Testosterone-Based Treatment Options Rob Prostate Cancer of Fuel
No guy wants to hear that he has prostate cancer. Along with panic, the diagnosis is likely to unleash an avalanche of questions: What are the survival rates? Do I need surgery? Or radiation therapy?
As you and your doctor weigh treatment options, you might explore hormone therapy to combat prostate cancer, a disease of the walnut-sized gland that produces semen. Two options are an orchiectomy and androgen suppression therapy, also known as androgen deprivation therapy, or ADT.
ADT and orchiectomy work by decreasing the amount of sex hormones in men, including testosterone and dihydrotestosterone (DHT). This slows the growth of prostate cancer because cancer cannot grow and survive without androgens, or sex hormones. Hormone therapy for prostate cancer is typically when the cancer has recurred or spread elsewhere in the body. ADT is also given at times with radiation to improve the effectiveness of the treatment.
What is ADT?
For ADT, the patient takes special medications that reduce hormone levels. Luteinizing hormone-releasing hormone (LHRH) agonists, LHRH antagonists, androgen inhibitors and antiandrogens are the four main types of drugs used in this therapy.
LHRH agonists cause the testicles to stop producing testosterone. They are typically injected or placed as small implants under the skin and administered anywhere from once a month to once a year. Patients might experience temporary tumor growth as a result of the short-term surge in testosterone. LHRH antagonists also stop the body from producing testosterone but don't come with the testosterone spurt of LHRH agonists.
Androgen inhibitors are drugs that prevent the production of androgens by all tissues that produce them. Surgical or medical castration does not prevent the adrenal glands and prostate cancer cells from producing androgens. While these cells produce a relatively small amount of androgens, they can be enough to support the growth of prostate cancer.
Antiandrogens, which are often used along with LHRH agonists, block the action of androgens in the body. Treatments include androgen receptor blockers, which are drugs that compete with androgens for binding to the androgen receptor. This reduces the ability of androgens to promote the growth of prostate cancer.
What is an orchiectomy?
An orchiectomy, or surgical castration, involves surgically removing the testicles. Although it's a type of surgery, it's essentially a form of hormone therapy because the testicles are where more than 90 percent of testosterone is made. An orchiectomy is an effective strategy for blocking testosterone release and, as a low-cost, one-time procedure, usually causes prostate cancer to stop growing or to shrink. This surgery can be done on an outpatient basis.
There are two main types of orchiectomy: simple and subcapsular. Simple orchiectomy is the removal of both testicles through an incision in the front of the scrotum. Some men choose to have artificial testicles made of silicone or saline implants inserted into their scrotum to present the appearance of testicles to their partners.
Subcapsular orchiectomy involves the removal of the tissue from inside of the testis but leaves the outside (capsule) in place. With the capsule in place, there is still a testicle-like appearance (though not identical) rather than an “empty sack.” Both methods work well for stopping the production of testosterone and both surgeries take less than 30 minutes.
Most men are able to resume regular daily activities one to two weeks after surgery, with a full recovery within two to four weeks.
What are the side effects of hormone therapy?
Androgens affect many organs and both ADT and orchiectomy can have a wide range of side effects, such as:
- Erectile dysfunction (ED)
- Decreased sexual desire
- Hot flashes
- Thin or brittle bones (osteoporosis)
- Loss of muscle mass
- Changes in blood lipids
- Insulin resistance
- Memory problems
- Weight gain
- Elevated cholesterol levels
- Growth of breast tissue
Most men experience at least some of these side effects. You will meet with your doctor regularly for follow-up visits while you are taking hormone therapy, and it's important to discuss your side effects so your doctor can help minimize them. Regular exercise can help prevent or reduce some side effects, including muscle and bone loss, weight gain and fatigue.
Hormone therapy is effective in slowing down prostate cancer growth. Although it isn't a cure for prostate cancer, it could help you feel much better and add years to your life.