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Shall I receive hormone therapy?

Hormone therapy prevents the prostate cancer cells from getting the male hormones they need to grow. When a man undergoes hormone therapy, the level of male hormones is decreased. This drop in hormone level can affect all prostate cancer cells, even if they have spread to other parts of the body. For this reason, hormone therapy is called systemic therapy. 

Not every patient diagnosed with prostate cancer needs hormonal therapy. Hormonal therapy is usually used prior to surgery or radiotherapy to reduce the volume of the prostate gland. This procedure is called cytoreduction. Patients with poorly differentiated disease, locally advanced disease, and severely enlarged prostate gland should receive hormonal treatment before their definitive therapy. 

Prostate cancer that has metastasized to other parts of the body usually can be controlled with hormone therapy for a period of time, often several years. Eventually, however, most prostate cancers are able to grow with very little or no male hormones. When this happens, hormone therapy is no longer effective, and the doctor may suggest other forms of treatment that are under study.

Types of hormonal treatment: 

There are several forms of hormone therapy. One is surgery to remove the testicles. This operation is called orchiectomy. Orchiectomy eliminates the main source of male hormones and produces rapid decline in the male hormone level. It is very effective but it is irreversible.

The use of luteinizing hormone-releasing hormone (LHRH) agonists is another type of hormone therapy. LHRH agonists prevent the testicles from producing testosterone. Commonly used LHRH agonists include leuprolide (Lupron) and goserelin (Zoladex). These medications appear to be as effective as orchiectomy.

In another form of hormone therapy, patients take the female hormone estrogen to stop the testicles from producing testosterone. Estrogen is rarely used in treatment of prostate cancer because of its side effects. 

After orchiectomy or treatment with an LHRH agonist or estrogen, the body no longer gets testosterone from the testicles. However, the adrenal glands still produce small amounts of male hormones. Sometimes, the patient is also given an antiandrogen, a drug that blocks the effect of any remaining male hormones. This combination of treatment is known as a total androgen blockade. Total androgen blockade is believed to be superior to LHRH agonists alone. Commonly used antiandrogens include Flutamide (Eulexin) and bicalutamide (Casodex).

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