Hormonal Therapy In Prostate Cancer

Short presentation prepared from an internet article about Hormonal theraphy in advanced prostate cancer

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