. In external
beam radiation therapy, an enlarged prostate gland
gives a bigger “target,” but increases the
likelihood that healthy organs and tissue will be damaged
by radioactive energy.
Prostate Cancer Salvage Therapy
When primary treatment fails to eliminate all of a patient’s
prostate cancer, hormone therapy may be used as salvage
therapy. Hormone therapy may be used as adjuvant for
another salvage therapy. Adjuvant means that a therapy
is used to enhance the effectiveness of another treatment.
Patients preparing to undergo cryotherapy after radiotherapy
fails, will sometimes take hormone therapy, specifically
an anti-androgen. The anti-androgen will shrink
the prostate gland enough to give the surgeon a few
millimeters to avoid damaging the rectum.
Recurrent Prostate Cancer
Patients who have undergone therapy but are now seeing
their PSA
levels begin to rise or whose doctors
find irregularities in their DRE’s may find that
they have recurrent prostate cancer. Hormone therapy
will not cure the disease, but, for a time, hormone
therapy can halt or dramatically slow the growth and
the spread of the tumor. When treatment stops working,
the disease is called hormone
refractory prostate cancer.
Prostate Cancer Bone Metastasis
Patients who have distant bone metastasis associated
with the advanced stages of prostate cancer cannot take
LHRH agonists due to a phenomenon called hormone flare.
Hormone flare is sometimes called tumor flare, and occurs
when the level of testosterone spikes for a period of
7 to 10 days after beginning the agonist. Flare can
be extremely dangerous for patients with bone metastasis.
Some men may also be eligible for combined hormone blockade in which 100% of the body's androgens (produced in both the testicles and the adrenal glands) are blocked. LHRH antagonists do not cause hormone flare,
but these drugs are less often prescribed because they
can cause a severe allergic reaction in some men.
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