Hormone therapy | Treatment of prostate cancer

Hormone therapy

Especially if the prostate carcinoma is already in an advanced stage, hormone therapy (anti-androgenic therapy) is indicated. Hormone therapy for prostate cancer can be used either alone or in combination with surgery or radiotherapy. In this case, the patient is administered certain hormones, so-called anti-androgens, which ensure that the tumour cells no longer divide and the cancer does not spread further.

Antiandrogens are preparations which cancel the effect of the male sex hormones (androgens) and thus lead to a hormone withdrawal in the patient’s body. Since prostate cancer is a type of cancer that almost always grows hormone-dependent (especially testosterone-dependent), anti-hormonal treatment slows down tumour growth. Tumours that do not respond to hormone withdrawal therapy and still continue to grow are called “hormone-deaf”.

Approved drugs used in antiandrogenic therapy include androgen receptor blockers (bicalutamide, flutamide), GnRH antagonists (Defarelix, Abarelix) or GnRH analogues (goserelin, leuprorelin). Oestrogens (Fosfestrol) are rarely used nowadays in the hormone therapy of prostate cancer. The hormones are either taken in tablet form or injected under the skin as a depot injection.

Alternatively, there is also the possibility of an orchiectomy (castration), as the majority of male sex hormones are produced in the testicles. However, hormone therapy can only inhibit the growth of the tumour, but cannot lead to complete healing. Therefore, hormone therapy is the treatment of first choice in cases of inoperable findings, metastases (scattered tumour metastases in the body) or lymph node infestation. However, it must be remembered that after two to three years, a large proportion of tumours become resistant to hormone withdrawal and the treatment therefore no longer responds. and hormone therapy for prostate cancer

Which treatment is the best for me?

The treating team of doctors decides which treatment is the best therapy option for the patient in each individual case. Affected persons should seek comprehensive advice from their doctor as to which treatment option is best for them and which side effects they are most likely to cope with. Often it can also make sense to get a second opinion in another clinic before deciding on treatment.

The type of treatment depends mainly on the stage of the tumour and how aggressively it is growing. In the case of localised tumours with a low risk profile, which are still in the prostate and have not spread to the surrounding tissue, the cancer does not necessarily need to be treated. One waits in a controlled manner (“active surveillance”) and examines the tumour at regular intervals.

This strategy is particularly suitable for older patients. Only if the tumour marker PSA continues to rise or the cancer causes symptoms, surgery or radiation can be considered. Patients who are in poor general condition and are not stable enough for surgery can be treated with hormone therapy. Advanced prostate cancer is treated by surgery or radiation in combination with a much more aggressive chemotherapy. If metastases have already metastasized and affected lymph nodes or other organs in the body, there is the option of anti-androgenic hormone treatment or chemotherapy.