| What are androgens? Androgens are 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). Stimulating sexual development while also strengthening muscle tone and bone mass, testosterone is the most potent androgen. 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 to manufacture and secrete luteinizing hormone (LH), the hormone that actually activates the testicles in producing testosterone. What causes prostate cancer? The prostate may be no bigger than a walnut, but it is a major male sex gland. Weighing just a few grams, it discharges substances into the semen as the seminal fluid passes through ejaculatory ducts connecting the seminal vesicles to the urethra. Prostate cancer occurs when abnormal cells, fueled by male hormones such as testosterone, grow uncontrollably to form tumors. Since it frequently produces no symptoms in its earliest stages, you may only become aware of the cancer during routine screening. But 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. What is hormone therapy for prostate cancer? If detected early, prostate cancer is curable. While treatment choices are still controversial, they are generally based on the stage of the disease. Surgical removal of the gland is used for early and confined tumors. Radiotherapy or small pellet radioactive implants (brachytherapy) is also used in patients with earlier stage prostate cancer or whose health makes surgery unacceptable. When the prostate cancer is advanced, spreading to other parts of the body, treatment shifts to reducing the testosterone (male hormone) that feeds the prostate and its tumors. By depleting it, hormone therapy reduces symptoms and prevents further growth. But while hormonal manipulation causes prostate cancer to shrink in 85 to 90 percent of advanced prostate cancer patients, it does not cure the disease. In addition, the effects only last between 24 and 36 months. Scientists believe the results are only short-lived because prostate cancer contains different genetically identical 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 death. The good news is that there is now evidence that hormonally sensitive cells may influence hormonally insensitive cells, decreasing their rate of progression. Androgen deprivation is usually achieved by either surgery or medication, in what is commonly referred to as monotherapy because one method is used. Testosterone can be reduced by removing the testes during a bilateral orchiectomy — 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 agonists (blocks an action) or antagonists (stimulates an action) into the body every three to four months to suppress the natural production of testosterone. A second option focuses on interfering with the effects of other adrenal hormones in addition to testicular testosterone. Referred to as complete androgen blockade (CAB), this treatment choice combines an orchiectomy or LH-RH antagonist with anti-androgens, drugs that block the effects of adrenal gland hormones by influencing 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. 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 patients. (At best, improvement is seven months.) But there is evidence that it may be more advantageous for patients with minimal disease, or those undergoing medical therapy. On the other hand, orchiectomy does not seem to benefit from adding the anti-androgen flutamide. 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 to continue the treatment until the disease progresses or ends in death. In fact, most physicians prescribetestosterone-suppressing monotherapy even after other second-line hormonal agents or chemotherapies are introduced. But recently, research has focused on intermittent androgen deprivation (IAD), irregular hormonal therapy to possibly inhibit the molecular pathways that allow cells to become cancerous. The idea is that by stopping and starting therapy, IAD delays that transformation and may even improve quality of life. But until a current randomized National Cancer Institute trial yields its findings, scientists will not know which 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. While preliminary evidence suggests that hormonal treatment may improve cure rates when combined with radiation or surgery, that theory is still under investigation. Frequently asked question: Can prostate cancer be cured with hormonal therapy? At this time, there is no evidence that prostate cancer is cured with hormonal therapy. Withdrawing androgens, however, can keep the disease from progressing and relieve symptoms. |