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Hormonal Therapy in Prostate Cancer Dr.Ahmad Kharrouby
<ul><li>Androgen deprivation induces a remission in 80 to 90 percent of men with advanced prostate cancer </li></ul><ul><l...
Indications <ul><li>Metastatic Prostate Cancer </li></ul><ul><li>In recurrence after XRT or Surgery, most patients receive...
Nobel Prize <ul><li>The scientist Charles Huggins first established this over 60 years ago in work that led to his winning...
Androgens Sources <ul><li>About 90% to 95% of all androgens are made in the testicles </li></ul><ul><li>While the rest are...
How Does Hormone Therapy Work?  <ul><li>By either: </li></ul><ul><ul><li>Preventing the body from making these androgens  ...
In what Percentage? <ul><li>In 85% to 90% of cases, it can shrink the tumor </li></ul><ul><li>However, hormone therapy for...
What Types of Hormone Therapy Are There?  <ul><li>There are two basic kinds: </li></ul><ul><ul><li>One class of drugs stop...
Here's a rundown of the techniques
LHRH Agonists <ul><li>The inhibitory action is due to a combination of receptor down-regulation and changes in the signali...
LHRH Agonists <ul><li>Side effects can be significant. They include:  </li></ul><ul><ul><li>Loss of sex drive </li></ul></...
Anti-androgens <ul><li>LHRH agonists and orchiectomies only affect the testicular androgens </li></ul><ul><li>Thus they ha...
<ul><li>In some cases, starting treatment with an LHRH agonist can cause a &quot;tumor flare,&quot; a temporary accelerati...
<ul><li>Strangely, if treatment with an anti-androgen doesn't work, stopping it may actually improve symptoms for a short ...
Combined Androgen Blockade <ul><li>This approach combines anti-androgens with LHRH agonists or an orchiectomy </li></ul><u...
Estrogens <ul><li>In fact, they were one of the early treatments used for the disease </li></ul><ul><li>However, because o...
Other Drugs <ul><li>Proscar (finasteride)  </li></ul><ul><li>Nizoral (ketoconazole)  </li></ul><ul><li>Cytadren (aminoglut...
Orchiectomy <ul><li>The surgical removal of the testicles was the earliest form of hormone therapy for prostate cancer </l...
<ul><li>Hormone therapy for prostate cancer can cause osteoperosis </li></ul><ul><li>However, treatment with bisphosphonat...
What Type of Hormone Therapy Works Best?  <ul><li>LHRH agonists remain the usual first treatment </li></ul><ul><li>But in ...
Different Approaches to Starting Hormone Therapy  <ul><li>Experts debate how early treatment with hormone therapy should b...
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Hormonal Therapy In Prostate Cancer

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Transcript of "Hormonal Therapy In Prostate Cancer"

  1. 1. Hormonal Therapy in Prostate Cancer Dr.Ahmad Kharrouby
  2. 2. <ul><li>Androgen deprivation induces a remission in 80 to 90 percent of men with advanced prostate cancer </li></ul><ul><li>And results in a median progression-free survival of 12 to 33 months </li></ul>
  3. 3. Indications <ul><li>Metastatic Prostate Cancer </li></ul><ul><li>In recurrence after XRT or Surgery, most patients receive androgen ablation therapy </li></ul><ul><li>Most patients with T3 are, at the present time, treated with neoadjuvant hormonal therapy followed by XRT </li></ul>
  4. 4. Nobel Prize <ul><li>The scientist Charles Huggins first established this over 60 years ago in work that led to his winning the Nobel Prize </li></ul><ul><li>Huggins found that Bilateral orchiectomy could slow the growth of the disease </li></ul>
  5. 5. Androgens Sources <ul><li>About 90% to 95% of all androgens are made in the testicles </li></ul><ul><li>While the rest are made in the adrenal glands </li></ul>
  6. 6. How Does Hormone Therapy Work? <ul><li>By either: </li></ul><ul><ul><li>Preventing the body from making these androgens </li></ul></ul><ul><ul><li>Or by blocking their effects </li></ul></ul>
  7. 7. In what Percentage? <ul><li>In 85% to 90% of cases, it can shrink the tumor </li></ul><ul><li>However, hormone therapy for prostate cancer doesn't work forever </li></ul>
  8. 8. What Types of Hormone Therapy Are There? <ul><li>There are two basic kinds: </li></ul><ul><ul><li>One class of drugs stops the body from making these hormones </li></ul></ul><ul><ul><li>The other blocks its effects </li></ul></ul><ul><li>Some start treatment with both to achieve a total androgen block, but it is not the rule </li></ul>
  9. 9. Here's a rundown of the techniques
