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
- 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
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