Testosterone serves as the main fuel for prostate cancer cells to grow and survive. That’s why it’s a common target for therapeutic intervention.
Hormone therapy, also known as androgen-deprivation therapy (ADT), is designed to stop testosterone from being released or to prevent it from acting on the prostate cells.
Although ADT plays an important role in men with advancing prostate cancer, it is increasingly being used before, during, or after local treatment as well. It will likely be a part of every man’s therapeutic regimen at some point during his fight against recurrent or advanced prostate cancer.
Because some cells grow independently of testosterone, ADT is not a full-proof strategy. It often must be used in concert with other treatments.
The Most Common Types of Hormone Therapy
About 90% of testosterone is produced by the testicles. Orchiectomy—the surgical removal of the testicles—is effective for blocking testosterone release.
The procedure is typically done on an outpatient basis in the urologist’s office. Recovery tends to be rather quick with no further hormone therapy needed, which is good for a man who prefers a low-cost, one-time procedure.
Because this approach is permanent and irreversible, most men opt for drug therapy instead.
LHRH, or luteinizing-hormone releasing hormone, is one of the key hormones released by the body before testosterone is produced. Blocking its release is the most common hormone therapy option.
This is done with drugs administered through regular shots once a month, once every three, four, or six months, or once per year.
However, these drugs can create a testosterone surge or flare reaction because of an initial transient rise in testosterone over the first three weeks after the shot. This can result in a variety of symptoms, ranging from bone pain to urinary frequency or difficulty. This flare reaction can be prevented with the addition of anti-androgens, which can help block the action of testosterone in prostate cancer cells.
A newer class of medications can block LHRH from stimulating testosterone production without causing an initial testosterone surge. This class includes degarelix, which is given monthly to men as an alternative to orchiectomy or LHRH agonists.