Hope on the Horizon: Advances in Hormone Therapy for Advanced Prostate Cancer

Hormones, produced by glands and circulated in the bloodstream, play a significant role in driving the growth of certain cancers, including prostate cancer. Hence, Hormone therapy is a critical component of cancer treatment that aims to inhibit the growth of cancer cells by either removing hormones from the body or blocking their action. Prostate cancer that has spread beyond the prostate or returns after the treatment is often referred to as advanced prostate cancer. Let us decode in detail the advances in hormonal therapy for advanced prostate cancer.

Prostate Cancer Treatment

When it comes to prostate cancer treatment, several options are available depending on the stage and aggressiveness of the disease. For cases where the cancer hasn't spread beyond the prostate gland, standard treatments include surgery or radiation therapy, sometimes coupled with hormone therapy. However, for men with low-risk prostate cancer, active surveillance has emerged as a viable alternative. This involves close monitoring of the cancer with regular biopsies, delaying treatment unless there are signs of progression. Notably, the adoption of active surveillance has significantly increased in recent years, underscoring its acceptance as a management strategy.

In the case of advanced prostate cancer that has spread beyond the prostate, while it may not be curable, it can be managed through a variety of treatments. These treatments include hormonal therapy, chemotherapy, immunotherapy, combination therapy, radiation therapy, bone-targeted therapy, active surveillance, and participation in clinical trials. Each of these approaches aims to control the progression of the disease, alleviate symptoms, and improve the quality of life for patients.

Androgen Deprivation Therapy (ADT)/ Hormonal Therapy for Prostate Cancer

In prostate cancer, male sex hormones, particularly testosterone, can fuel the growth of cancer cells. Androgen deprivation therapy (ADT) is a common approach in hormone therapy for prostate cancer and may involve various methods to reduce the levels of male hormones or block their activity.

Types of Hormone Therapy

1. Abiraterone Acetate: 

This medication prevents prostate cancer cells from producing androgens. It is typically used in men with advanced prostate cancer that has not responded to other hormone therapies. It may also be prescribed for high-risk prostate cancer that has shown improvement with hormone-lowering treatments.

2. Orchiectomy (Surgical Hormonal Therapy): 

Orchiectomy is a surgical procedure involving the removal of one or both testicles, which are the primary source of male hormones. By reducing the production of testosterone, this procedure aims to decrease hormone levels in the body.

3. Estrogens: 

While estrogens can inhibit the testicles from producing testosterone, their use in prostate cancer treatment is rare due to the risk of serious side effects.

4. Luteinizing Hormone-Releasing Hormone Agonists: 

Medications like leuprolide, goserelin, and buserelin work by halting testosterone production in the testicles.

5. Antiandrogens: 

These medications block the action of androgens, such as testosterone, thereby impeding their ability to promote cancer growth. Examples include flutamide, bicalutamide (such as Caluran CP 50mg Tablet), enzalutamide, apalutamide, nilutamide, and darolutamide.

6. Adrenal Gland Inhibitors: 

Certain medications can prevent the adrenal glands from producing androgens, further reducing hormone levels. Examples include ketoconazole, aminoglutethimide, hydrocortisone, and progesterone.

Evolution of Hormone Therapy for Advanced Prostate Cancer

Over the past decade, significant strides have been made in hormone therapy for advanced or metastatic prostate cancer. Hormone therapy works by targeting the hormones that fuel cancer growth. Unfortunately, many prostate cancers initially respond to standard hormone therapy but eventually develop resistance, leading to what's known as castrate-resistant prostate cancer (CRPC). To address this challenge, researchers have developed several new medications that have shown promise in extending survival for certain groups of men with CRPC.

Breakthrough Medications

Four notable medications—enzalutamide, abiraterone, darolutamide, and apalutamide —have emerged as game-changers in the treatment of advanced prostate cancer. These medications work by inhibiting the action of hormones that drive CRPC, offering renewed hope for patients facing this aggressive form of the disease. What is particularly encouraging is that these medications are not only effective in men with CRPC but are also being used in individuals whose cancer has spread beyond the prostate gland (metastatic prostate cancer).

Side Effects

Hormone therapy for prostate cancer may lead to various side effects, including hot flashes, sexual dysfunction, decreased libido (lack of desire for sexual drive), and weakened bones. Other potential side effects include diarrhea, nausea, and itching. Despite these challenges, hormone therapy remains a valuable tool in managing prostate cancer, particularly in advanced or metastatic cases.

Conclusion

Advancements in research and clinical trials promise hope for improving the survival rates of those undergoing advanced prostate cancer care. In this context, hormonal therapies have made a significant impact in the realm of prostate cancer treatment. However, side effects pose a substantial burden. There is a need for a collaborative approach between patients and healthcare professionals to ensure the best-suited prostate cancer care.