Urologic Oncology Program: Prostate, Bladder, Kidney

Urologic Oncology: Prostate Cancer

Hormone treatment (Androgen Deprivation Therapy) uses drugs or surgery:

Hormone therapy is also known as androgen deprivation therapy (ADT) or androgen suppression therapy. The goal of hormone therapy is to keep prostate cancer cells from receiving the male hormones (androgens) they need in order to grow. The main androgens in the body are testosterone and dihydrotestosterone (DHT). The main sources of the male hormones (androgens) are the testicles, but the adrenal glands also produce small amounts.

Your doctor may suggest a drug that can block natural hormones.

  • Luteinizing hormone- releasing hormone (LHRH) agonists- drugs that can prevent the testicles from making testosterone. Examples are leuprolide and goserelin.
  • Anti-androgens- drugs that can block the action of male hormones. Examples are flutamide, and bicalutamide.
  • Other androgen-suppressing drugs- Some drugs can prevent the adrenal gland from making testosterone. Examples are ketoconazole and abiraterone.

Surgery can also be used to reduce hormone levels. The surgical operation is to remove the testicles; this procedure is called an orchiectomy.

Combined Androgen Blockade (CAB)

After orchiectomy or treatment with an LHRH agonist, your body no longer gets testosterone from the testicles. However, the adrenal gland still produces a small amount of male hormones. You may receive an antiandrogen to block the action of the male hormones that remain. This combination of treatments is known as total androgen blockade. Studies have not shown whether total androgen blockade is more effective than surgery or an LHRH agonist alone.

Other advanced forms of Prostate Cancer Treatment

Doctors can usually control prostate cancer that has spread to other parts of the body with hormone therapy. The cancer often does not grow for several years. But in time, most prostate cancers can grow with very little or no male hormones. Hormone therapy is no longer helpful. At that time, your doctor may suggest other forms of treatment.

Castrate –resistant prostate cancer (mCRPC) means that the androgen deprivation therapy (ADT) measures stop adequately controlling the cancer. At this point some patients will go on to further forms of treatment.

  • Enzalutamide - an oral drug that further blocks the effects of testosterone on the cancer throughout the body.
  • Abiraterone - an oral drug that further prevents even small amounts of testosterone from being produced within the body.
  • Chemotherapy - drug agents have been shown to be effective against prostate cancer and their toxicities have improved immensely over the last decades.
  • Vaccine Treatment – Sipuleucel –T (Provenge) is a vaccine approach where one’s blood is removed, exposed to prostate cancer identifiers and then placed back into body to boost the patient’s own immune response to cancer.
  • Xofigo (radium Rz 223 dichloride)- is an injection used to treat prostate cancer that is resistant to medical or surgical treatment that lowers testosterone (castrate resistant prostate cancer) and has spread to your bones with symptoms, but not to other parts of your body. It delivers a brief but strong energy to the cancer to lessen symptoms and prolong survival. St. Joseph Hospital is one of the few sites in Orange County providing this treatment. For question or more information on Xofigo treatment contact the Urologic Oncology Nurse Navigator at (714) 734-6237 or visit www.xofigo-us.com