Hormonal Therapy

The Facts About Hormonal Therapy

Hormonal Therapy may be prescribed for patients as part of their treatment at Dattoli Cancer Center. Simply put, certain hormones have the ability to temporarily halt or slow the growth of prostate cancer, as well as to shrink the overall size of the gland. Men with enlarged prostates can benefit by reducing the size of the prostate gland, making it a smaller target for radiation treatment.

Many patients do not require hormones.

It has long been known that prostate cancer is to some extent dependent on and nourished by the male sex hormone, testosterone. This is one of a group of hormones known as androgens. Since testosterone stimulates the growth of prostate cancer cells, depleting or ablating the body’s testosterone tends to shrink the size of many tumors, specifically those that are hormone-sensitive. The goal of hormonal therapy is to decrease the production of testosterone in the body, inhibiting the growth and progression of the cancer. Hormonal therapy, also known as Androgen Ablation Therapy (ADT), can shrink a man’s prostate by as much as 50%. Hormones have also been shown to have a synergistic effect when combined with radiation, making cancer cells more sensitive to radiation therapy (known as “radiosensitization”).

Hormonal treatment can be optional for patients with intermediate risk disease but is generally encouraged for patients with high risk features, as indicated by PSA, Gleason score, the PAP test and clinical stage. With the low-risk or mildly aggressive cancers, unless the size of the gland is markedly large, we don’t normally give the conventional hormonal therapy in order to avoid the side-effects of the hormones.

In these select cases a modified version of hormones, which do not reduce testosterone, but rather act as blocking agents (e.g. oral anti-androgens), are utilized thus not allowing the testosterone to bind with the prostate cancer cells’ receptors. Other non-hormonal agents that may also be utilized are oral agents (e.g. 5 alpha-reductase inhibitors) which do not allow testosterone to convert to dihydrotestosterone (DHT), a metabolite which is 10 times as potent as testosterone in stimulating prostate cancer growth. This type of hormonal therapy is just enough to arrest the cancer and allow the patient to make a more relaxed decision about treatment, without the potential side effects associated with formal ADT, that is, a combined hormonal blockade that uses two or more agents.

While often combined with primary therapies including radiation for treating early stage prostate cancer, hormonal therapy is a standard treatment for patients whose cancer has spread beyond the prostate gland. ADT is the first-line treatment of choice for patients with advanced, late stage disease. If, after radiation or surgery or any other other primary curative treatment, the patient experiences a recurrence as indicated by a rising PSA (biochemical failure) or a positive biopsy, hormonal therapy is likely to be prescribed. The same holds true for patients initially diagnosed with advanced prostate cancer who are not candidates for primary therapy. In these cases, hormonal therapy is considered a palliative rather than curative treatment.