Hormone therapy is also called “androgen deprivation therapy (ADT)” or “androgen suppression therapy.” The purpose of this treatment is to reduce the levels of male hormones called androgens, or to stop them from affecting prostate cancer cells
Androgens trigger the proliferation and spread of prostate cancer cells.The main androgens in our body are testosterone and dihydrotestosterone.Most androgens are produced by the testes, but some androgens are also produced in the adrenal glands called the adrenal glands.Reducing androgen levels or preventing them from being used by prostate cancer cells, it mostly helps to shrink prostate cancers for a while or slow their growth.But hormone therapy alone does not cure (cure) prostate cancer completely
When to use hormone therapy
Hor Mon therapy can be used in the following situations:
– If the prostate cancer has spread too far to be completely treated with surgery or radiotherapy, or if surgery or radiotherapy cannot be performed for various reasons
– If the cancer has recurred after surgery or radiotherapy
– With radiation therapy; if there is a high probability of recurrence of the disease after treatment (Patients are divided into low-medium-high risk groups according to Gleason score, high PSA level, and/or spread of cancer outside the prostate. In high-risk group patients, the probability of recurrence of the disease is higher.)
– Before radiotherapy, to increase the effectiveness of the treatment by shrinking the cancer further
Hormone therapy types
Many types of hormone therapy are used for the treatment of prostate cancer.
Treatments that reduce androgen levels
Orchiectomy (surgical castration)
The testicles are the most important source of androgens. In this surgical method, the testicles are surgically removed. Thus, growth stops or shrinks for a while in many prostate cancers. It is an outpatient surgical method and may be the simplest and cheapest method of hormone therapy.
LHRH agonists
These drugs reduce testosterone production in the testicles. Treatment with these drugs is sometimes called chemical castration or medical castration because they reduce androgen levels as effectively as orchidectomy.
LHRH agonists are mostly administered as monthly or quarterly injections. The most commonly used drugs in this group in our country are Leuprolide (Eligard) and Goserelin (Zoladex).
When LHRH agonists are first administered, there is a rapid rise and then a decrease in testosterone levels. This is called the flare effect. To avoid this effect, drugs called anti-androgens should be started a few weeks before LHRH agonists are started (we will talk about these drugs in our next article).
LHRH antagonists
Degarelix (Firmagon) is an LHRH antagonist. It works like LHRH agonists, but lowers testosterone levels faster and does not cause flare-ups.
It is used in the treatment of advanced prostate cancer. It is administered as a monthly subcutaneous injection.
CYP17 suppressor
LHRH agonists and antagonists work to inhibit androgen production in the testicles. But if prostate cancer has spread throughout the body, these cells still continue to produce a small amount of androgens, which trigger cancer growth. The drug Abiraterone (Zytiga) blocks the enzyme CYP17, thereby blocking androgen production not only in the testicles, but also in the adrenal glands or prostate cancer cells that have spread (metastasized) throughout the body. Abiraterone is a daily pill and is used in the treatment of advanced prostate cancer resistant to hormone therapy.
