Prostate Cancer Treatment by Hormone Therapy

Hormone therapy is also called androgen suppression therapy or androgen deprivation therapy (ADT). The goal is to lower the levels of male hormones, called androgens, in the body, or to stop them from influencing prostate cancer cells.   

Androgens stimulate prostate cancer cells to develop. The primary androgens in the body are testosterone and dihydrotestosterone (DHT). The testicles make many of the androgens, but the adrenal glands (glands that sit above your kidneys) also make a little amount. Reducing androgen levels or stopping them from getting into prostate cancer cells causes prostate cancers shrink or develop more slowly for a time. However, hormone therapy alone does not treat prostate cancer.                    

Uses of Hormone Therapy  

 Hormone therapy may be utilized for the following: 

• If cancer has reached too far to be cured by surgery or radiation, or if you cannot have these therapies for some other reason
• If cancer remains or returns after treatment with surgery or radiation treatment
• Along with radiation surgery as initial treatment if you are at higher possibility of cancer coming back following the treatment (based on a high Gleason score, high PSA level, and growth of cancer outside the prostate)
• Before radiation to try to shrink cancer to make treatment or surgery more effective

Types of Treatments for Hormone Therapy   

Treatments to reduce androgen levels

Orchiectomy (Surgical Castration)

Even though this is a kind of surgery, its primary effect is a form of hormone therapy. In this surgery, the surgeon removes the testicles, where many of the androgens (testosterone and DHT) are made. It causes most prostate cancers to stop growing or shrink for a time. It is done as an outpatient procedure. It is possibly the least expensive and simplest form of hormone therapy. However, different from some of the other treatments, it is permanent, and many men have trouble accepting the separation of their testicles. Some men having this operation are concerned about how it will look afterward. If needed, artificial testicles that look much like the usual ones can be inserted into the scrotum.

LHRH Agonists

Luteinizing hormone-releasing hormone (LHRH) agonists are drugs that lower the quantity of testosterone made by the testicles. Treatment with these drugs is sometimes called medical castration or chemical castration because they lower androgen levels just as well as orchiectomy.

Even though LHRH agonists are more costly than orchiectomy and need more frequent doctor visits, most men select this method. These drugs enable the testicles to remain in place, but the testes will shrink over time, and they also become too small to feel.

LHRH agonists are injected or placed as small implants under the skin. Relying on the drug used, they are given anywhere from once a month up to once a year. The LHRH agonists available includes: 

• Leuprolide (Lupron, Eligard)
• Goserelin (Zoladex)
• Triptorelin (Trelstar)
• Histrelin (Vantas)

LHRH antagonist

Degarelix is one of the LHRH antagonists. It runs like the LHRH agonists, but it reduces testosterone levels more swiftly and doesn’t cause tumor flare like the LHRH agonists do. Prostate cancer treatment with this drug can also be considered a form of medical castration. This medication is used to cure advanced prostate cancer. It is provided as a monthly injection under the skin. The most common side effects are complications at the injection site (pain, redness, and swelling) and higher levels of liver enzymes on lab tests.

CYP17 inhibitor

LHRH antagonists and agonists can stop the testes from making androgens, but other cells in the body, including prostate cancer cells themselves, can still make few amounts, which can fuel cancer growth. Abiraterone blocks an enzyme called CYP17, which helps stop these cells from making androgens.

Abiraterone can be used in men with improved castrate-resistant prostate cancer (cancer that is still growing in spite of low testosterone levels from an LHRH agonist, LHRH antagonist, or orchiectomy).

This drug is consumed as pills every day. It does not stop the testicles from making testosterone, so men who have not had an orchiectomy required to continue treatment with an LHRH antagonist or agonist. Because abiraterone also reduces the level of some other hormones in the body, prednisone (a cortisone-like drug) requires being taken during treatment as well to avoid certain side effects. 

Prostate Cancer Treatment Cost

Prostate cancer treatment in India is performed at best hospitals for prostate cancer treatment in India at an affordable cost. With improvements in technology like a robotic arm for prostate surgery, the success rate for prostate cancer treatment has gone up by several folds. Robotic surgery for prostate cancer authorizes maximum precision during the surgery making it the safest bet for the patients even at old age.