Prostate cancer: drugs and hormones

Hormone therapy is the first choice in the treatment of prostate cancer, but sometimes you need to rely on other medications as well.

Prostate cancer is particularly common in men after the age of 50.

The symptoms are variable: prostate cancer is silent in the early stages, while in the more advanced ones there may be difficulty urinating (ie urinating) accompanied by pain and / or blood in the urine or semen or the feeling of not being able to complete urination.

Often these symptoms can be confused with those of other prostate disorders, such as prostatitis and benign prostatic hypertrophy.

The etiology of prostate cancer, that is, the explanation of its causes, is not yet well understood. However, over the years some risk factors have been identified, including age (the risk of uncontrolled proliferation of prostate cells increases with increasing age), but also obesity, ethnicity and previous family history.

Unfortunately there is no specific prevention for this type of cancer, so some general rules are valid to improve the well-being of the organism:

• eat plenty of fruits and vegetables, reducing the intake of fats and red meat/sausages
• regularly perform physical activity – even if not intense – to maintain normal weight, thus reducing the risks related to obesity (some recent studies seem to show that physical activity, thanks to the cardiovascular effects it entails, can also help to counteract and reduce the side effects due to some prostate cancer treatments).
• perform routine checks (and possibly scheduled urological visits) able to highlight any prostate abnormalities.

When dealing with prostate cancer, the best therapeutic approach depends on very different factors, including the age of the patient, the speed of growth of the tumor mass, the side effects related to therapy.

Hormone therapy

Possible treatment options include hormone therapy, which is the preferred approach if the cancer has already metastasized, or is at high risk of developing recurrence. Hormone therapy alone does not cure prostate cancer, but it can be an important aid to slow down the progression of neoplasmsin an advanced state and alleviate symptoms, so as to contribute significantly to improving the quality of life.

But how does hormone therapy work? Androgen hormones, and in particular testosterone, determine the growth of prostate cells: the muscle tissue of this gland is in fact rich in receptors for testosterone, which is released in an increasingly high way over the years. The purpose of hormone therapy is therefore to block the effects of testosterone, stopping its production and release or making sure that it does not interact with the receptors present on the cells of the prostate gland.

The drugs most used for hormone therapy are agonists or antagonists of the hormone GnRH (molecules that block the hormonal cascade that leads to the synthesis of testosterone) or antiandrogens (active ingredients that prevent testosterone from stimulating tumor growth). The effect of these two classes of molecules is therefore to decrease the effect of androgens: it is therefore said that they generate an androgenic blockade.

Hormone therapy can be administered in several ways:

– injections aimed at stopping testosterone production

– tablets to block its effects

– a combination of the 2: in this case the action is enhanced, and the so-called total androgenic blockade (or androgen deprivation) is obtained.

Hormone therapy, however, is not without side effects. The most common ones are related to the action of testosterone on other tissues/systems, and usually disappear when treatment is stopped. Among the most common side effects are loss of sexual desire and erectile dysfunction (the latter more common with injections than tablets). Outside the sexual sphere, other possible side effects of hormonal treatment are hot flashes, excessive sweating, weight gain, swelling of the breasts.

An alternative to hormone therapy is surgical removal of the testicles (orchiectomy). Also in this case, it is good to remember, it is a treatment that does not cure prostate cancer, but – determining the definitive removal of circulating testosterone – allows to keep under control the growth of the tumor mass and the symptoms associated with the disease. Following an orchiectomy, the reduction in testosterone levels is faster, but in reality the long-term effectiveness is very similar to that of drugs used in hormone therapy. Even in the face of the important psychological implications that can accompany surgery of this kind, therefore, many men prefer hormonal treatment to block the effects of testosterone on the prostate.

Hormone therapy can also be used in combination with other treatments, particularly before or after radiation therapy and tumor removal surgery.

If it is carried out before, it is usually called neoadjuvant therapy and has the task of reducing the size of prostate cancer as much as possible, so that the surgery is less invasive and / or radiotherapy more effective. Usually neoadjuvant therapy – which typically lasts a few months – is used to treat tumors that are still confined to the prostate gland and prostate capsule, but which are at high risk of spreading to adjacent tissues (or have already invaded surrounding areas, but have not yet spread to more distant areas of the body).

When it is used after surgery or a course of radiotherapy, hormone therapy is called adjuvant. It is particularly indicated to reduce the risk that the cancer may recur (i.e. that a recurrence develops) or that “survivor” cancer cells can generate – traveling through the blood and / or lymph nodes – metastases in other parts of the body. Like all hormonal therapies, even the adjuvant one is not without side effects: for this reason it is used only in cases where prostate cancer is at high risk of spreading. Its duration is very variable and is generally longer than the neoadjuvant: it can last up to 2-3 years, but some patients (with a view to prevention and balancing between side effects and benefits) take it for life.

Other drug-based treatments

As with many other types of cancer, chemotherapy is often used when prostate cancer has spread to other parts of the body (metastatic prostate cancer). Chemotherapy can therefore help increase life expectancy and alleviate symptoms related to cancer, first of all pain. There are different types of chemotherapy drugs: for example, in the event that prostate cancer becomes resistant to hormone therapy, you can opt for medicines that can destroy or control the multiplication of cancer cells, reducing the mass of the tumor: the most common treatments are those based on docetaxel and cabazitaxel.

Like hormone therapy, chemotherapy is not without side effects (which depend on the effect of medicines on healthy cells, such as those of the immune system). The main side effects related to chemotherapy include frequent infections, hair loss (induced alopecia), tiredness and fatigue even in the face of modest exertion, nausea and vomiting, loss of appetite, injury to the oral cavity (like canker sores), which is sore. Many of these side effects, however, can be prevented or controlled with other medications that your doctor or oncologist may prescribe.

At the same time, it is possible to rely on some antiangiogenic drugs, now at an advanced stage of clinical trials. These molecules work by blocking the formation of new blood vessels, thus preventing the tumor mass from feeding.

Moreover, in the case of prostate cancer with bone metastases, it is now possible to rely on an innovative radiopharmaceutical, radium 223, which exploits its physical characteristics by binding calcium in areas of bone metastases and destroys cancer cells; Its use allows to reduce the doses of radiation normally used to treat bone metastases and the possible side effects of therapy. As with hormone therapy, therefore, it is often used before radiation treatment.

Finally, another category of drugs used in case hormone therapy is not very efficient are corticosteroids: even these medicines – such as dexamethasone, which has proven to be among the most effective – act by preventing the further growth of the tumor mass, trying to reduce its volume.