What is hormonal treatment for prostate cancer

Hormone therapy for prostate cancer

Prostate cancer is a malignant disease of a hormonal nature, which occurs mainly in old age. hormone therapy plays an important role in the treatment of Prostate Cancer. It is aimed at suppressing androgenic activity. It should be understood that this method of treatment will not help to completely get rid of the pathology, however, it significantly improves the prognosis for the patient if hormone therapy is started in a timely manner.

Principle of treatment

The cause of prostate pathologies is the activity of dihydrotestosterone. As a result of a number of disorders, this substance is actively absorbed by prostate cells, causing the rapid growth of a malignant tumor. Hormone therapy for Prostate cancer is based on drugs that block the production of male hormones. Hormone treatment can significantly reduce the rate of progression of the disease, however, it has a number of features that you should familiarize yourself with before you start taking this group of medications.

Indications for hormone therapy

Despite the fact that hormone treatment often does not completely get rid of cancer, this method is widely used, especially for the treatment of men over 70 years old.

Hormon therapy for prostate cancer is justified in the following cases:

• the initial stage of the disease;
• contraindications for surgical treatment;
• Contraindications for chemotherapy;
• patient's advanced age;
• relapse of the disease.

Hormone therapy is especially widely used for older patients

The most effective way to treat cancer is radical prostatectomy - the complete removal of the prostate gland. In some cases, the intervention is contraindicated, first of all, this is true for patients older than 70 years. When it is impossible to use other methods of treatment, hormone therapy for prostate cancer remains the only way to prolong the patient's life.

Quite often, hormonal treatment of prostate cancer is carried out with the development of the disease in young patients, as a more gentle method compared to prostatectomy.

There are cases when the removal of a malignant neoplasm without complete removal of the prostate gland is ineffective. Over time, the disease recurs, but for a number of reasons, a second operation may be contraindicated. In such cases, hormone therapy for carcinoma is the only available method of combating the disease.

Surgical castration

The main volume of male sex hormones is produced by the testicles. It is possible to reduce the production of androgens and stop the progression of the disease with the help of castration. The operation involves the removal of the testicles and is called an orchiectomy.

The whole procedure is carried out quickly enough, it does not require a stay in the hospital or a long rehabilitation. However, not all patients are ready for such a drastic measure, since, unlike medical castration, surgical castration is irreversible.

Surgical castration has an irreversible result

Female sex hormones in prostate cancer therapy

One of the drug methods of fighting a tumor is estrogen therapy. The introduction of female sex hormones to men blocks the production of testosterone, thereby achieving a therapeutic effect in prostate cancer.

Benefits of prescribing estrogen for PCa:

• fewer dangerous side effects than other hormonal drugs;
• high remission rate;
• inhibition of tumor growth.

According to statistics, the remission rate when taking estrogen reaches a record 87%. In addition, preparations analogous to female hormones have a cytotoxic effect on prostate cells, reducing the size of the tumor. At the same time, estrogens do not provoke the development of osteoporosis, which is often observed with hormonal therapy with antiandrogenic drugs. Also, preparations of female hormones do not affect the cognitive functions of the brain.

The lack of drugs in this group is damage to the cardiovascular system, which can lead to death in the treatment of men over 75 years of age with atherosclerosis and other age-related pathologies in history. To minimize the risk of damage to the cardiovascular system, intravenous administration of drugs is practiced. Additionally, drugs are prescribed that reduce the load on the heart muscle (cardioprotectors).

Estrogen therapy causes fewer side effects than other hormone therapies

GnRH: analogues and antagonists

The most common method of hormone therapy is the injection of GnRH analogues.This substance first stimulates the production of testosterone, but over time, the number of GnRH receptors decreases, and testosterone production decreases to a level corresponding to the synthesis of this hormone after castration.

Medicines of this group are administered once a month. In the first week after the injection, the symptoms worsen due to an increase in the production of male hormones, but they subside over time. In the first days after the injection, patients note:

• pain in bones and joints;
• urination disorders;
• pain in the perineum;
• general malaise.

Despite the absence of an effect on the cardiovascular system, after the administration of the drug, the patient must be observed for several days in the hospital. A sharp release of testosterone in some cases can lead to acute renal failure. In addition to the likely side effects, drugs in this group are ineffective in about 12% of cases. Nevertheless, it is GnRH analogues that make up the standard treatment regimen for prostate cancer.

