Hormonal Deprivation Therapy
for Prostate Cancer
Duke K. Bahn M.D.
Dr Bahn is best known for his work in Cryotherapy.
Hormonal Deprivation Therapy, also known as Androgen Ablation Therapy is a well established form of treatment for various stages of prostate cancer. Historically, bilateral orchiectomy ( removal of the testicles ) and estrogens have been the main methods of hormonal manipulation. This is based on the fact that the male hormone (androgen ) is responsible for tumor growth. Recently, a combination androgen ablation therapy was introduced, and is currently commercially available to maximize androgen blockade. There are two organs in the human that body that excrete the male hormone. The major source is the testicles. It can be blocked by utilizing LHRH agonists such as LUPRON or ZOLADEX. The other source of androgen is the adrenal glands. The adrenal activity can be blocked by using anti-androgen drugs, such as FLUTAMIDE or CASODEX. Lupron and Zoladex are injectable forms of medication. However, Flutamide and Casodex are oral medications. There are known side effects of these drugs which include : impotence, hot flashes, enlarged breasts, nausea, diarrhea, liver damage and untoward effects on the cardiovascular system. Therefore, strict supervision by a physician is mandatory. Combination Androgen Ablation Therapy can be used as a primary form of treatment if someone has an advanced cancer (Stage D, cancer spread to bones, lymph node, etc.). However, in many cases, these are temporary measures. This treatment is effective for an average of 3 - 5 years, and then often the cancer starts to re-grow and become hormone refractory. Lately, use of hormonal blockade along with other treatment options has proven to be effective and beneficial. The major problem of prostate cancer treatment is under -estimation of the disease (understaging). Approximately 50 % of all cancers which are considered to be localized in the prostate have actually already escaped outside of the prostatic capsule. In these instances,the success of radical prostatectomy, radiotherapy, or cryotherapy is compromised. Since androgen blockade therapy can kill the tumor, or decrease the size of the tumor (downstage), the chances of having unexpected tumor extension outside of the prostate at the time of surgery can be minimized . A Small volume prostate gland and tumor are the most important factors for successful cryotherapy, and are also beneficial to radiotherapy and surgery.
In conclusion, hormonal deprivation therapy is known to be an effective primary form of treatment in selected cases. However, it is recommended that this therapy be used in combination with other treatment modalities, for the reasons mentioned above. Pre-treatment with hormonal therapy followed by more definitive measures (cryosurgery, radical surgery, radiation therapy) may lead to a better outcome.
Cancer News on the Net wishes to thank Dr Bahn for contributing this fine article to our service!!!
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