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Common Treatments for Advanced Prostate Cancer

If you have advanced prostate cancer, your cancer has spread beyond the prostate. Your doctor may consider a variety of approaches for treatment.

These treatments cannot cure the cancer at this stage. But they often slow its spread and help with symptoms. Talk with your doctor about what might work best for you.

The good news is that most men, even with advanced prostate cancer, live a high-quality life for many years.

Here's a look at the common order of treatment for advanced prostate cancer.

Hormone Therapy for Advanced Prostate Cancer

The male hormones (androgens), primarily testosterone, stimulate the growth of prostate cancer cells in and outside the prostate gland. The goal of hormone therapy is to:

  • Dramatically reduce your levels of testosterone
  • Keep any low levels of androgens from being used by the prostate cancer cells

Most doctors think it makes sense to start this type of treatment as soon as the cancer becomes advanced. This is called early intervention.

There are several types of hormone therapy drugs. Your doctor may give you one or more of these types of treatment. They include:

LHRH antagonists. These block production of luteinizing hormone (LH), which stimulates testosterone production in the testicles. The drugs quickly drop testosterone to very low levels. They're usually able to do this without causing a "hormone flare" -- a brief upsurge in testosterone seen with other types of drugs called agonists. LHRH antagonists are given monthly.

Two common LHRH antagonists are:

  • Plenaxis (abarelix)
  • Firmagon (degarelix)

LHRH agonists. These drugs take a different approach from LHRH antagonists. They temporarily cause a surge in LH and testosterone levels. This tricks your brain to stop LH or testosterone production. The levels of LH and testosterone then drop to low levels.

LHRH agonists can be taken every month, 3 months, or 6 months.

Some examples of LHRH agonists include:

  • Lupron (leuprolide)
  • Zoladex (goserelin)
  • Eligard (leuprolide)
  • Vantas (histrelin)           

Anti-androgens. These completely shut down the prostate cancer cell's ability to use any androgens. 

Three common types of anti-androgen drugs are:

  • Eulexin (flutamide)
  • Casodex (bicalutamide)
  • Nilandron (nilutamide)

Starting anti-androgens before LHRH agonists may help lower the risk of a hormone flare. The doctor may also suggest this treatment if other hormone therapy stops working.

Many doctors use a combination anti-androgen with an LHRH medication to control advanced prostate cancer.

Hormone therapy drugs may be given in different ways, including:

  • Injection
  • Pellet under the skin
  • Pill

How often you receive hormone therapy drugs and how you get them depends on:

  • Type of therapy
  • Specific medication
  • How your cancer responds

If you become resistant to hormone therapy or don't tolerate the side effects, your doctor may try intermittent therapy. This means you'll have the drugs for a while, then go off, then go on again. This can improve your quality of life and make the hormone therapy more effective.

Orchiectomy. Your body makes most of its testosterone in the testicles. So outpatient surgical removal of the testicles (orchiectomy) is also a very effective type of hormone therapy that causes a very rapid and permanent drop in testosterone.

The doctor may combine orchiectomy with anti-androgen therapy.

WebMD Medical Reference

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