Reading Urology : Prostate cancer 5

When cancer has spread into the capsule of the prostate (T3) or into the surrounding tissue (T4) it is called locally advanced prostate cancer. If it has spread into other parts of the body (metastasised) it is called late prostate cancer.

Hormone manipulation therapy

In order to grow prostate cancer needs testosterone. When the cancer has spread to nearby glands or bones it can be treated most effectively by hormone manipulation therapy i.e. stopping testosterone from reaching it. There are four ways of doing this:

Orchidectomy, surgical removal of the testes
Injections of drugs called LH-RH agonists
Tablets of anti-androgen drugs
Tablets containing oestrogen, the female hormone

Most men with late prostate cancer respond to these therapies for an average of two years. If the cancer stops responding after this time there are other treatments you may be offered. Even though some men relapse, one in five will be alive after five years and one in ten after ten years.

Orchidectomy [N0680]

Orchidectomy is the easiest way to stop the production of testosterone as it is made in the testicles and helps stop the prostate cancer from growing and may even cause it to shrink. This operation is an alternative to taking medication over a long period and if you have been suffering from cancer-related pain most men find it is relieved for a time by having an orchidectomy.

Side-effects

An orchidectomy can not be reversed and you must consider the permanent adverse side-effects before going ahead

You will be impotent, unable to have an erection
You will lose your sex drive
You will be infertile
You will experience hot flushes due to hormonal changes
You will be left with a small amount of tissue in your scrotum although implants are available

The operation & risks

The operation is performed under a general anaesthetic and will carry the usual risks of anaesthetic complications. It is either done as a day case or overnight. There will be some pain in the weeks following the operation but this can usually helped by taking painkilling tablets.

You will have to have the wound checked by a nurse, either at your GPs surgery or at home, in the week following your discharge. You should take things easy in the first weeks and avoid heavy lifting, and keep your wound clean by taking regular baths.

LH-RH (Luteinising hormone – releasing hormone) agonist injections

These drugs stop the release of luteinising hormone that sends signals to the testicles to produce testosterone. This is as effective as an orchidectomy and the injections can be given by your GP.

These drugs do cause an initial rise in the testosterone level which is counteracted by a short course of anti-androgen drugs before and after the first injection. The drug has to be given at regular intervals for an indefinite period. As each patient responds differently, it cannot be predicted for how long this treatment will be effective.

Risks & adverse side-effects

You will be impotent and unable to have an erection, and lose your sex drive. This will be reversed when you stop receiving the drug.
You may experience to flushes due to hormonal changes.

Anti-androgen drug therapy

These drugs do not stop the production of testosterone but help to reduce its stimulation of prostate cancer. They are given as tablets and are an alternative for those men who cannot face an operation or injections.

Risks & adverse side-effects

There is a risk of impotence but at much less of a level than with orchidectomy or LH-RH therapy
The drugs can cause stomach upsets and diarrhoea
May cause liver damage so routine blood tests will be needed to check your liver function
They are not felt to be as effective in controlling cancer as other therapies
It is not possible to predict for how long the therapy may be effective

Oestrogen therapy

This therapy can be used if your prostate cancer does not or ceases to respond to the LH-RH or anti-androgen therapies. Oestrogen is the female hormone and is given in tablet form. It suppresses the effects of testosterone.

Side-effects

The most notable side-effect is the development of female characteristics. You may lose your body hair and begin to grow breasts. Radiation may be used on the breast area to help prevent growth.
This drug may affect your heart, and is therefore only used in small doses.
Associated risk of blood clots.

Palliative therapy

When these treatments are no longer affective you may develop pain elsewhere. Palliative therapy aims to reduce the pain caused by the growth of the cancer but cannot stop its growth. Palliative therapies are:

Radiotherapy which is very effective in reducing pain from prostate cancer
Steroid tablets can be effective but may cause stomach ulcers and fluid retention Other medication can be used to reduce these side-effects
Chemotherapy which involves taking drugs to poison the cancer cells. It is seldom used for prostate cancer but may be effective in some cases. Drugs can be taken to deal with the sickness caused by chemotherapy.

Go back to Prostate cancer 4

See also Prostate Cancer Diet Guidelines

Relevant links
Cancer BACUP      0808 800 1234
MacMillan CancerLine     0808 808 2020
Cancer Research UK      0800 226 237
Prostate Cancer Support Organisation      0845 650 2555
Covent Garden Cancer Research Trust     020 7679 9366
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