GnRH antagonists reduce testosterone production immediately after administration. This group of drugs is not widely used due to the large number of side effects. They often provoke the development of an acute allergic reaction. Such hormonal therapy is used when other drugs are ineffective. The main disadvantage of GnRH antagonists is a short-term effect, and therefore the drugs must be used frequently. This provokes the development of a large number of side effects.

The principle of antiandrogen therapy

Steroid and non-steroidal antiandrogens are used to treat prostate cancer. The first group of drugs blocks androgen-sensitive receptors, and also suppresses the activity of the pituitary gland. Despite the high efficiency, drugs of this group cause a large number of side effects, including:

• impotence;
• loss of sexual desire;
• gynecomastia;
• liver failure.

Impotence is the most common side effect of treatment

Non-steroidal drugs do not reduce testosterone production and do not affect the activity of the pituitary gland, but they are also not without side effects. Most often, patients experience impotence against the background of hormone therapy. Despite negative reactions, monotherapy with non-steroidal antiandrogens is widely used in the initial stages of cancer.

Types of hormone therapy

There are three types of hormone therapy for prostate cancer:

• combined;
• deferred;
• intermittent.

Combination therapy involves the use of drugs from different groups. Usually, simultaneous therapy with an anticancer drug (finasteride) and antiandrogens is prescribed.

Delayed therapy refers to the appointment of hormones after a long-term observation of the dynamics of changes in tumor size. There is no reliable data on the effectiveness of such a treatment regimen, however, in some cases, expectant management with a willingness to timely administration of hormonal drugs remains the only available treatment method.

After 16-24 months after the start of treatment with hormonal drugs, the development of resistance of cancer cells is noted. Intermittent therapy is understood as a course of administration of drugs for a short time in order to stop exposure before the formation of resistant cells.

Side effects

The greatest number of side effects is observed after surgical castration. Among them:

• complete lack of erection and sexual desire;
• gynecomastia;
• weight gain and muscle wasting;
• osteoporosis;
• impaired cognitive functions of the brain.

If negative consequences appear, symptomatic therapy is carried out. One of the common side effects is impairment of attention, memory and mental abilities. It is because of this consequence that surgical castration is rarely performed, drug therapy is preferred.

When taking estrogens, there is a high risk of cardiovascular damage and the development of side effects that are incompatible with life. The risk can be minimized by the simultaneous use of drugs that protect the heart muscle.

Gynecomastia - breast enlargement - another side effect

With antiandrogen therapy, erectile dysfunction, bladder obstruction, and decreased libido are observed. The use of steroid drugs is often accompanied by obesity and gynecomastia. With an increase in the mammary glands and pain in the nipples, their removal is indicated.

Hormone therapy is rarely used as an independent remedy. As a rule, a combination of radiation therapy and hormonal treatment allows you to achieve remission for a period of several years.Accurate predictions depend on a number of factors, among which the stage of the disease and the age of the patient are important.

Recommendations

When taking hormonal drugs, you must adhere to a number of rules. Patients are shown regular examinations and special nutrition. Minimizing the risk of side effects of the drugs taken allows the introduction of a large number of fruits and vegetables in the diet. Selenium-rich foods and antioxidants are helpful for cancer. It is recommended to consume citrus fruits and seafood daily. Fatty and fried foods are prohibited. It is necessary to completely exclude any raw smoked products, semi-finished products, spices.

Protein foods should be reduced to a minimum, if possible, it is recommended to completely abandon eggs, fatty milk, but sour-milk products are not prohibited.

Along with adjusting nutrition, the patient should undergo regular examinations. Every two to three months, you should take an analysis to determine the level of PSA.

Despite the fact that hormone therapy negatively affects the quality of life of the patient, in most cases this method of treatment gives good results. However, at the beginning of taking drugs, patients often experience emotional disturbances that are difficult to overcome alone. During treatment, it is important to enlist the support of relatives and friends.

, to all residents of the city and region!

Hormonotherapy in the treatment of prostate (prostate) cancer: indications and prognosis

Hormonal treatment of prostate cancer is one of the passive methods of fighting the disease.

It is based on the reduction or complete removal of sex hormones from the body, as they contribute to tumor growth.

May be given as primary therapy or as a secondary therapy, i.e. to prepare for surgery or radiation (radiotherapy).

Hormonotherapy: what is it?

