Intermittent Androgen Deprivation Therapy Prostate Cancer

Intermittent Androgen Deprivation Therapy Prostate Cancer

What does "systemic hormone deprivation therapy"?

Unfortunately, it can happen that a prostate cancer must be considered as no longer operable (inoperable). Causes of inoperability can be:

• already detectable secondary tumors (metastases) in the lymph nodes or in other organs,
• a locally so extensive findings , that no distance in the healthy tissue region more can be expected.
  

For these cases, several treatment options, the most important component is the so-called systemic hormone deprivation therapy exist.

Importance of sex hormones in prostate cancer

When hormones are chemical messengers called that engage in a variety of ways in all body functions.They are formed by specific organs and are subject to a control mechanism which either arises directly from the function of an organ in terms of feedback or interaction with a parent Control. The sexual development and function of the prostate are hormonally controlled. Parent Control is the diencephalon and the pituitary gland (hypophysis) which emits stimulating hormones for the sex glands.In this manner, inter alia, stimulation of the testicles, which then produce the male sex hormone testosterone, which in turn affects the growth of the prostate or the growth of prostate cancer cells. For an understanding of the various treatment options for prostate cancer knowledge of this control circuit is important because it can be affected in different ways (Figure 12).

The male sex hormone testosterone affects the growth of the prostate and the prostate carcinoma. This creates the possibility of further progression of prostate growths by affecting the hormonal balance to slow down. This discovery has already been made over 60 years ago and was honored in 1966 with the awarding of the Nobel Prize to the surgeon Charles Huggins.

Hormone deprivation therapy for prostate cancer

In order to evaluate the importance of hormone deprivation therapy in comparison to the other methods, it is important to understand that you can not all prostate cancer cells can kill by a withdrawal of the male sex hormone testosterone.

The growth inhibitory or tumor zurückdrängende effect may persist for a long time, but is not guaranteed permanently. The reason for this is that (1) adjust the prostate cancer to the hormone deprivation and then hormone-independent continue to grow or (2) only those prostate cancer cells remain which were from the beginning hormone deaf or have become hormone-deaf, and then later lead to a progression of the tumor. Nevertheless, the hormone deprivation therapy is assessed overall as a highly effective treatment option.

There are basically three ways to perform the hormone deprivation therapy:

• pharmacological inhibition of hormone production (depot injection therapy with GnRH agonists),
• pharmacological inhibition of hormone action (tablets therapy with antiandrogens)
• surgical removal (enucleation) of the hormone-producing testicular tissue.
  

The implementation of a drug hormone deprivation therapy is possible in two different ways.

• The most common method is to regularly (once a month, every three or every six months) to inject medication into the subcutaneous adipose tissue, leading to a blockage of the testicular-stimulating hormones of the pituitary gland, so that no more testosterone is produced in the testes. The effect of these referred to in the art as GnRH agonist substances with that of the operative testicular tissue removal completely identical.
• Another possibility is the administration of substances that block the action of male sex hormone produced in the testis and also in the adrenal cortex. These so-called anti-androgens occupy the attachment site of testosterone on the cell so that the sex hormone can no longer be taken into the cell and thus has no effect. These active substances are available in tablet form, and must be taken daily. Whether the sole input of these antiandrogens that of the operative or medical hormone deprivation is equivalent to the so-called GnRH agonists, is ultimately still unclear. With the combination of GnRH agonists and anti-androgens is called "complete" androgen blockade. Current standard medical therapy with GnRH agonists.
  

The surgical removal of the testicular tissue as a production plant of the male sex hormone (testosterone) as an alternative is a short and almost always uneventful surgery. Here, the hormone-producing testicular tissue is enucleated. Since the testis and epididymis are left, a difference is hardly noticeable externally. However, some patients find the consequences of this operation as emotional distress.

After surgical removal of the testes tissue a broken hormone deprivation therapy as a possible treatment strategy is naturally no longer available, so that the drug hormone withdrawal today is in the foreground.

Side effects of hormone deprivation therapy

Normally, the hormone deprivation therapy in men leads to side effects, which can be explained by the loss of stimulated by the male sex hormone functions of the body. It comes to nachlassendem beard growth, a decrease in sex drive, loss of erection, hot flashes, one in some cases painful breast swelling and slow bone decalcification.

Nevertheless, these side effects, in view of the hedged effect on prostate cancer can not be overstated. For questions about the possible reduction and therapy of certain side effects, please contact your attending urologist as a competent partner at your disposal.