Hormonal Deprivation Therapy

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 primary method for achieving this goal. This is based on the fact that the male hormone (androgen) is responsible for tumor growth.

Combination Androgen Ablation Therapy can be used as a primary form of treatment if someone has 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 before the cancer begins regrowth and becomes a hormone refractory (hormone resistant) tumor.

Lately, usage of hormonal blockades, 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 (understaged). Based on radical surgery experiences, approximately 35% of all cancers thought to be localized in the prostate have actually escaped out of prostate capsule. Therefore, the success of radical prostatectomy, radiotherapy, brachytherapy, or cryotherapy is compromised by the local extent of disease.

Since androgen blockade therapy can decrease the size of the tumor and the size of the prostate itself, the chances of an unexpected tumor extension outside of prostate at the time of surgery is minimized (downstaged). Small volume prostate and tumor are also the single most important factor for successful cryotherapy and seed implantation (brachytherapy), as well as being beneficial to radiotherapy and radical surgery.

Recently, combination androgen ablation therapy was introduced and became commercially available to maximize androgen blockade.

There are two major organs in the human body that excrete male hormone. The major source is testicles. These can be blocked utilizing LHRH agonists, such as LUPRON or ZOLADEX. Another source of androgen is the adrenal glands. Their function can be blocked using antiandrogen drugs, such as FLUTAMIDE or CASODEX. Lupron and Zoladex are injection forms of medication while Flutamide and Casodex are oral forms.

There are known complications on these drugs, including: hot flash, diarrhea, insomnia, liver function damage and untold effects on the cardiovascular system. Therefore, strict supervision by a physician is mandatory.

In conclusion, hormonal deprivation therapy is known to be effective as a primary form of treatment in selected cases. It is recommended for use in conjunction with other treatment modalities due to its known downsizing and downstaging effect on the cancer. Pretreatment with hormonal therapy, followed by more definite curative measures (cryosurgery, radical surgery, radiation therapy, brachytherapy) is usually recommended.