Once prostate cancer has spread beyond the prostate gland localized therapies are no longer sufficient to stop the growth of the cancer and treatment generally involves a combination of both radiation therapy to kill the cancer cells and hormonal treatment to slow the growth of the cancer by cutting off its fuel supply.
The aim of hormonal therapy is to cut off the production of the male hormones, such as testosterone, which fuel the growth of prostate cancer, or to render them ineffective, and this essentially means castration, either surgically or by other medical means such as using an antiandrogen drug to block the circulation of male hormones in the blood.
There are various different approaches when it comes to hormonal therapy and it is often a case of testing different combinations of drugs to discover what works best in individual patients. One approach is what is known as a ‘maximum androgen blockade’ which is a blanket approach using a wide range of drugs combined with either surgical or medical castration. This approach has proved effective in some patients but many doctors question whether it is in fact any more effective than standard hormonal therapy.
When it comes to considering whether or not to opt for the surgical removal of the testes or to choose medical castration this is not always an easy decision as surgical castration is understandably a major and life-changing step for many men. It is however an ultimate solution to the problem of the production of male hormones, unlike hormonal therapy which will simply block those hormones for as long as the therapy continues. If however you stop the therapy then, although it will generally take some time for cancer which has been slowed or halted to begin growing again, it will inevitably do so within a matter of months or at best within two or three years.
In either case there is also often a problem with some cancer cells which do not require testosterone to grow and here it is often necessary to use a second tier of hormonal drugs such as progesterone or hydrocortisone to deal with the problem.
One approach with hormonal therapy is not to use this simply as a treatment for advanced prostate cancer but in fact to start hormonal therapy as soon as prostate cancer is diagnosed, even if it is confined to a small area of the prostate gland and is slow growing. The aim here is to slow the growth of the cancer, and in some cases to actually shrink the tumor, so that it can possibly be confined to the prostate gland where it can do relatively little harm for the remainder of a patient’s life.
Despite the fear which surrounds prostate cancer, because it often appears late in life and does little if any harm as long as it is contained within the prostate gland, many men live quite happily with the disease and indeed die from a variety of other total disassociated conditions, including simple old age.