Hormone Therapy Before Prostate Radiation

Men with prostate cancer may undergo hormone therapy before getting radiation treatments if they have a high risk of cancer recurrence or to attempt to shrink a tumor so that radiation or other treatment eliminates the cancer. Men who have had prostate cancer surgery and those refusing radiation or chemotherapy may also choose hormone therapy. Before opting for this therapy, cancer patients should consider their quality of life, the cost of treatment and treatment safety and effectiveness.

Delaying metastasis

• If prostate cancer has spread beyond the gland, oncologists may recommend hormone therapy, although it does not cure cancer. Hormone therapy delays the spread, or metastasis, of cancer, and boosts the patient's chances of survival while improving his quality of life.
  Doctors can try several kinds of hormone treatment before suggesting chemotherapy or radiation treatment.

Hormones used

• The male hormone testosterone and similar hormones, or androgens, cause prostate cancer to grow and spread. Hormone treatment can halt testosterone and androgen production temporarily or permanently.
  Hormone treatments include injections and pills, which prevent the testicles from making testosterone and protect cells from other androgens in the body.

How therapy works

• Usually, doctors prescribe drugs that reduce testosterone levels or block how male hormones act upon organs. Medicines include anti-androgen agents and luteinizing hormone-releasing hormone, or LHRH, analogs. In addition to decreasing testosterone from the testicles, the drugs may act upon the adrenal glands, which also produce hormones.
  When a patient first receives LHRH analogs, testosterone production rises briefly before falling to low levels. Called flare, this happens due to the complex way that LHRH analogs function. Men whose cancer has metastasized to their bones may have some bone pain. If the cancer has spread to his spine, even a brief increase in growth could compress the spinal cord and cause pain or paralysis. Doctors can prevent flare by prescribing anti-androgens for a few weeks when treatment begins.
  Physicians may use the female hormone estrogen to counter testosterone production. Due to estrogen's possible side effects, such as blood clots and breast growth, estrogens have been replaced with anti-androgens and other drugs. Estrogens may be tried, though, if androgen deprivation is no longer working.

Surgical removal

• Occasionally, doctors will remove the testicles. This stops the hormones from fueling more cancer growth. More than 90 percent of androgens, mostly testosterone, are made in the testicles.
  Surgery can be done on an outpatient basis, and is probably the least expensive and easiest way to reduce androgen levels. It is permanent, though, and many men have trouble accepting the lack of testicles, often because of how it looks. Surgeons can implant artificial silicone sacs, which look like testes, into the scrotum.

Side effects

• Hormone therapy has some undesirable side effects, including lower or no sexual desire, impotence, hot flashes which may be temporary, breast tenderness and growth, osteoporosis, anemia, less mental ability, muscle mass loss, weight gain, fatigue, higher cholesterol levels, depression, high blood pressure, diabetes and even heart attacks.
  While anti-androgens have similar side effects, they seem to have less effect on the libido. If anti-androgens are used alone, libido and potency often aren't affected. If these drugs are combined with LHRH analogs, however, diarrhea, nausea and liver problems may occur.
  Most men can take hormone therapy safely for several years. Inevitably, though, most prostate cancers can grow with few or no male hormones. If this happens, hormone therapy will no longer work, and your doctor may suggest radiation or chemotherapy.