If you’ve been diagnosed with prostate cancer, you may have learned there’s a connection between hormones and the development of prostate cancer. To grow, prostate cancers need support from androgens, a group of hormones that are primarily responsible for biologically male attributes including testosterone and dihydrotestosterone.
One of the standard treatment paths for prostate cancer is hormone therapy which works by suppressing your body’s production of testosterone. Keep reading to learn more about the different hormone therapy options.
How does hormone therapy work?
Hormone therapy helps treat prostate cancer by lowering androgen levels to cut off the supply of testosterone. This helps shrink and slow the growth of cancer. Although hormone therapy is often used to treat advanced prostate cancer, it can also be used to treat recurrent prostate cancer and early-stage prostate cancer with an intermediate/high risk of recurrence.
In a recent Outcomes4Me webinar with Dr. Zin Gao, a medical oncologist who practices at Massachusetts General Hospital, said, “Prostate cancer is pretty unique among cancers in that it really needs androgens and testosterone to grow, survive, spread, and we know that these medications can help in a variety of different ways.”
The different types of hormone therapy
Depending on your specific tumor, your care team may recommend one or a combination of the following hormone therapies.
Luteinizing hormone-releasing hormone
There are hormone treatment drugs for prostate cancer that stop the testicles from producing testosterone. Often called luteinizing hormone-releasing hormone (LHRH) agonists and antagonists or gonadotropin-releasing hormone agonists and antagonists, these therapies reduce or block androgens from circulation. This cuts off a vital supply from your prostate cancer cells. These medicines are usually given in an injectable form or implanted into your skin.
Anti-androgens
Some medicines stop testosterone from “acting on cancer cells.” These hormone therapies are called anti-androgens and are often used in combination with LHRH agonists since they can sometimes cause testosterone levels to temporarily rise before decreasing. These medicines are typically taken orally.
These therapies can alter your body’s hormonal balance and can cause side effects, including infertility, loss of sexual interest, hot flashes, fatigue, changes in muscle mass, and osteoporosis. Be sure to speak to your medical team about what can be expected during these treatments.
Surgery
Another method of hormone therapy for prostate cancer is an orchiectomy, which is a surgery to remove one or both testicles, as they produce testosterone. This is an option for those who require lifelong hormone medication but would prefer an alternative treatment. An orchiectomy can quickly reduce testosterone levels in the body, but this procedure can impact fertility in men who might still be interested in having biological children. If you fall into this group, be sure to talk to your care team about fertility preservation options.
In addition to common surgical side effects, such as transient pain, swelling, bleeding, and post-operative risk of infection, an orchiectomy quickly alters the hormone levels in your body. This can lead to possible hormonal side effects including mood swings and a decrease in sex drive. Be sure to talk about how an orchiectomy will impact you in the long term as part of your discussions with your medical team.
What if hormone therapy stops working?
Prostate cancers may eventually stop responding to hormone therapy and become “castrate resistant,” meaning the cancer continues to grow even when androgen levels are very low. However, there are newer hormone therapies that can be used to treat these cases or your doctor may recommend targeted therapy drugs.
It’s also important to remember that every individual might benefit from a different treatment plan, depending on their medical team’s assessment and the individual’s cancer profile.
According to Dr. Gao, “[Treatment options] come with different trade-offs; different logistical considerations. There are some patients who are truly a better fit for surgery rather than radiation-based therapies based on their specific factors and there are other patients who are actually better suited for radiation-based therapy than surgery.”
If you have additional questions about hormone therapies or you’d like to speak with someone, you can connect with an Outcomes4Me oncology nurse practitioner at no charge through the Outcomes4Me app, using the “Ask Outcomes4Me” button.
