Hormonal therapy

Prostate cancer needs the male sex hormone testosterone for its growth. The aim of hormone therapy is therefore to prevent the production of testosterone in the patient’s body or to prevent its effect on the tumour cells. As a result of the administration of hormone therapy, the PSA drops to zero and the metastases are reduced or disappear.

The production of testosterone is blocked by the so-called castration therapy, which can be performed surgically or with the help of drugs.

Surgical treatment affecting testosterone production consists of bilateral removal of the testicles (bilateral orchiectomy). The advantages of the treatment is the rapid onset of action, the possibility of performing it under local anaesthesia and the absence of the need to check testosterone levels during follow-up. The disadvantage is the psychological and cosmetic effect, when the patient loses a certain feature of his “manhood”.

Drug castration:

It is performed by injections that block the production of testosterone at the level of the hypothalamus and subsequently in the testes. Injections are given every 1-3 months intramuscularly or subcutaneously. The disadvantage is the need for regular checks of testosterone levels. In about one tenth of patients these injections do not work, then the above-mentioned surgery is performed.

Another option is to use direct blockers of hypothalamic hormone production, so-called production antagonists (degarelix).

The last option is to block the special receptors for testosterone on the surface of the tumour cells using so-called antiandrogens. This is in tablet form, most commonly one tablet a day. Liver function must be monitored regularly during treatment.

In general, the disadvantage of hormone treatment is the induction of the so-called male menopause=andropause (“transitions”), when hot flushes, breast enlargement, decreased sexual desire (libido), erectile dysfunction, weight gain, fatigue, muscle loss and thinning of the bones (osteoporosis) may occur. When PSA increases during treatment with one procedure (e.g. after testicular removal), the patient is then advised to undergo another procedure (i.e. tablet hormone therapy) to ensure maximum testosterone blockade = maximum androgen blockade.

Hormonal treatment is also administered in selected groups of patients, depending on the type of tumour, several months before and during radiotherapy for prostate cancer. In some patients, hormone therapy is given even after the end of radiotherapy.