The basis of hormone therapy is the blockade of androgens. That is, the synthesis of those components that are directly involved in the production of testosterone - the main sex hormone in men. What is it for? In order to drastically slow down the growth of the tumor, since it directly depends on the concentration of testosterone.

The simplest method is drug adjustment, that is, taking blockers of those same androgens. Another option is a mechanical obstruction of testosterone production, which is better known as physical or chemical castration. It is worth noting that this sex hormone is produced in the testicles. It turns out that the main influence is on them, and not on the prostate itself.

Hormone therapy also involves taking the so-called LHRH-releasing drugs. They suppress the production of LHRH hormones (synthesized by the pituitary gland), which is responsible for regulating the concentration of testosterone. At the same time, there is no physical effect on the testicles and the reproductive system, but the production of sex hormones is suppressed. The effect lasts exactly as long as the drug is taken, which contributes to faster rehabilitation.

An indication for hormone therapy for prostate cancer is:

The need to reduce the size of the tumor itself before surgery or radiation therapy; a case of recurrence after more aggressive treatment (removal of part of the prostate gland or radiation). Such treatment is more recommended even in cases where the treatment of prostate cancer in people of retirement age or with diseases of the cardiovascular system is meant.

For them, in principle, the operation is undesirable, since it will be too much load for the body. In such situations, conservative treatment in the form of hormone therapy is used.

As a basis for the fight against prostate cancer, this method is used in case of recurrence of a tumor not caused by metastases, or if surgery or chemotherapy has already been performed before.

Hormonal treatment of prostate cancer

The main methods of hormonal treatment of prostate cancer:

The second method is more effective, but in many cases men refuse it due to numerous psycho-emotional reasons.

Injections with blockers slow down or completely remove testosterone production.

This preparation is used for this:

Their purpose is to block the excitation of LHRH-active receptors. Those, when receiving a signal, synthesize the LHRH hormone. It is he who is responsible for the production of testosterone. If LHRH receptors do not respond to the “commands” of the pituitary gland, then the production of testosterone will simply stop. However, its concentration in the blood will still be normal for some period.

Removal of the testicles for prostate cancer (orchiectomy) is a more radical method of hormone therapy for prostate cancer.

It is more preferable from a medical point of view, but in most cases already infertile men and the elderly (who already have impaired erectile function) decide to take such a step.

Orchiectomy for prostate cancer prognosis: you need to understand that with stage 3 cancer, the likelihood of infertility is already very high, so you should reasonably evaluate your chances of recovery.

That is, orchiectomy for prostate cancer is used only in emergency cases, when surgery or radiation needs to be performed as soon as possible, since after a certain period of time the tumor will become inoperable.

There is a third option for hormone therapy - the use of estrogens, which are considered female sex hormones (they are also produced in the male body, but in a much smaller proportion). This also helps to suppress the synthesis of male sex hormones.

Contraindications for hormone therapy are as follows:

• diseases of the endocrine system (including the thyroid gland);
• liver disease (cirrhosis, hepatitis).

Despite the many side effects, there are practically no reasons to stop hormone therapy for prostate cancer. What negative consequences can occur after this therapy?

Most often it is:

• soreness of the mammary glands (due to the predominance of female sex hormones in the body);
• weight gain;
• diarrhea;
• alopecia (minor hair loss);
• liver dysfunction (so diet is a must);
• potency reduction;
• emotional disorder (decreased libido, that is, sexual desire for women).

The course of treatment is determined by the doctor and monitored for a long time in order to timely relapse, and you also need to monitor the results of PSA in hormonal treatment of prostate cancer. If injections are used, then they are done about 1 time in 2 months until a complete cure for cancer. And how long it will take - purely individual physiology. On average, the standard course is 6 months (2-3 months after surgery or the last exposure, if any).

What is it prescribed for before surgery or radiation?

Before surgery, hormone therapy is prescribed in order to reduce the likelihood of complications. In fact, the volume of tissue removed then decreases, which reduces the rice.

And before irradiation, the blockade of hormones allows you to reduce the number of necessary "shots" of radiation rays, since the volume of the prostate gland will decrease again.

All this is to reduce the negative consequences of oncology treatment.

In summary, hormone therapy is a very effective treatment for prostate cancer. Used to reduce the concentration or complete blockade of testosterone.

Predominantly prescribed as an additional therapy. It has minor side effects that resolve themselves when the level of testosterone in the blood is restored.

