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Hormone Therapy

Hormone therapy is used when prostate cancer has spread to other parts of the body or returned after treatment. It can also be used temporarily during radiation therapy for six months to two years to improve outcomes for localized cancers. The goal of hormone therapy
is to eliminate testosterone and other androgens because these molecules are the fuel that the prostate cancer uses to grow. Hormone therapy can eliminate testosterone and other androgens and slow the growth of prostate cancer cells. Though not curative, hormone therapy can be effective for several years.

Hormone therapy can be used for:
  • Metastatic disease as initial treatment
  • An elevated PSA or recurrence of prostate cancer following radical prostatectomy, radiation therapy or cryotherapy
  • Men who are not candidates for surgery or radiation therapy and are not interested in active surveillance
  • To shrink the prostate gland before having a radical prostatectomy or radiation therapy (Therapy performed around the time of other therapy is called neoadjuvant therapy.)

There are two categories of hormone treatments:

  • Medical therapy is used to stop production of testosterone by the testicles and other androgens from the adrenal glands. There are several types of medical therapy including luteinizing hormone-releasing hormone (LHRH) analogues, antiandrogens, and gonadotropin-releasing hormone (GnRH) antagonists.
  • Surgical therapy, known as bilateral orchiectomy, is performed to remove both testicles, which are the main source of androgen production. Surgical removal results in a fast drop in testosterone levels that slows the growth of prostate cancer. Surgery may be performed via one or two incisions, depending on what your surgeon decides. For men who are bothered by the change of scrotal
    appearance (empty scrotum), prosthetic testes can be placed as implants.

Secondary Hormone Therapy

  • Abiraterone Acetate (Zytiga®) is an oral prescription medicine that is used along with prednisone to treat men with castrate-resistant prostate cancer, or in some men found to have spread of cancer at diagnosis. Zytiga works by blocking other steps in the testosterone pathway, decreasing the production of a hormone called cytochrome P450 17A1 that stimulates cancer cells to continue to grow.
  • Ensalutamide (Xtandi®) is an oral medication used to treat castrate-resistant prostate cancer. It works by blocking the connection between testosterone and androgen receptors, which can help slow cancer cell growth.
  • Apalutamide (Erleada™) is an oral medication used to treat nonmetastatic castrate-resistant prostate cancer and works by blocking the connection between testosterone and androgen receptors, which can help slow cancer cell growth.

Treatment Options for Advanced Prostate Cancer

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