Hormone Treatment Fights Prostate Cancer
What Type of Hormone Therapy Works Best?
Unfortunately, understanding the details of hormone therapy for prostate
cancer can be difficult. Which drug or combination of drugs works best? In what
order should they be tried? Research hasn't answered these questions yet.
"Right now, there's a level of art to figuring out which agents to
use," says Durado Brooks, MD, MPH, director of prostate cancer programs at
the American Cancer Society. "We don't have clear evidence yet."
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, since these drugs don't completely
shut down sex drive. When anti-androgens stop working -- based on PSA tests --
a person then might shift onto an LHRH agonist.
Other doctors prefer to begin therapy with a combination of two or even
three drugs, especially for patients with symptoms or advanced disease, says
Researchers originally hoped that combined androgen blockade would
significantly add to the benefits of LHRH agonists. However, the results, to
date, have been mixed. Some studies have shown slightly longer survival
with combined androgen blockade, but the results haven't been as dramatic as
many experts had hoped. Other studies have shown no benefit. A possible
explanation may be the type of anti-androgen used, but further studies are
needed to answer this question.
"I think early on, there was hope that it would have a more profound
effect," Thrasher tells WebMD.
Brooks agrees. "I think that anti-androgens have made a significant
difference in terms of quality of life for men with advanced prostate
cancer," says Brooks. "However, we haven't really seen proof that they
let people live longer" when combined with LHRH agonists.
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
"Unfortunately, there are still some doctors who are offering hormonal
therapy earlier in the course of the disease than is commonly recommended,"
Brooks says. Given that the side effects can be serious, Brooks argues that
starting treatment with hormone therapy so early may not be a good idea.
However, Holden argues that early treatment may be helpful. "I think one
of the reasons that the death rate from prostate cancer is going down is that
we're using hormone therapy early," he tells WebMD. "We haven't proved
that early treatment improves overall survival yet, but I think we
Researchers are also looking at "intermittent therapy," starting and
stopping hormone treatment for months at a time. The big advantage is that men
could go off therapy temporarily and thus be free of the side effects. Early
study results have been promising.
Hormone therapy for prostate cancer is also being tested in combination with
other therapies, like radiation and chemotherapy. One recent study looked at
men with locally advanced prostate cancer - cancer that has spread outside the
prostate, but not yet into other parts of the body. Researchers found that
adding just six months of hormone therapy to radiation allowed the men to live
longer. Researchers are also studying the effects of hormone therapy earlier in
treatment, for instance right after or even before surgery.