Hormone Treatment for Prostate Cancer


Email Raji.Kooner@svha.org.au or call 02 8382 6980 for a confidential appointment.

Hormone therapy for prostate cancer is a very important topic and it’s really evolving as to when you should treat patients with hormone therapy and whether they should be on it all the time or an intermittent basis.1

You can divide the hormones into the LHRH agonists and into anti-androgens.2

The LHRH acts centrally, they result in a decreased testereone level3 from the testes and that is how they work and that’s why they have their side effects.

The commonly used agents in Australia are prescription medications.

They’re all by different companies, they have the same efficacy4.

They’re usually given as an injection either subcutaneously in the abdomen or intramuscularly and they can be given on a one monthly, three monthly or a six monthly basis.

In general they do have side effects which may include hot flushes, some lethargy, some erectile dysfunction and maybe some breast enlargement.5

There is some work getting done to show that long term hormone therapy can result in other problems such as bone thinning and some other problems.6

So this is getting analysed at the moment.

Anti-androgens work at the level where testereone interacts with the receptor and so these agents may also affect the testereone that comes from other sources besides the testes such as the adrenal glands.7

So these agents are also prescription medications.

The studies that have been done have shown that the LHRH agonists by themselves are probably just as efficacious as opposed to using the LHRH agonists with an anti-androgen.8

There was a big study done at the Lancet which proved the efficacy of these two ways of treatment were very similar, so hence we now usually just use LHRH agonist.9

This is the equivalent of performing a surgical castration or removing the testes.

One of the advantages of going on injection therapy is that we can give pulse or intermittent therapy and there’s a lot of data on intermittent androgen blockade10 now showing that we think the outcomes are at least equivalent but what we say to patients is we’re really not sure if they’re better, worse or the same. 

The data is coming out showing that probably the outcome is the same with a better quality of life because you have less side effects.11

So we can give patients a pulse of hormone therapy, stop it, monitor their PSA, if the PSA goes up treat it again.

So that’s how hormone therapy is used. 

The indications are usually in patients that have advanced disease, maybe spread of disease or maybe in very elderly men. 

Sometimes it’s used in combination with radiotherapy because the results have shown that in active cancers radiotherapy plus hormones give better results than just radiotherapy by themselves.12

So it’s, it’s a very important treatment modality and it’s important for patients to be aware of the potential side effects. Treatment is usually provided by general practitioners, it’s not very uncomfortable and it’s well tolerated.13

References

1. Xavier Bonfill-Cosp, Ariadna Auladell-Rispau, Ignasi Gich, et al - Prevalence study of intermittent hormonal therapy of Prostate Cancer patients in Spain - PMID: 36330533 - doi: 10.12688/f1000research.53875.2
2. Types of Hormone Therapy - Prostate Cancer Foundation - https://www.pcf.org/about-prostate-cancer/prostate-cancer-treatment/hormone-therapy-prostate-cancer/types
3. David Homewood, Ming Hei Fu, Niranjan Sathianathen - Evolution of hormonal therapy for prostate cancer - Australian Journal of General Practice - doi: 10.31128/AJGP-11-23-7028
4. Davide Meani, Mladen Solarić, Harri Visapää, et al. - Practical differences between luteinizing hormone-releasing hormone agonists in prostate cancer: perspectives across the spectrum of care - Ther Adv Urol. 2018 Feb; 10(2): 51–63. - doi: 10.1177/1756287217738985 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805008/
5. What are the side effects of hormone therapy for prostate cancer? - National Cancer Institute - https://www.cancer.gov/types/prostate/prostate-hormone-therapy-fact-sheet
6. Gerald L Andriole, Jr - The Impact of Prostate Cancer and Hormonal Therapy on Bone - Rev Urol. 2009 Fall; 11(4): 185–189 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC280998
7. Edina C. Wang, Robert Lee, Andrew J. Armstrong - Second Generation Anti-Androgens and Androgen Deprivation Therapy with Radiation Therapy in the Definitive Management of High-Risk Prostate Cancer - Prostate Cancer Prostatic Dis. 2023 Mar; 26(1): 30–40 - doi: 10.1038/s41391-022-00598-3
8. Nicola J. Nasser - Androgen Flare after LHRH Initiation Is the Side Effect That Makes Most of the Beneficial Effect When It Coincides with Radiation Therapy for Prostate Cancer - Cancers (Basel). 2022 Apr - doi: 10.3390/cancers14081959
9. Anders Widmark, Olbjorn Klepp, Arne Solberg, et al. - Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial - https://doi.org/10.1016/S0140-6736(08)61815-2
10. Jean de Leval, Philippe Boca, Enis Youssef, et al - Intermittent Versus Continuous Total Androgen Blockade in the Treatment of Patients with Advanced Hormone-Naive Prostate Cancer: Results of a Prospective Randomized Multicenter Trial - Clinical Prostate Cancer - https://doi.org/10.3816/CGC.2002.n.018
11. K. Miller, U. Steiner, A. Lingnau, et al - Randomised prospective study of intermittent versus continuous androgen suppression in advanced prostate cancer - Journal of Clinical Oncology - https://doi.org/10.1200/jco.2007.25.18_suppl.5015
12. John Nikitas, Matthew Rettig, John Shen - Systemic and Tumor-directed Therapy for Oligorecurrent Metastatic Prostate Cancer (SATURN): Primary Endpoint Results from a Phase 2 Clinical Trial - European Urology - https://doi.org/10.1016/j.eururo.2024.01.021
13. Fabio Turco, Lavinia Di Prima, Chiara Pisano - How to Improve the Quality of Life of Patients with Prostate Cancer Treated with Hormone Therapy? - Res Rep Urol. 2023; 15: 9–26 - doi: 10.2147/RRU.S350793