In the second part of our article on hormone therapy in prostate cancer, we will talk about drugs called anti-androgens. Androgen hormones, which have a key role in the growth and proliferation of prostate cells, work by binding to proteins called androgen receptors (algae) on the surface of prostate cells. Anti-androgens prevent androgens from binding to these receptors.
The most commonly used drugs in this group are Flutamide (Eulexin) and Bicalutamide (Casodex).
They are used as daily pills.
Anti-androgens are often not used alone. It is often used as a supplement when the efficacy of LHRH agonists is reduced. Also, when used with LHRH agonists, they are used for a few weeks to prevent tumor flare.
Additionally, anti-androgens can be used as first-line hormone therapy in addition to orchiectomy or LHRH agonists. This method is called combined androgen blockade.
If anti-androgen ceases to act in a patient with prostate cancer, interrupting anti-androgen therapy may result in a brief halt in the growth of the cancer. We call this the anti-androgen withdrawal effect. The reason for this is not clear yet.
Enzalutamide (Xtandi)
It is a new generation anti-androgen treatment method. Normally, when androgens bind to their receptors, the receptor sends a signal to the cell control center to grow and divide. Enzalutamide blocks this signal. It is used as a daily pill.
Enzalutamide may be beneficial in men with surgery-resistant prostate cancer. In many drug studies, male patients were treated with LHRH agonists. However, there is no clear information about how it works in men with testosterone levels who have not undergone surgery.
Possible side effects of hormone treatments
Orchiectomy and LHRH agonists and antagonists have similar side effects due to decreased testosterone levels. These side effects are;
– Decreased or lost sexual desire
– Impotence
– Shrinkage in penis and testicles
– Hot flashes that improve or disappear over time
– Breast tenderness and breast tissue growth
– Osteoporosis (thinning of the bone) that can cause fractures
– Anemia (low red blood cell count)
– Mental weakness
– Loss of muscle mass
– Weight gain
– Fatigue
– High cholesterol
– Depression
Some studies have shown Of course, the risk of death due to high blood pressure, diabetes, stroke, heart attack and heart diseases is high in male patients treated with hormone therapy. However, not all studies on this subject have been able to confirm this.
Antiandrogens have similar side effects. The main difference between LHRH agonists, antagonists and orchiectomy is that anti-androgens have low sexual side effects. When these drugs are used alone, sexual desire and erection usually persist. However, when these drugs are administered to a male patient treated with LHRH agonists, diarrhea is the main side effect.
Abiraterone may cause joint or muscle pain, high blood pressure, fluid build-up, hot flashes, stomach problems and diarrhoea.
Enzalutamide may cause diarrhoea, tiredness and worsening of hot flashes. This drug also causes some side effects in the nervous system. These are dizziness and rarely paralysis. Men taking this drug are prone to fall-related injuries.
Most of the side effects from hormone treatments can be prevented or treated
For example,
– Antidepressants and other medications can often help with hot flashes.
– Many drugs can have preventive and therapeutic effects in preventing osteoporosis.
– Depression can be treated with antidepressants or psychological counseling.
– Exercise can help reduce side effects such as fatigue, weight gain, bone loss, muscle loss.
