Testosterone, is the male sex hormone that controls the development and activity of the healthy prostate. Through changes in the hormone distribution, elderly males experience fluctuations and mismatches of their hormones. The result is an increase of benign as well as the stimulation of malignant prostate cells.
Realizing these hormonal behaviors, the most important pillars of a prostate cancer drug therapy are:
The prevention of the action of testosterone at the prostate, resultsin slowing down the growth of the prostate (cancer) cells and sometimes it also kills the cells(apoptosis).
The desired anti-hormonal effect can be achieved:
(1) by treatment with drugs or
(2) by the surgical removal of the testes, where testosterone is produced
Since an operation is for most patiants a serious psychological burden and is also not reversible, the treatment is mostly determined by the administering of appropriate medication:
GnRH agonists inhibit the formation of testosterone in the testicles. Possible side effects of hormonal changes include hot flushes, sweating, and a decrease in the potency and performance. Hormone treatment is limited, the testosterone levels, however, can recover after discontinuation of the medication.
Anti-androgens suppress the effect of testosterone by blocking the entry into the cancer cell. There are two different classes of substances having a similar effect: the steroidal and non-steroidal anti-androgens. The latter have the advantage that they the overall performance, bone density, and even the potency remain intact. Anti-androgens are usually administered at the start of the hormone treatment to accompany the GnRH agonist over a few days to compensate for the fluctuations in hormone levels.
Whether and how long a hormone treatment is needed, depends both on the tumor stage, the type of therapy, the size of the prostate, and of the patient's age, general condition and expected life expectancy. Hormone therapy is generally at issue in:
patients with localized high-risk prostate cancer
Patients at risk (PSA> 20ng/ml, Gleason score> 6, surgical margins after surgery not tumor-free, lymph nodes) a hormone therapy over a period of time is recommended in order to keep the risk of recurrence as low as possible.
The administration of medication in combination with an external radiation or brachytherapy may be useful.
Patients with metastatic prostate cancer
In patients with advanced prostate cancer in which metastases in the bones or other organs have formed already, hormone therapy is usually used as a permanent treatment. A sole local treatment (surgery, radiotherapy, brachytherapy) cannot lead to healing in such cases.
Patients with tumor recurrence
If after radiotherapy or surgery the patient experiences a relapse, the hormone treatment is the best choice for most patients.
Elderly patients with local tumor
If an operation is too risky and a an irradiation is not possible because of the side effects, hormone treatment may be considered. However, a long-term cure cannot be achieved.
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