Hormone therapy for prostate cancer: What you need to know

This is an automatically translated article.

Prostate cancer is a dangerous disease that threatens men's health, at severe levels, the disease can spread to other areas of the body, especially the bones and lymph nodes. There are now many different treatments for prostate cancer, among them hormone therapy - also known as systemic therapy, which is applied to cases where the cancer has spread beyond the prostate gland. paralysis.

1. What is hormone therapy in cancer treatment?

Hormone therapy in cancer treatment is a systemic therapy that works to add, block and remove hormones from the body, helping to slow or stop the growth of cancer cells. . This therapy is used to fight many different types of cancer that share the common feature of tumors that use hormones to grow.
Hormone therapy often uses drugs that stop cancer cells from growing into disease. Hormone therapy can be combined with other cancer treatments, such as surgery, chemotherapy, or radiation, to help reduce the risk of the cancer coming back. In addition, hormone therapy is often used before surgery to shrink tumors and make them easier to remove.

2. Hormone therapy in the treatment of prostate cancer

Hormone therapy for prostate cancer is also known as androgen suppression therapy (ADT) or androgen suppression therapy. The aim is to reduce the levels of male hormones, called androgens, in the body or to stop them from affecting prostate cancer cells.
Androgens stimulate prostate cancer cells to grow. The main androgens in the body are testosterone and dihydrotestosterone (DHT). Most androgens are made by the testicles, but the adrenal glands (glands located above your kidneys) also make small amounts. Reducing androgen levels or preventing them from entering prostate cancer cells often causes prostate cancer to shrink or grow more slowly for a while. However, hormone therapy alone does not cure prostate cancer.

3. When should hormone therapy be used?

Hormone therapy may be used in the following situations:
If the cancer has spread so far that you cannot be cured with surgery or radiation, or you cannot have these treatments because some other reasons. If cancer persists or comes back after treatment with surgery or radiotherapy, hormone therapy may be combined with radiation therapy if you have a higher risk of developing cancer after treatment (based on the extent of your cancer). PSA or cancer growth outside the prostate) Used before radiation therapy to shrink the cancer so that treatment is more effective

4. Types of hormone therapy in the treatment of prostate cancer

Several types of hormone therapy may be used to treat prostate cancer, including:
4.1 Treatments to reduce androgen levels Orchiectomy (surgical castration):

Although this is a type of surgery, its main effect is as a form of hormone therapy. In this surgery, the doctor removes the testicles where most of the androgens (testosterone and DHT) are made. This causes most prostate cancers to stop growing or shrink for a while.
This is probably the least expensive and simplest form of hormone therapy. But unlike some other treatments, it's a tough choice for people who have to accept a permanent orchiectomy. In this case, the doctor may use a normal-looking artificial testicle to insert into the scrotum.
LHRH agonists: LHRH stands for luteinizing hormone-releasing hormone, which are drugs that reduce the amount of testosterone produced by the testicles. Treatment with these drugs is sometimes called chemical castration or medical castration because they reduce androgen levels as well as remove the testicles.
Most men opt for this method, although LHRH agonists cost more than orchiectomy and require more frequent doctor visits. With these drugs, the testicles stay in place, but they shrink over time and they may even become too small to feel.
LHRH agonists are injected or placed as small implants under the skin. Depending on the medication used, they may be given once a month or once a year.
When LHRH agonists are first introduced, testosterone levels rise rapidly for a short time before dropping to very low levels. This effect is known as “flare”. Men with cancer that has spread to the bones may experience bone pain. If the cancer has spread to the spine, even a short-term increase in tumor caused by an outbreak can press on the spinal cord and cause pain or paralysis. Flare-ups can be avoided by using an anti-androgen for several weeks when initiating treatment with an LHRH agonist.
LHRH Antagonist: Degarelix (Firmagon) is an LHRH antagonist. It works like LHRH agonists, but it lowers testosterone levels more quickly and doesn't cause tumors like LHRH agonists do. Treatment with this drug may also be considered a form of medical castration.
This medicine is used to treat advanced prostate cancer. It is given as a monthly injection under the skin. The most common side effects that may be seen are problems at the injection site (pain, redness, and swelling) and increased liver enzyme levels in tests. Other side effects are discussed in detail below.
CYP17 Inhibitors: LHRH agonists and antagonists can stop the testes from making androgens, but other cells in the body, including prostate cancer cells, can still make one. Small amounts can promote cancer growth.
Abiraterone (Zytiga) blocks an enzyme called CYP17, which helps prevent these cells from making androgens. Abiraterone may be used in men with advanced prostate cancer:
High risk of cancer metastasizing to certain points in the bone or spreading to other organs Castrate resistant (cancer still growing) despite low testosterone levels from LHRH agonists, LHRH antagonists, or orchiectomy) Because abiraterone also reduces levels of certain other hormones in the body, prednisone (a type of drug corticosteroids) during treatment to avoid certain side effects.
4.2 Antiandrogens work Antiandrogens: Androgens must bind to a protein in prostate cells called the androgen receptor in order to work. Anti-androgen drugs include: bicalutamide (Casodex), flutamide (Eulexin), and nilutamide (Nilandron). They are taken in pill form.
An antiandrogen may be added to treatment if orchiectomy, an LHRH agonist or antagonist no longer works. It is also sometimes used for a few weeks when an LHRH agonist is first used to stop tumor outbreaks.
An anti-androgen may also be combined with orchiectomy or an LHRH agonist. This is called combined androgen blockade (CAB).
Enzalutamide (Xtandi) and apalutamide (Erleada): These are newer anti-androgen drugs. Normally when androgens bind to their receptor, the receptor sends a signal to the cell's control center to initiate growth and division. Enzalutamide (Xtandi) and apalutamide (Erleada) help block this signal. They are taken in pill form every day.
These drugs can often be helpful for men whose cancer is no longer responding to other forms of hormone therapy (called castrate-resistant prostate cancer). Enzalutamide can be used for metastatic cancer (cancer that has spread to other parts of the body), while apalutamide is more commonly used for non-metastatic cancer.

5. Side effects of hormone therapy

Orchiectomy, LHRH agonists, and antagonists can all cause similar side effects from lower levels of hormones like testosterone. These side effects may include:
Decreased or no sex drive

Erectile dysfunction (impotence) Contraction of testes and penis Hot flashes, sweating Feminization of male genital organs, manifested by breast tenderness and growth of breast tissues Osteoporosis, which can lead to fractures Anemia (low red blood cell count) Decreased morale Loss of muscle mass Weight gain Fatigue Increased cholesterol levels Depression Some studies have also shown an increased risk of high blood pressure, diabetes, stroke, heart attack, and heart attack. Even death from heart disease was higher in men treated with hormone therapy.
References: Cancer.org
MORE:
Hormone replacement therapy: Benefits and risks Menopausal hormone replacement therapy (HRT) Is prostate cancer curable?