Hormone Treatment for Prostate Cancer
Email Raji.Kooner@svha.org.au or call 02 8382 6980 for a confidential appointment.
Hormone therapy for prostate cancer is a very important topic and it’s really evolving as to when you should treat patients with hormone therapy and whether they should be on it all the time or an intermittent basis.
You can divide the hormones into the LHRH agonists and into anti-androgens.
The LHRH acts centrally, they result in a decreased testereone level from the testes and that is how they work and that’s why they have their side effects.
The commonly used agents in Australia are Lucrin, Eligard and Zoladex.
They’re all by different companies, they have the same efficacy.
They’re usually given as an injection either subcutaneously in the abdomen or intramuscularly and they can be given on a one monthly, three monthly or a six monthly basis.
In general they do have side effects which may include hot flushes, some lethargy, some erectile dysfunction and maybe some breast enlargement.
There is some work getting done to show that long term hormone therapy can result in other problems such as bone thinning and some other problems.
So this is getting analysed at the moment.
Anti-androgens work at the level where testereone interacts with the receptor and so these agents may also affect the testereone that comes from other sources besides the testes such as the adrenal glands.
So these agents are agents such as Nilutamide and Cosadex.
The studies that have been done have shown that the LHRH agonists by themselves are probably just as efficacious as opposed to using the LHRH agonists with an anti-androgen.
There was a big study done at the Lancet which proved the efficacy of these two ways of treatment were very similar, so hence we now usually just use LHRH agonist.
This is the equivalent of performing a surgical castration or removing the testes.
One of the advantages of going on injection therapy is that we can give pulse or intermittent therapy and there’s a lot of data on intermittent androgen blockade now showing that we think the outcomes are at least equivalent but what we say to patients is we’re really not sure if they’re better, worse or the same.
The data is coming out showing that probably the outcome is the same with a better quality of life because you have less side effects.
So we can give patients a pulse of hormone therapy, stop it, monitor their PSA, if the PSA goes up treat it again and that way they have a better quality of life and less side effects.
So that’s how hormone therapy is used.
The indications are usually in patients that have advanced disease, maybe spread of disease or maybe in very elderly men.
Sometimes it’s used in combination with radiotherapy because the results have shown that in active cancers radiotherapy plus hormones give better results than just radiotherapy by themselves.
So it’s, it’s a very important treatment modality and it’s important for patients to be aware of the potential side effects. Treatment is usually provided by general practitioners, it’s not very uncomfortable and it’s well tolerated.