Hormonal therapy

With hormonal therapy, the goal is to cut off all production of male hormones, such as testosterone, resulting in castration. 

Castration can be surgical or medical but the end result is the same and for good reason.

Prostate cancer cells can actually “feed” on male hormones causing them to grow.  Blocking the hormones with an antiandrogen (drugs that block male hormones from circulating in the blood) will slow the growth of the cancer cells.  This process is the equivalent of a medical castration.

There are numerous approaches to the use of hormonal therapy.  Different drugs have been combined to test the results.  An example of one such combination is known as maximum androgen blockade.  This is a total hormonal therapy usually combined with either surgical or medical castration.  An antiandrogen pill is ingested each day for months or years. 

Evidence as to the efficacy of this approach has proven that there is no significant difference in the effectiveness of this process as opposed to standard hormonal therapy.  However, surgical and hormonal therapies in combination do seem to relieve symptoms.

When considering surgical castration versus medical castration, it’s important to keep one fact in mind.  Medical castration can be reversed simply by ending use of the drug.  Oddly enough, in some cases ceasing the hormonal treatment has temporarily interrupted the growth of the cancer.

While hormonal therapy in the case of metastatic cancer seems to work, sadly, the reprise is only temporary.  Remission will normally last for 2 or three years.  At some point, those cancer cells that do not need testosterone to grow will begin the growth cycle again.  If this takes place a second array of hormonal drugs (progesterone or hydrocortisone to name two) may be considered.