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Prostate cancer cells are like other living organisms—they need fuel to grow and survive. Because the hormone testosterone serves as the main fuel for prostate cancer cell growth, it’s a common target for therapeutic intervention in men with the disease.

Hormone therapy, also known as androgen-deprivation therapy or ADT, is designed to stop testosterone from being released or to prevent it from acting on the prostate cells. Although hormone therapy plays an important role in men with advancing prostate cancer, it is increasingly being used before, during, or after local treatment as well.

The majority of cells in prostate cancer tumors respond to the removal of testosterone. But some cells grow independent of testosterone and remain unaffected by hormone therapy. As these hormone-independent cells continue to grow unchecked, hormone therapies have less and less of an effect on the growth of the tumor over time.

For this reason, hormone therapy is not a perfect strategy in the fight against prostate cancer, and it does not cure the disease. It also carries some unwanted toxicities. But it remains an important step in the process of managing advancing disease, and it will likely be a part of every man’s therapeutic regimen at some point during his fight against recurrent or advanced prostate cancer.

Types of Hormone Therapy

The most common types of hormone therapy are described below. Although each option is effective at controlling prostate cancer growth, the loss of testosterone confers significant side effects in nearly all men. These side effects range from hot flashes and loss of bone density to mood swings, weight gain, and erectile dysfunction. Learn more about the side effects of hormone therapy—and how to manage or minimize them.

Orchiectomy—About 90% of testosterone is produced by the testicles. So orchiectomy—the surgical removal of the testicles—is an effective solution to blocking testosterone release. This approach has been used successfully since the 1940s. Because it’s permanent and irreversible, most men opt for drug therapy instead.

For those who choose this option, the procedure is typically done on an outpatient basis in the urologist’s office. Recovery tends to be rather quick and no further hormone therapy is needed, making it a very attractive choice for someone who prefers a low-cost, one-time procedure.

LHRH Agonists—LHRH, or luteinizing-hormone releasing hormone, is one of the key hormones released by the body before testosterone is produced. (Note that LHRH is sometimes called GnRH, or gonadotropin-releasing hormone.)

Blocking the release of LHRH through the use of LHRH agonists or LHRH analogues is one of the most common hormone therapies used in men with prostate cancer. Drugs in this class, including leuprolide (Eligard, Lupron, and Viadur), goserelin (Zoladex), and triptorelin (Trelstar), are given in the form of regular shots: once a month, once every three, four, or six months, or once per year.

LHRH Antagonists—A newer class of medications can block LHRH (GnRH) from stimulating testosterone production without causing an initial testosterone surge. This class includes degarelix, which is given monthly to men as an alternative to orchiectomy or LHRH agonists.

Anti-androgens

LHRH agonists cause what is known as a “flare” reaction because of an initial transient rise in testosterone over the first three weeks after the shot is given. This can result in a variety of symptoms, ranging from bone pain to urinary frequency or difficulty. Fortunately, this can be prevented.

Anti-androgens such as bicalutamide (Casodex), flutamide (Eulexin), and nilutamide (Nilandron) can help block the action of testosterone in prostate cancer cells. They are often added to the LHRH agonist to prevent flare reactions.

Although the sexual side effects of the anti-androgens when given alone are typically far fewer compared with the LHRH agonists, anti-androgens might not be as effective as orchiectomy or LHRH agonists, and they are not the optimal choice for men with documented metastatic prostate cancer.

When used in combination with LHRH agonists, anti-androgens tend to increase the risk of hot flashes and breast tenderness, and they can rarely result in liver injury. Your liver function tests should be monitored while you take these medications.

In addition, nilutamide is known to cause visual light-dark adaptation problems and—rarely—cause inflammation and scarring in the lungs. If you develop a persistent cough or persistent shortness of breath while on nilutamide, you should contact your doctor.

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