Hormonal Therapy

Testosterone, male sex hormones (androgens) controls the development and activity of the healthy prostate. Through changes in the hormonal distribution, there may be fluctuations and disproportionateness that affect the hormonal balance, which stimulate the growth of benign, but also malignant prostate cells. These findings are the foundation for a medical treatment of prostate cancer.

Prostate cancer therapy:
Hormone therapy is also called androgen deprivation therapy (ADT) or androgen suppression therapy. The goal is to reduce levels of the male hormones, called androgens, in the body. The main androgens are testosterone and dihydrotestosterone (DHT). Androgens, produced mainly in the testicles, stimulate prostate cancer cells to grow. Lowering the levels of the male hormones stops the growth of the cancer, and particularly leads to the dying of the cancer cells (apoptosis).

The desired effect can be achieved:

(1) through medication therapy or
(2) through surgical removal of the testis in which testosterone is being produced (orchidectomy).

Since the surgical removal of the testis is for many patients an enormous psychological strain, and can also not be reversed, medical treatment is the primary option:

GnRH Agonists (gonadotropin-releasing hormone)
GnRH agonists constrain production of testosterone in the testis and reduce the level of testosterone. Possible side effects are hot flashes, sweating, decreased sexual interest (libido). However, after the hormonal therapy is concluded, these symptoms may disappear.

Anti-Androgen
Anti-androgen block the male hormone testosterone from reaching the androgen receptors located on prostate cancer cells. Currently there are two different substances with comparable effect: the steroidal anti-androgen and the non-steroidal anti-androgen. The latter has the advantage that the overall sexual interest, bone density, and even the potency can be retained. Anti-androgen is at the beginning of the therapy administered over several days in combination with GnRH agonists to adjust the hormonal balance.

Whether a hormonal therapy is recommendable and for how long, dependents on the stage of tumor, the type of therapy, the size of the prostate, as well as the age of the patient. General health and estimated life expectancy are also important factors to be considered. Hormonal therapy is generally recommended for

Patients with localized high-risk prostate cancer
Patients with high-risk cancer (PSA >20ng/ml, Gleason score >6, resection margin after surgery not clear of tumor, lymph node metastases), it is recommended to keep the risk of recurrence as low as possible. The application of a combination of external radiation or a brachytherapy can here be meaningful.

Patients with metastasized prostate cancer
For patients with advanced prostate cancer, which has already spread into the bones or other organs, the hormonal therapy will in most cases be applied as a permanent treatment. A mono-local therapy (surgery, radiation, and brachytherapy) will in such cases not result in a cure.

Patients with recurrent tumors
If, after a radiation therapy or a surgical procedure, the cancer becomes recurrent, a hormonal therapy will become for some patients the primary choice.

Older patients with local tumors
If surgical procedure is too high a risk and a radiation therapy is not possible because of the side effects, hormonal treatment may be considered. However, a long-term cure cannot be achieved.