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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 Holden.

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 later.

"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 will."

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.

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