What Happens During Hormone Treatment for Prostate Cancer

There are 2 approaches to hormone therapy: drug-based and surgical. Drug-based therapies are also called medical hormone therapy. Here’s how each approach works. The surgical approach is called orichiectomy.

Medical Hormone Treatment

For this treatment, you take antihormone drugs. Many men prefer this to surgical removal of the testicles. The drugs prevent the testicles from secreting testosterone. Complete blocking of the testosterone action is done by taking pills every day. Your doctor will recommend 1 or more of these 3 drugs. They’re listed in order of the most to least commonly prescribed.

• Luteinizing hormone-releasing hormone (LHRH) analogues. You’ll get a shot once a month, every 3 or 4 months, or yearly. It’s very important that you don’t skip the shots. If you do, your testosterone may go up and cause your cancer to grow. There are 2 kinds of LHRH analogues. They are Lupron (leuprolide) and Zoladex (goserelin). They work about the same. Luteinizing hormone tells your testes to produce testosterone. So when you start taking LHRH analogues, your testosterone levels go up. But then your brain tells your testes to stop producing testosterone. This process takes about 5 to 8 days. This treatment can be expensive. You may receive LHRH analogues by themselves, or your doctor may recommend them with another type of treatment. If your PSA level continues to increase even with LHRH analogue shots, your doctor may add an antiandrogen.

• Gonadotropin-releasing hormone (GnRH) antagonists. These drugs are still being studied. Here’s what we know so far. The GnRH antagonist currently undergoing clinical trials is called Plenaxis (abarelix). It’s injected into a muscle every month. It also requires a booster dose on day 15.  This is very promising since testosterone levels affect the growth of the prostate cancer. The faster a drug works, the faster it controls the cancer.

• Antiandrogens. These are usually pills in the United States . These drugs don’t lower testosterone production. They’re receptor blockers. They prevent hormones from acting on prostate cells. There are 3 commonly used antiandrogens. They are Casodex (bicalutamide), Eulexin (flutamide), and Nilandron (nilutamide). Usually doctors give them with LHRH analogues. When they are used together, it’s called total androgen blockade.

Orchiectomy

This is a surgical approach to hormone therapy in which your surgeon removes both of your testicles. Without testicles, you can’t produce the male hormones that cause prostate cancer to grow.

This is a simple procedure. But many men opt for hormone treatment with drugs instead of surgery because either they don’t like the idea of losing their testicles or they sometimes want to go off of the hormone treatments. The advantage of this procedure is that it’s over in one treatment. It’s also less expensive than the shots. 

This surgery is performed under local anesthesia. That means the area is numbed, but you aren’t put to sleep. Your urologist will make 1 or 2 cuts, called incisions, on each side of your scrotum. Your doctor ties off the blood vessels that supply your testes and sperm duct. Then he or she removes your testes. The skin of your scrotum is still there. Some urologists remove just the center of your scrotum, leaving some fullness to it. Your surgeon closes the incisions with dissolvable stitches that don’t need to be removed. Usually you can go home the next day.

The empty feeling in their scrotum after having the testes removed bothers some men. If that’s true for you, ask your doctor about testicular prostheses. These gel-filled plastic sacks are about the same size as adult testes.