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Hormonal Therapy for Prostate Cancer

Posted Aug 24 2008 1:49pm
ANNOUNCER: Prostate cancer is the second leading cause of cancer death in the U.S. Treatment options include surgery to remove the tumor and radiation therapy to kill the cancer cells. But because most prostate cancers depend on male hormones, to grow and spread, hormonal therapy is commonly used.

DEREK RAGHAVAN MD PHD: Prostate cancer is driven by a male hormone, or a male chemical called testosterone. We know for example that if males are for some reason castrated before puberty, they just don't develop prostate cancer. If you remove testosterone from the body, then prostate cancer, primary tumors and metastases will shrink.

You can remove testosterone in one of three or four different ways. These days, the commonest way is to use a type of medication called an LHRH agonist. It's a complex term, and what it basically is, is this is the medication that interferes with the brain's production of triggers that cause testosterone to be made in the testicles.

ANNOUNCER: The LHRH agonists commonly used are Zoladex and Lupron. They are given as injections every 1 to 4 months. Another treatment Viadur is an implant inserted for 12 months. The use of these drugs is sometimes called medical castration. But there is also a surgical option in hormonal therapy.

DEREK RAGHAVAN MD PHD: Another option is what was used from about 1900 commonly to 1960 or 1970 and still is occasionally used today, and that is an operation to remove the testicles. What is called a bilateral orchiectomy, or removal of both testicles.

ANNOUNCER: This procedure decreases testosterone levels in the body. However because a small amount of testosterone is also made by the adrenal glands, doctors also use drugs called, anti-androgens or peripheral blockers.

DEREK RAGHAVAN MD PHD: What they are, are chemicals that get into the blood and stop testosterone from getting into prostate cells. They actually block the part of the prostate cell that allows testosterone to enter. It's called a receptor.

ANNOUNCER: These treatments, usually oral medicines, are used in combination with medical or surgical castration to completely block testosterone activity. This is called combined androgen blockage. And there is yet another option that is used less frequently.

DEREK RAGHAVAN MD PHD: A third possibility it to use feminizing hormones. So agents or drugs such as the estrogens can be given to men. And because of complex chemical reasons, they basically trick the body into discontinuing the production of testosterone. The problem with using estrogens is they have some really quite unpleasant side effects. They give many men big breasts. They also give the risk of an increased chance of getting a stroke or a coronary. So we're very careful in the use of those agents.

ANNOUNCER: All of these treatments can possibly cause side effects that range from hot flashes, nausea, and body pain, to fatigue and a decrease in sexual desire. But whatever course of treatment is chosen, those living with prostate cancer have several options to discuss with their doctor.

DEREK RAGHAVAN MD PHD: The question of what advice, globally to give to a patient with prostate cancer is a tough one. I think the simplest answer is to be well informed. Today there are so many advances in the management of prostate cancer. And there's actually a lot of information available to patients.

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