  10. 10. LHRH Agonists <ul><li>The inhibitory action is due to a combination of receptor down-regulation and changes in the signaling pathways activated by GnRH </li></ul><ul><li>During the first 7–10 days, serum testosterone levels increase </li></ul><ul><li>Within about 2 weeks, serum testosterone levels fall to the hypogonadal range </li></ul><ul><li>Most LHRH agonists are injected every one to four months </li></ul><ul><li>Some examples are Lupron, Trelstar, Vantas, and Zoladex </li></ul><ul><li>A new drug, Viadur, is an implant placed in the arm just once a year </li></ul>
  11. 11. LHRH Agonists <ul><li>Side effects can be significant. They include: </li></ul><ul><ul><li>Loss of sex drive </li></ul></ul><ul><ul><li>Hot flashes </li></ul></ul><ul><ul><li>Development of breasts (gynecomastia) </li></ul></ul><ul><ul><li>Loss of muscle </li></ul></ul><ul><ul><li>Weight gain </li></ul></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><li>Decrease in levels of HDL </li></ul></ul>
  12. 12. Anti-androgens <ul><li>LHRH agonists and orchiectomies only affect the testicular androgens </li></ul><ul><li>Thus they have no effect on the 5% to 10% that are made in the adrenal glands </li></ul><ul><li>Anti-androgens are designed to affect the hormones made in the adrenal glands </li></ul><ul><li>The advantage of anti-androgens is that they have fewer side effects than LHRH agonists </li></ul><ul><li>Many men prefer them because they are less likely to diminish libido </li></ul><ul><li>Taken as pills each day </li></ul><ul><li>Examples are Casodex, Eulexin, and Nilandron </li></ul>
  13. 13. <ul><li>In some cases, starting treatment with an LHRH agonist can cause a &quot;tumor flare,&quot; a temporary acceleration of the cancer's growth due to an initial increase in testosterone before the levels drop </li></ul><ul><li>This may worsen symptoms </li></ul><ul><li>Thus starting with an anti-androgen drug and then switching to an LHRH agonist can help avoid this problem </li></ul>
  14. 14. <ul><li>Strangely, if treatment with an anti-androgen doesn't work, stopping it may actually improve symptoms for a short time </li></ul><ul><li>This phenomenon is called &quot;androgen withdrawal,&quot; and experts aren't sure why it happens </li></ul>
  15. 15. Combined Androgen Blockade <ul><li>This approach combines anti-androgens with LHRH agonists or an orchiectomy </li></ul><ul><li>By using both approaches, you can cut off or block the effects of hormones made by both the adrenal glands and the testicles </li></ul><ul><li>However, using both treatments can also increase the side effects </li></ul>
  16. 16. Estrogens <ul><li>In fact, they were one of the early treatments used for the disease </li></ul><ul><li>However, because of their serious cardiovascular side effects, they're not used as often anymore </li></ul><ul><li>Examples of estrogens are DES (diethylstilbestrol), Premarin, and Estradiol </li></ul>
  17. 17. Other Drugs <ul><li>Proscar (finasteride) </li></ul><ul><li>Nizoral (ketoconazole) </li></ul><ul><li>Cytadren (aminoglutethimide) </li></ul>
  18. 18. Orchiectomy <ul><li>The surgical removal of the testicles was the earliest form of hormone therapy for prostate cancer </li></ul><ul><li>As with LHRH agonists, side effects can be significant </li></ul><ul><li>However, it can be the right choice in certain cases </li></ul><ul><ul><li>Non compliant men </li></ul></ul><ul><ul><li>Non sexually active men </li></ul></ul><ul><ul><li>Financial reasons </li></ul></ul>
  19. 19. <ul><li>Hormone therapy for prostate cancer can cause osteoperosis </li></ul><ul><li>However, treatment with bisphosphonates -- like Aredia, Fosamax, and Zometa -- may help prevent this condition from developing </li></ul>
  20. 20. What Type of Hormone Therapy Works Best? <ul><li>LHRH agonists remain the usual first treatment </li></ul><ul><li>But in some cases, doctors are trying anti-androgens first </li></ul><ul><li>Anti-androgens may be especially appealing to younger men who are still sexually active </li></ul><ul><li>Others prefer to begin therapy with a combination of two or even three drugs, especially for patients with symptoms or advanced disease </li></ul><ul><li>Some studies have shown slightly longer survival with combined androgen blockade, but the results haven't been encouraging </li></ul>
  21. 21. Different Approaches to Starting Hormone Therapy <ul><li>Experts debate how early treatment with hormone therapy should be started </li></ul><ul><li>Some argue that the benefits of hormone therapy for prostate cancer should be offered to men earlier in the course of the disease </li></ul><ul><li>Others assert that there's little evidence that getting treatment early is better than getting it later, especially that these drugs have serious side effects </li></ul>
  22. 22. Thank you
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