Prostate Cancer is one of the most prevalent cancers in men and affects majority of the men post the age of 50 yrs. Testosterone is the male hormone that is produced by the testicles and the adrenal glands that control the growth and the development of the prostate. Cancer of the prostate gland depends on the testosterone to grow. The risk of early prostate cancer recurring after treatment can be minimised by lowering the amount of testosterone in the body. If the testosterone is taken away from the body, even the advanced cancer will shrink and slow its growth. Hormone therapy is a sought after treatment for advanced prostate cancer. It is used as an adjunct after surgery, for men who chose not to have other therapies and for men who can’t be treated with other therapies. In an interview with us Dr RN Tagore, Sr Consultant Medical Oncology, Paras Cancer Centre, shares the importance of hormone therapy as treatment for prostate cancer. Paras Cancer Centre is the first and premier centre in Bihar offering comprehensive cancer care & bone marrow transplant.
Q. When to opt for hormone therapy for prostate cancer?
The timing of the hormone therapy depends on the stage and the grade of the cancer. Patient who are low risk and have early prostate cancer that can be cured with radiotherapy or surgery don’t need any hormone therapy. Hormone therapy is given in combination with radiotherapy if the cancer has grown through the covering of the prostate (stage 3) or if the patient has very high prostate specific antigen (PSA level) or on diagnosis if high Gleason score or positive surgical margins following radical prostatectomy. The treatment lasts between 3 months and 3 years depending upon the above factors and side effects of the treatment. Hormone therapy is also combined with chemotherapy drugs if the cancer has spread to other parts of the body or has grown too far into the tissue and around the prostate gland to be successfully treated with surgery or radiotherapy.
Q. What are the types of hormone therapy recommended for prostate cancer patients?
There are three main types of hormone therapy. The treatment will depend on the stage of the cancer, other treatments, patient’s condition and preferences. A patient can be treated with more than one type of hormone therapy at the same time known as CAB(Complete Androgen Block)/ ADT(Androgen deprivation therapy). Dose of injectable(IM/SC) was given at interval of monthly/ three monthly/ six monthly depends upon strength of drug. To prevent the surge of testosterone “Orchidectomy” can be also done and in this operation-usually removal of the both testicles, or the part of the testicles . Surgery is an effective tool to reduce the testosterone levels. There is no need to take regular injections. However it is irreversible and hamper loss of libido, hence it is usually offered to men who need long term hormone therapy but now a days hormone therapy is preferred mode of treatment than orchidectomy and it is scientifically proved by medical research.Injections to stop testicles making testosterone
These work by stopping the message from the brain that tell the testicles to make testosterone. LHRH(Luteinizing Hormone – Releasing Hormone) agonists are more commonly used. GnRH (Gonadotrophin – releasing hormone) antagonists are used but less often.
Q. How do you check if the hormone therapy is working?
Regular blood tests are done to check the levels of prostate specific antigen (PSA), a protein made by normal and cancerous prostate cells. We can say the hormone therapy is working if the levels of PSA stays stable or goes down. But if the prostate cancer cells are starting to grow and develop, the level of PSA may go up. Hormone therapy is effective however by itself, it can’t cure cancer, but it can control it, for many years.
Q. What are the side effects of hormone therapy?
All medications have some side effect or the other. Hormone therapy produces hot flushes, weakness, bony pains, bone thinness, mood swings, erectile dysfunction or breast pain. All side effects are temporary and reversible. They can be managed and treated.