Hormone therapy for prostate cancer

Hormone therapy for prostate cancer - reducing testosterone levels to minimal values by taking medications or removing the testicles. It is usually used in case of recurrence of pathology, metastasis to neighboring organs or in conjunction with radiation therapy. Treatment does not stop the development of the tumor, after 2-3 years, cancer cells adapt to low testosterone levels and begin to multiply again.

Not so long ago, the only method of hormone therapy was orchiectomy - the surgical removal of the testicles. Currently, specialists have developed a number of medicines in the form of tablets, injections and implants, which lead to a decrease in the level of male hormones without the use of radical surgery.

First research

In the 1940s, the American physiologist and oncologist Charles Huggins conducted several studies, during which he came to the conclusion about the influence of male hormones on prostate cancer. He discovered that the degree of growth of certain types of cancer cells depends on the presence in the body of a group of steroid male sex hormones called androgens.

They are responsible for the development of the male genital organs, the growth of beards and mustaches, the increase in muscle mass and changes in the vocal cords. Testosterone is a type of androgen. About 90-95% of all hormones in this group are produced in the testicles, the rest in the adrenal glands.

Hormone therapy caused such a wide resonance that it was considered the only way to completely get rid of prostate cancer. Unfortunately, long-term clinical trials have shown cancer cells to be resistant to treatment. The reasons for the further progression of the tumor remain unknown.

Prescribing hormone therapy

Hormonal treatment of prostate cancer is prescribed by an oncologist, depending on the degree of development of the disease.In most cases, this happens:

• when cancer is metasized to other organs;
• to increase the efficiency of radiation therapy or reduce the size of the tumor before carrying out brachytherapy;
• When the PSA level in the blood begins to rise after the operation or radiation therapy, which indicates the recurrence of the tumor.

The beginning of the use of hormonal therapy also depends on the opinion of the attending physician. Some experts consider the procedure in the early stages of the disease ineffective, referring to serious side effects. Others are confident that reducing the mortality from prostate cancer is just caused by the use of hormone therapy in early detection.

Hormone therapy options

The removal of the testicles during the two-sided orchiectomy was the earliest form of hormonal therapy of prostate cancer. Surgical intervention has recently replaced the reception of medicines that reduce the level of hormone to the required values.

For men, the normal level of testosterone is from 300 to 1000 ng / dl. Medical organizations try to produce hormonal drugs that can reduce this indicator up to 50 ng / dl. In practice, some specialists reduce testosterone levels to even smaller values of 20-30 ng / dl.

Agonists LGRG

Relaxing luteinizing hormone (LGRG) - peptide hormone, sending the first chemical signal to the brain to generate testosterone. Agonists LGRG block this process, preventing the further production of male hormones in the testicles.

Drugs are among the most popular hormone therapy options for prostate cancer. They do not have a tablet for form because the peptides included in their composition are destroyed in the digestive system. The drug is introduced into the muscle or fatty tissue under the skin with the help of an injection month.

Some manufacturers produce LGRG agonists in the form of a subcutaneous implant, which provides a very slow drug release. Its replacement is made every six months or a year.

For 3-4 weeks after the first administration of the medication, a temporary testosterone splash occurs in the body, leading to a deterioration of cancer symptoms. If a man begins to experience pain or tumor cells penetrated other parts of the body, oncologist additionally prescribes the reception of antiandrogen. Over time, the state normalizes and the number of hormone begins to drop.

Among the side effects of the admission of agonists of the LGRG, experts identify:

• Loss of sexual attraction;
• Increasing the chest (gynecomastia);
• chest pain;
• loss of muscle mass;
• weight gain;
• fatigue;
• Reducing the level of "good" cholesterol.

Popular is the method of intermittent dosing, when therapy stops for several months and then renewed again. With this approach, the patient has fewer side effects. The long-term advantages of intermittent dosing were not fully studied.

LGRG antagonists

LGRG antagonists are used less than agonists and at the moment there is only one approved type of active substance - Degalelix

Usually oncologists prescribe a medication during the primary treatment of prostate cancer, whose metastases penetrated into the bone. It helps prevent the spinal cord compression, which occurs in the case of its squeezing with tumor cells.

Unlike LGRG agonists, Degalers does not cause a temporary burst of testosterone. Hormone levels start immediately decline, cancer symptoms disappear and blocked.

