Prostate Cancer Therapies: A Comparison Between Hormone-Based and Non-Hormone-Based Approaches
Prostate cancer is a common form of cancer in men, ranking as the sixth most common cause of cancer-related deaths worldwide. Hormonal treatments and non-hormonal treatments are two main approaches used in managing this disease.
Hormonal treatments, also known as Androgen Deprivation Therapy (ADT), aim to slow down prostate cancer growth by either lowering testosterone levels or blocking its effect. These treatments can include surgical removal of the testicles (orchiectomy), LHRH agonists like triptorelin and goserelin, LHRH antagonists like degarelix and relugolix, anti-androgens like flutamide and nilutamide, abiraterone, ketoconazole, enzalutamide, apalutamide, and darolutamide.
Common side effects associated with hormonal treatments include hot flashes, sexual dysfunction (impotence, decreased libido), decreased testicular size, joint and muscle pain, fatigue and flu-like symptoms, emotional changes such as depression, urinary symptom worsening, injection site reactions (for injectable drugs), and rare severe skin reactions or neuropathy. These effects arise due to the broad role hormones play in many body systems, leading to significant impacts on sexual, physical, and emotional health [1][2][4].
On the other hand, non-hormonal treatments such as chemotherapy, radioisotopes (e.g., lutetium Lu 177), and other cytotoxic or targeted agents do not primarily work by altering hormone levels but by directly killing cancer cells or delivering radiation. Their side effects are usually different and may include chemotherapy-related effects such as nausea, hair loss, lowered blood counts (increased infection risk), fatigue, radiation-related effects depending on the location targeted, and less impact on sexual function compared to hormonal therapy, which may be preferred by patients concerned about sexual side effects [2][3].
Radiation therapy for non-hormonal therapy can lead to erectile dysfunction and urinary issues. Different non-hormonal therapies work in different ways, such as surgery, radiation therapy, chemotherapy, immunotherapy, and targeted therapy which attacks specific cancer-causing genetic mutations.
The goal of treatment for prostate cancer can vary, but often includes slowing the growth of the cancer, reducing symptoms, and improving quality of life. Hormonal treatments, called androgen suppression therapy, aim to reduce the amounts or potency of certain hormones to slow the development of the cancer. Non-hormonal treatments for prostate cancer include surgery to remove all or part of the prostate (prostatectomy), radiation therapy, chemotherapy, targeted therapy, and immunotherapy.
The efficacy of hormone therapy is a topic of ongoing scientific interest, with many issues surrounding its use, including when to start, when to stop, and the best way to administer it. Non-hormonal treatments for prostate cancer have been shown to increase the survival rate of people with prostate cancer, according to a 2017 systematic review and meta-analysis. However, it's important to note that hormone therapy cannot cure prostate cancer alone.
Surgery for non-hormonal therapy can lead to erectile dysfunction, hernia, and bladder or rectum leakage. Chemotherapy for non-hormonal therapy can cause nausea, weakness, and hair loss. Targeted therapy can cause fatigue, mouth sores, and high blood pressure. Immunotherapy can cause coughing, diarrhea, and headaches.
In conclusion, both hormonal and non-hormonal treatments for prostate cancer have their unique side effects and benefits. Patients' preferences regarding these side effect profiles can significantly influence treatment choices. It's crucial for individuals diagnosed with prostate cancer to discuss their treatment options thoroughly with their healthcare providers to make informed decisions.
[1] American Cancer Society. (2021). Prostate cancer treatment: Hormone therapy. Retrieved from https://www.cancer.org/cancer/prostate-cancer/treatment/hormone-therapy.html
[2] National Cancer Institute. (2021). Prostate cancer treatment: Hormone therapy. Retrieved from https://www.cancer.gov/types/prostate/patient/prostate-treatment-hormone-pdq
[3] Mayo Clinic. (2021). Prostate cancer: Hormone therapy. Retrieved from https://www.mayoclinic.org/diseases-conditions/prostate-cancer/in-depth/hormone-therapy/art-20046868
[4] UpToDate. (2021). Prostate cancer: Hormone therapy. Retrieved from https://www.uptodate.com/contents/prostate-cancer-hormone-therapy-beyond-the-basics?search=prostate%20cancer%20hormone%20therapy&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2
- Mens dealing with prostate cancer may consider hormonal treatments, such as Androgen Deprivation Therapy (ADT), which aim to slow down the growth of cancer by either lowering testosterone levels or blocking its effects.
- Side effects associated with hormonal treatments for prostate cancer include hot flashes, sexual dysfunction, decreased testicular size, joint and muscle pain, fatigue, depression, urinary symptom worsening, and rare severe skin reactions or neuropathy.
- Non-hormonal treatments for prostate cancer, like chemotherapy, radioisotopes, and other cytotoxic or targeted agents, work by directly killing cancer cells or delivering radiation, and their side effects are usually different from hormonal treatments.
- Radiation therapy for non-hormonal treatment of prostate cancer can lead to erectile dysfunction and urinary issues, while chemotherapy can cause nausea, hair loss, lowered blood counts, and fatigue.
- The treatment options for prostate cancer, which may include hormonal or non-hormonal therapies such as surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy, should be thoroughly discussed with healthcare providers to make informed decisions, considering the unique side effects and benefits of each approach.
