100%(1)1 out of 1 people found this document helpful
This preview shows page 116 - 119 out of 156 pages.
to using antiandrogens alone, this approach requires further study. (Forhigh-risk patients, however, antiandrogen monotherapy is usually not recommended). Antiandrogens can, and often are, used in combinationwith LHRH agonists. The very first dose of LHRH agonist causes a brief,sharp increase in testosterone before the testosterone drops to castrate levels. Such a rapid increase in testosterone can cause a painful tumor ﬂareif there’s cancer in the bone. Since the nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com116
antiandrogen plugs up the androgen receptors, it helps prevent this ﬂare. There are a few names for the dual treatment with LHRH agonists and antiandrogens — combined hormonal therapy, total androgen blockade, or complete hormonal blockade. Men on total androgen blockade tend to experience more side effects than those taking a single hormonal agent.EstrogenEstrogen is a hormone that can interfere with testosterone production. For years, higher doses of diethylstilbestrol (DES) — a synthetic form ofestrogen — were used to treat prostate cancer as an alternative to orchiectomy. These doses are not recommended today because of the availability of the LHRH agonists. At higher doses, DES increases the chance of developing serious heart disease or blood clots. Lower dosesare often used to treat hormone-refractory prostate cancer. One advantage to DES is that it is effective and very inexpensive. There arealso other estrogen-containing pills or patches.155Use of Hormone TherapyIn the past, hormone therapy was used only in cases of metastatic cancer.This is because orchiectomy — an irreversible operation — was the best way to control testosterone levels. But with LHRH agonists and antiandrogen drugs — whose effect is reversible — hormonal therapy is no longer just for men with metastatic prostate cancer. That’s why if the patient has other stages of prostate cancer his provider might recommend hormonal therapy along with radiation or surgery.156nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com117
Occasionally men with early stage prostate cancer will be treated solely with hormones. Although hormones can control prostate cancer for many years, hormonal therapy by itself generally does not cure it. Because hormones have so many side effects and there are other excellent curative treatments, it’s uncommon to give hormones alone to early stage patients. When it’s used alone for early prostate cancer, it’s usually for elderly patients who cannot tolerate conventional treatments such as surgery, seed implantation, or external beam radiation.When prostate cancer is confined to the organ, survival rates tend to be better than when there is a positive surgical margin or extracapsular extension. Since hormonal therapy shrinks cancer cells, the idea is to shrink the tumor so that it is completely inside the prostate. Unfortunately, hormonal therapy for three to eight months before surgery has not resulted