Metro Urology

WHAT IS HORMONAL ABLATION?

Hormonal ablation therapy stops cancer growth by getting rid of or blocking the effect of testosterone in a man’s body. Testosterone is typically the driver of cancer growth, and by removing the testosterone from a man’s body the cancer will stop growing and regress. There are many names for this kind of treatment: Hormone Therapy, Androgen Blockade, Antiadrogen Treatment are commonly used.

IF THE CANCER STOPS GROWING, ISN’T THAT A CURE?

Yes, the cancer stops growing for a period of time, but most cancers will begin to grow again despite the lack of testosterone. In other words, the cancer becomes “hormone-refractory”. Most cancers stop growing for an average of 2-3 years.

WHEN ARE HORMONES USED?

Hormones are used most often for cancer that has spread outside of the prostate and cannot be controlled with other therapies. Some older men choose Hormones as their treatment because they are not candidates for other treatments.

MY DOCTOR HAS PUT ME ON HORMONES BUT I AM HAVING ANOTHER TREATMENT ALSO.

This type of combined therapy is common, and it is used to make the cancer more sensitive to the other treatment (usually radiation therapy) or to decrease the size of the prostate to make it easier to treat. Some cancers have already spread outside of the prostate and therefore hormones are used to control the cancer outside of the prostate while a treatment to the prostate itself if used to treat any symptoms you may be having.

HOW IS THE TESTOSTERONE BLOCKED?

There are several ways that we can affect the level of testosterone in a man’s body.

The majority of the testosterone in the body is made by testicles. The simplest way of removing testosterone, then, is to remove the testicles. Removing the testicles (orchiectomy) has fallen out of favor as we now have medications that stop the testicles from producing testosterone.

Medications called LHRH-agonists (Lupron, Zoladex, Eligard) fool the brain not to signal the testicles to make testosterone. These medications are usually the treatment of choice when beginning hormone therapy and are most often chosen when a single medication (monotherapy) is going to be used. They are usually delivered by injection every few months, but an implantable pellet that lasts one year is also possible.

Some of the body’s testosterone (5-10%) and testosterone-like hormones are made in the adrenal glands, and there are cancers that are sensitive to that low level of hormone. There are medications (Casodex, Flutamide, Nilutamide) that block that level of hormone by not allowing the body to recognize the hormone. These medications are most often used in conjunction with the LHRH-agonists.

There are medications (Proscar, Avodart) that inhibit the body’s cells from converting the testosterone absorbed into the body’s cells into its active form, dihydrotestosterone (or DHT). This form of medication is used most often for non-cancerous enlargement of the prostate and is not often used for cancer.

WHAT ARE THE SIDE EFFECTS OF HORMONAL ABLATION?

Testosterone is the main male hormone. Testosterone increases in a man’s body during puberty to help develop the man’s body. As an adult the testosterone helps men maintain energy, sex drive, muscle mass, and bone structure. When the testosterone is blocked most men experience fatigue, lowered sex drive, and “hot flashes”. Weight gain, erectile dysfunction, bone loss, anemia, mild muscle weakness, breast tenderness or growth are also possible but are experienced less frequently.

HOW DO I KNOW IF THE HORMONES ARE WORKING?

The PSA blood test is very sensitive to the effects of the hormone treatments. If the hormones are effective the PSA will drop to a very low number (often undetectable levels). When the cancer becomes hormone-refractory the PSA will begin to rise. Your doctor may then discuss adjusting the hormone treatments or begin to discuss other treatments.

DO I EVER GET OFF THE HORMONES?

Some physicians and patients choose to take the hormones intermittently. By following the PSA carefully the physician can tell when the cancer is beginning to grow and will choose to give the hormones at that time to make the cancer stop growing a regress. Because many patients have side effects on the hormones, by intermittently going off of the hormones patient can have a respite from the side effects.