Why and for whom

Hormones called androgens (which include testosterone and DHT) contribute to the growth of prostate cancer cells. Hormone therapy is used to fight prostate cancer. It works by preventing your body from secreting or using these hormones, which slows down the growth and spread of your cancer. Hormone therapy treats your whole body rather than just targeting your prostate.

Hormone therapy can be administered

• As the primary treatment for advanced or recurrent prostate cancer.
• Before, during, or after radiotherapy in cases of high-risk prostate cancer and in certain cases of intermediate-risk cancer.
• To relieve pain or manage symptoms of advanced prostate cancer (palliative treatment).

The most frequently used approaches and modalities

• Injectable medications that block testosterone production by the testicles.
• Oral medications that prevent prostate cancer cells from using testosterone or reduce the amount of testosterone that prostate cancer can use for growth.
• An intervention that involves removing the testicles, which produce the majority of testosterone in the body (to maintain appearance, artificial testicles may be inserted during the procedure).

Although these treatments can help relieve your symptoms, they do not lead to a cure. However, since they act on your whole body, they can help slow down the growth of your cancer, regardless of which parts of the body the cancer cells have spread to.

Is it for you

Hormone therapy aims to lower the amount of androgens (male hormones) circulating in your body and to slow down the growth of your prostate cancer. It achieves this by blocking testosterone production or blocking signals from your brain that instruct the testicles and adrenal glands (hormone secretors) to produce testosterone.

Male hormones are called androgens. Testosterone, the hormone responsible for the development of male sexual characteristics, is produced mainly by your testicles and to a lesser extent by your adrenal glands.

Testosterone stimulates the growth of your prostate. Cancer cells that can develop in your prostate are also stimulated by your testosterone to grow.

Hormone therapy is mainly used when initial treatments fail, including radical prostatectomy or radiotherapy.

Hormone therapy is also useful when a patient cannot undergo surgery or radiotherapy or refuses to undergo them. Occasionally, it may be combined with another treatment, such as radiotherapy.

Who can have hormone therapy?

• Men whose cancer has returned after another type of treatment (e.g., radiotherapy or surgery) or whose risk of cancer returning after these treatments is high.
• Men who do not qualify for surgery, radiotherapy, or brachytherapy.
• Men whose prostate cancer has spread outside the prostate and invaded other parts of the body (N1 or M1 stage).
• Men with very advanced cancer, as a way to control it and manage symptoms.

Neoadjuvant Hormone Therapy (before treatment)

Hormone therapy may be recommended a few months before your external radiotherapy or brachytherapy to shrink your tumor. This makes it easier to irradiate. This is called “neoadjuvant hormone therapy.” Hormone therapy before radical prostatectomy is not recommended.

Adjuvant Hormone Therapy (after treatment)

Adjuvant” hormone therapy is administered after radiotherapy or after radical prostatectomy. The doctor uses it when (due to your grade, stage, and PSA level) cancer cells may be spread throughout your body.

This does not mean you have metastases, but there is a risk of recurrence if isolated cells, often undetectable, remain in your body. The duration will be 4 to 6 months for an intermediate risk of recurrence and 2 to 3 years for a high risk of recurrence.

The three main types

There are three main types of hormone therapy for prostate cancer.

• Injections or implants to stop your testosterone production
• Tablets to block the effects of testosterone
• Surgery, called orchidectomy, to remove your testicles

The most frequently used types of hormone therapy in the treatment of prostate cancer are:

• Luteinizing hormone-releasing hormone (LH-RH) analogs
• Luteinizing hormone-releasing hormone (LH-RH) antagonists
• Anti-androgens
• Estrogens
• Surgical removal of the testicles (orchidectomy)

LH-RH Analogues (or antagonists)

For hormone therapy before or after your treatment, the doctor mainly administers LH-RH analogs (or antagonists).

These medications prevent your testicles from producing testosterone (which feeds prostate cancer). By stopping testosterone production, the size of your tumor and prostate is reduced.

How it’s administered

The medication is administered by regular injections. Depending on the medication, the injection may be given every month or every 3, 4, or 6 months. Depending on the situation, this treatment may be given continuously for the rest of your life or intermittently depending on your cancer’s response.

The most commonly used LH-RH analogs are:

• leuprolide (Lupron, Lupron Depot, Eligard)
• goserelin (Zoladex)
• buserelin (Suprefact)
• triptorelin (Trelstar)

The LH-RH antagonist is:

• degarelix (Firmagon)

Anti-androgens

Anti-androgens work by blocking the effects of testosterone on your prostate cancer cells. The medication binds to androgen receptors on your prostate cancer cells, preventing them from using the testosterone present in your bloodstream.

You may be given anti-androgens for a short period if you are taking LH-RH analogs to alleviate a tumor flare reaction caused by the analogs.

How it’s administered

Anti-androgens can be taken orally in tablet or liquid form.

• As monotherapy
• Before receiving injections or implants
• Simultaneously with injections or implants
• After surgery to remove the testicles (orchidectomy).

The most common types are:

• bicalutamide (Casodex)
• flutamide (Euflex)
• cyproterone acetate (Androcur)
• nilutamide (Anandron)

Estrogens

Estrogens are female hormones that lower androgen levels. They are no longer used due to the cardiovascular problems they caused.

Orchidectomy

Orchidectomy is a form of hormone therapy that involves removing the testicles. It is a radical treatment since testosterone concentration can decrease by 90 to 95%. This procedure is also known as “surgical castration.” It is performed under regional anesthesia as a day surgery.

The advantage of orchidectomy is that the treated man does not need frequent injections of medication. The disadvantage of orchidectomy is that most men are sometimes afraid that this procedure will diminish their masculinity.