When is Hormone Therapy Used for Prostate Cancer


Farshid Dayyani: Hormone therapy is highly
effective and used in all stages of prostate cancer. By hormone therapy, we actually mean antihormonal
therapy or reducing the serum testosterone levels. This is highly effective in controlling
the growth and progression of prostate cancer cells in early stage as well as advanced stage.
So, let’s review the indication and use of this therapy for each stage. In localized
prostate cancer, meaning prostate cancer that has not spread to other organs. The treatment
options include observation of the patients with very low risk disease, radical prostatectomy,
or radiation therapy. There are clinical factors that try to predict the risk for this patient
to have a recurrence of his cancer after local therapy. Those include a so called Gleason
score, the serum PSA level and the size or clinical stage of the tumor at diagnosis.
Based on those criteria, we classify patients in low risk, intermediate risk, and higher
risk. This is important because if the patient chooses to undergo radiation therapy for an
intermediate risk disease, it is recommended to combine the radiation with six-month of
hormone deprivation therapy. In big trials, we have seen that patients live longer if
they receive six-month of hormone therapy in addition to radiation compared to radiation
alone. If the patient is higher risk, for example with a PSA greater than 20 or a Gleason
score of 8 or greater and he chooses to undergo radiation then the combination with hormone
therapy should be significantly longer. We know that three years of hormone deprivation
is superior to six month of hormone deprivation in higher risk patients, but given the scientifics
of hormone deprivation, the new trials are tying to see whether we can come down to two
years. In the more advanced prostate cancer, meaning when the cancer has spread to other
organs, the first line of therapy is actually to reduce the patient’s testosterone level
with hormone deprivation therapy. More than 8 or 9 out of 10 patients will benefit upfront
from this treatment, the pain will get better, the lymph nodes will shrink, and the PSA will
come down. Unfortunately, this will last only on an average for 18 to 24 months before other
treatments have to be added to that modality. Some prostate cancers are high risk, aggressive,
and more likely to spread. Others are low risk, least likely to have bad outcomes. The
biopsy says cancer, but current diagnostic tools provide limited information about how
aggressive a man’s individual disease is, so most men decide to treat prostate cancer
immediately. Once treated, many men experience serious long-term side effects like incontinence
and sexual impotence. Immediate treatment is not always needed, but right now a man
can’t be sure if his cancer is the kind that is likely to require treatment or if he is
okay to wait for now. What if there was a test that could determine how aggressive prostate
cancer is. Genomic health is developing a new test to do just that. By reviewing the
underlying biology of the tumor and using genes from multiple biologic pathways, the
test can predict the aggressiveness of prostate cancer when diagnosed, allowing a man to make
a more informed treatment decision with confidence, taking care of himself with more information
and greater peace of mind.

1 thought on “When is Hormone Therapy Used for Prostate Cancer

  1. why don't you say to STOP ALL SUGAR…we know cancer cells can only grow with sugar. for a pet scan you have to be off sugar for at least 24hr before test because the tumers cell take up the sugar in the IV along with the small amount of isotopes and show up on the pet scan. your cells can work just fine using ketons for fule but cancer cells need sugar to grow and cannot use ketons for growth,but not one of my oncologists would even speak to me on that subject. All of you learn this in med school but no $$$ for you if you put patients on a strict keto diet and let them know Sugar, prossesed food,Beer,soda is the building blocks of cancer tumers. Why? please check this out before you let anyone inject you with posion…

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