Firmagon with the help of a syringe is introduced into the skin fold on the abdomen at an angle of 45 degrees. The initial dose is divided into two injections of 120 mg, supporting - a month later in an amount of 80 mg. In the future, injections are held monthly.

With frequent side effects of treatment with antagonists are anemia, diarrhea and nausea, headaches and insomnia, redness and pain in the place of the injection. There are no data on overdose.

Antiandrogens

Antiandrogens are peripherally active drugs that block the production of male hormones in adrenal glands. They have less side effects in contrast to other types of hormone therapy, but powerless in the case of cancer cells into other organs.

The class of antandrogens includes:

In most cases, the beginning of treatment with agonists of the LGRG causes a strong burst of the testosterone level in the body, leading to an increase in prostate gland and difficult urination. In patients with metastases in the bone, a testosterone splash can lead to significant complications: pains in bones, fractures and pinching nerves.

It is believed that if hormone therapy is started with antiandrogenic drugs and subsequently switched to LHRH agonists, then these problems can be avoided.

Specialists have noticed that if the treatment with antiandrogens does not work, then when you stop taking the drugs, there is a short-term improvement in the state of the body. The phenomenon is called "androgenic rejection".

Diethylstilbestrol is a synthetic form of the female hormone estrogen used in hormone Therapy for Prostate Cancer. Taking the medication helps to reduce testosterone levels by suppressing the secretion of luteinizing hormone in the hypothalamus.

In moderate to high doses (3-5 mg per day), diethylstilbestrol causes serious cardiovascular problems and increases the risk of a heart attack. To reduce side effects, some doctors reduce the dose to 1 mg per day, but at this dosage, testosterone levels often begin to rise after 6-12 months of therapy.

Orchiectomy

Since 90% of androgens are produced in the testicles, bilateral orchiectomy can significantly reduce testosterone levels in the body. The operation is performed under local or general intravenous anesthesia for one and a half hours. The surgeon makes an incision along the scrotal suture 2-6 cm long and removes the testicles. At the request of the patient, implants are placed in their place to give an aesthetic appearance. The incision is closed with a suture.

The procedure is radical. As with LHRH agonists, orchiectomy leads to significant side effects: hot flashes, loss of sex drive, breast enlargement, muscle loss, and weight gain.

Modern methods of hormone therapy for prostate cancer have relegated surgical intervention to the background. Surgery is offered only in case of long-term treatment or lack of funds for medicines. Also, an orchiectomy is sometimes recommended for older men who are unable to visit the doctor's office for an injection.

Combined androgen blockade

Combined androgen blockade (maximum androgen blockade) consists in the simultaneous use of drugs that act centrally on the brain (LHRH agonists or LHRH antagonists) and peripherally on the adrenal glands (antiandrogens). With this approach, not only the production of testosterone is blocked, but also its action in the prostate. The only disadvantage of this method are the numerous side effects: decreased libido, impotence, diarrhea, nausea and liver problems.

Dr. Mark Garnik, in the analytical article "Hormonal Therapy for Prostate Cancer", recommends the use of a combined treatment method. His published studies led to the conclusion that the simultaneous use of drugs in the last stage of cancer prolongs life from seven months to two years. The results may not seem impressive for doctors, but for the patient and his relatives, this is an additional life time.

Standards for the treatment of patients with prostate cancer

Which treatment option works best

The issues of choosing hormonal drugs, their combinations and the sequence of application have not been fully studied. The appointment of LHRH agonists is used in primary treatment in most cases. For young men who wish to remain sexually active, a doctor may prescribe an antiandrogen. Withdrawal of the drug and switching to LHRH agonists occurs with an increase in the prostate specific antigen in the blood, indicating a relapse of the disease.

Patients with overt symptoms or in advanced stages of cancer are advised by oncologists to use a combination of two or even three drugs. A study published in the New England Journal of Medicine shows a 25% increase in survival. However, a 2002 meta-analysis estimated that the drug combination improved five-year survival by only 2-3%. Experts attribute such discrepancies to the type of antiandrogen used.

The use of hormonal treatment in combination with radiation therapy and chemotherapy is being actively studied. A recent study in men with locally advanced prostate cancer found an increase in life expectancy after just six months of hormonal therapy plus radiotherapy. In the future, experts want to study the effect of combined treatment on patients with grade 1 and 2 cancer.