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How is secondary endocrine therapy used to treat prostate cancer?

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At some point, prostate specific antigen levels begin to rise despite treatment with hormone therapy. This signals that hormone therapy is no longer working to reduce testosterone levels in the body. When this happens, doctors may decide to make changes to the hormone therapy. This is called secondary hormone therapy. It can be done in a number of ways. For instance, if you have had surgery to remove your testicles, your doctor may suggest that you begin taking an antiandrogen. If you have been using combination therapy that involves an antiandrogen and luteinizing hormone-releasing hormone (LHRH) analogs, your doctor may stop the use of the antiandrogen. This is known as anti-androgen withdrawal. Another option is to change the type of hormone drug. However, the use of an LHRH drug must be continued to prevent a testosterone rebound from stimulating the growth of prostate cancer cells.

Ketoconazole, an antifungal agent, inhibits adrenal and testicular synthesis of testosterone when used at high doses. Response rates in a second line setting are 20%-40% with significant side effects. Doses range from 200 mg 3 times a day to 400 mg three times a day. The drug must be given with hydrocortisone to prevent adrenal insufficiency.

SOURCES: 

American Cancer Society. 

National Cancer Institute. 

Cancer Research UK.  

News release, Astellas Pharma Inc.

UpToDate.

Reviewed by Jennifer Robinson on July 24, 2018

SOURCES: 

American Cancer Society. 

National Cancer Institute. 

Cancer Research UK.  

News release, Astellas Pharma Inc.

UpToDate.

Reviewed by Jennifer Robinson on July 24, 2018

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What are issues in the timing of treatment for prostate cancer?

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