Hormonal therapy for prostate cancer is effective in 80-90% of advanced cases, primarily through androgen deprivation techniques. Various hormonal therapies exist, including LHRH agonists and anti-androgens, with some approaches combining both to enhance efficacy while managing side effects. The choice of therapy may vary based on patient status and preferences, and there is ongoing debate regarding the timing and combination of treatments.

1. Hormonal Therapy in Prostate Cancer Dr.Ahmad Kharrouby

2. Androgen deprivation induces a remission in 80 to 90 percent of men with advanced prostate cancer And results in a median progression-free survival of 12 to 33 months

3. Indications Metastatic Prostate Cancer In recurrence after XRT or Surgery, most patients receive androgen ablation therapy Most patients with T3 are, at the present time, treated with neoadjuvant hormonal therapy followed by XRT

4. Nobel Prize The scientist Charles Huggins first established this over 60 years ago in work that led to his winning the Nobel Prize Huggins found that Bilateral orchiectomy could slow the growth of the disease

5. Androgens Sources About 90% to 95% of all androgens are made in the testicles While the rest are made in the adrenal glands

6. How Does Hormone Therapy Work? By either: Preventing the body from making these androgens Or by blocking their effects

7. In what Percentage? In 85% to 90% of cases, it can shrink the tumor However, hormone therapy for prostate cancer doesn't work forever

8. What Types of Hormone Therapy Are There? There are two basic kinds: One class of drugs stops the body from making these hormones The other blocks its effects Some start treatment with both to achieve a total androgen block, but it is not the rule

9. Here's a rundown of the techniques

10. LHRH Agonists The inhibitory action is due to a combination of receptor down-regulation and changes in the signaling pathways activated by GnRH During the first 7–10 days, serum testosterone levels increase Within about 2 weeks, serum testosterone levels fall to the hypogonadal range Most LHRH agonists are injected every one to four months Some examples are Lupron, Trelstar, Vantas, and Zoladex A new drug, Viadur, is an implant placed in the arm just once a year

11. LHRH Agonists Side effects can be significant. They include: Loss of sex drive Hot flashes Development of breasts (gynecomastia) Loss of muscle Weight gain Fatigue Decrease in levels of HDL

12. Anti-androgens LHRH agonists and orchiectomies only affect the testicular androgens Thus they have no effect on the 5% to 10% that are made in the adrenal glands Anti-androgens are designed to affect the hormones made in the adrenal glands The advantage of anti-androgens is that they have fewer side effects than LHRH agonists Many men prefer them because they are less likely to diminish libido Taken as pills each day Examples are Casodex, Eulexin, and Nilandron

13. In some cases, starting treatment with an LHRH agonist can cause a "tumor flare," a temporary acceleration of the cancer's growth due to an initial increase in testosterone before the levels drop This may worsen symptoms Thus starting with an anti-androgen drug and then switching to an LHRH agonist can help avoid this problem

14. Strangely, if treatment with an anti-androgen doesn't work, stopping it may actually improve symptoms for a short time This phenomenon is called "androgen withdrawal," and experts aren't sure why it happens

15. Combined Androgen Blockade This approach combines anti-androgens with LHRH agonists or an orchiectomy By using both approaches, you can cut off or block the effects of hormones made by both the adrenal glands and the testicles However, using both treatments can also increase the side effects

16. Estrogens In fact, they were one of the early treatments used for the disease However, because of their serious cardiovascular side effects, they're not used as often anymore Examples of estrogens are DES (diethylstilbestrol), Premarin, and Estradiol

17. Other Drugs Proscar (finasteride) Nizoral (ketoconazole) Cytadren (aminoglutethimide)

18. Orchiectomy The surgical removal of the testicles was the earliest form of hormone therapy for prostate cancer As with LHRH agonists, side effects can be significant However, it can be the right choice in certain cases Non compliant men Non sexually active men Financial reasons

19. Hormone therapy for prostate cancer can cause osteoperosis However, treatment with bisphosphonates -- like Aredia, Fosamax, and Zometa -- may help prevent this condition from developing

20. What Type of Hormone Therapy Works Best? LHRH agonists remain the usual first treatment But in some cases, doctors are trying anti-androgens first Anti-androgens may be especially appealing to younger men who are still sexually active Others prefer to begin therapy with a combination of two or even three drugs, especially for patients with symptoms or advanced disease Some studies have shown slightly longer survival with combined androgen blockade, but the results haven't been encouraging

21. Different Approaches to Starting Hormone Therapy Experts debate how early treatment with hormone therapy should be started Some argue that the benefits of hormone therapy for prostate cancer should be offered to men earlier in the course of the disease 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

22. Thank you