Is Hormone Therapy for Prostate Cancer Right for Me?

There are many different types of treatment for prostate cancer, including surgery, active surveillance, radiation and hormone therapy.

Androgens are hormones required for normal function of the prostate. They promote the growth of both normal and cancerous prostate cells by binding to and activating a protein called the androgen receptor. Early in their development, prostate cancers need relatively high levels of androgens to grow. Such cancers are called androgen dependent because treatments that decrease androgen levels or block their activity can stop their growth.

What is androgen deprivation therapy?
Androgen deprivation therapy, or ADT, is a treatment that reduces androgen production. This form of hormone therapy includes:

• Orchiectomy, surgical procedure to remove one of both testicles—removal of the testicles can reduce the level of testosterone in the blood by up to 95%. This type of treatment is permanent and irreversible.
• Drugs called luteinizing hormone-releasing hormone (LHRH) agonists or LHRH antagonists—these cause the pituitary gland to stop producing luteinizing hormone, and as a result the testicles are not stimulated to produce androgens. These can be given by injection and the effects of the drugs on androgen production can be reversible once the treatment is stopped.
• Drugs called androgen synthesis inhibitors—these prevent the production of androgens by the adrenal glands and prostate cells themselves, as well as by the testicles. They block testosterone production by inhibiting an enzyme necessary for the body to make testosterone. There are multiple approved androgen synthesis inhibitors in the United States and they are given in pill form.

Who should receive hormone therapy?
Hormone therapy may be used in several ways to treat prostate cancer, including:

• Men with early-stage prostate cancer with an intermediate or high risk of recurrence can receive hormone therapy before, during and/or after radiation therapy or surgery to remove the prostate gland (called a prostatectomy).
• Hormone may be recommended for men with recurrent prostate cancer after previous treatment with radiation or surgery.
• Hormone therapy can be used for men who have advanced or metastatic prostate cancer.

What are the side effects of hormone therapy?
Because androgens are used by many other organs besides the prostate, ADT can have a wide arrange of side effects, including:

• Loss of interest in sex
• Erectile dysfunction
• Hot flashes
• Loss of bone density
• Fatigue
• Loss in muscle mass and strength
• Weight gain
• Mood swings
• Insulin resistance

A new study from Penn Medicine found long-term ADT is associated with higher rates of Alzheimer’s disease and dementia. Researchers followed more than 154,000 men over age 65 diagnosed with prostate cancer for 10 years and found 13% of the men who received ADT were diagnosed with Alzheimer’s compared to 9% who didn’t receive the hormone therapy. Twenty-two percent of the men who were given ADT were eventually diagnosed with dementia, compared to 16% who weren’t.

Prostate cancer treatment is not a one-size-fits-all approach. Talk to your doctor to make sure you receive the right treatment for you.