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Hormone therapy
The discovery that male sex hormones (androgens), testosterone in particular, are required to maintain the size and function of the prostate led to the developments of treatments designed to interfere with these effects of testosterone. Preventing testosterone from acting on prostate cancer cells can temporarily cause the cancer to regress, or to least to grow more slowly. However, because some prostate cancer cells are able to grow without testosterone (they are called androgen-independent or androgen-insensitive cells), the tumor will continue to grow despite the withdrawal of this hormone. Thus, hormone therapy is useful for the treatment of prostate cancer but does not offer a cure.
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Hormone therapy used to be reserved for men whose prostate cancer had spread to other tissues (such as the lymph nodes or the bones) and could not be completely eradicated by surgery or radiation. Now, hormone therapy also can be used to treat men whose disease has not spread but is expected to. Because all effective forms of hormone therapy produce erectile dysfunction and loss of libido (sex drive)—and none is curative regardless of when treatment begins—an earlier start may not be worth the risks of these and other side effects (such as hot flashes or loss of energy) or the costs of hormone therapy. However, the short-term use of hormone therapy in men with early-stage prostate cancer—particularly in combination with surgery or radiation therapy—has grown in popularity.
The most significant side effects of hormone therapy are erectile dysfunction in about 90 percent of patients and loss of libido. Other side effects include breast enlargement, weight gain, loss of muscle mass, osteoporosis (decreased bone mass), and fatigue. About two thirds of men have hot flashes—like those experienced by women during menopause. Hot flashes are not harmful. Hormone therapy does not cause the voice to change in pitch, as some men fear.
There are two approaches to hormone therapy, also called testosterone withdrawal, androgen blockade, or castration. The first is surgical removal of the testicles, which produce about 95 percent of the body's testosterone (surgical castration). The second is the use of medications that interfere with the manufacture or actions of testosterone (medical castration). These medications include estrogens, luteinizing hormone-releasing hormone (LH-RH) analogs, gonadotropin-releasing hormone antagonists, and antiandrogens.
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