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Pharmacy Link

TREATING ADVANCED PROSTATE CANCER: HOW HORMONE THERAPY WORKS

Hormone therapy works in almost every man; it prolongs life and eases many symptoms of advanced prostate cancer. In some men, its effects last for years. Why doesn’t it cure the disease? Because prostate cancer is “heterogeneous”—it’s a bunch of different cells mixed up together. Some of these cells respond to hormones; some of them don’t. This means that a hormone treatment which targets one kind of cell, the kind that responds to hormones, has absolutely no effect on the hormone-insensitive cells all around it. They keep right on growing, unfazed. Ultimately, if a man lives long enough, these cells eventually overtake the hormone-sensitive cells. And right now, we don’t have any way to stop them.

This fact has two important implications for patients: One, there’s no evidence that starting hormone therapy early in the course of prostate cancer is any more effective in prolonging survival than starting treatment if and when a patient needs it—when a man has bone pain from the cancer, for instance. Again, the cells that ultimately prove fatal are the hormone-insensitive cells—and to these cells, whether hormone therapy comes earlier or later does not matter one bit. Two, there is no good evidence that other forms of hormone manipulation—total androgen ablation, for instance— provide much benefit after hormone therapy has stopped working.

If hormones lose their effect on the tumor, there are several other options for treatment of the disease and specific symptoms, including new chemotherapy drugs, “spot” radiation to painful sites of metastases (chunks of cancer that have broken off from the main tumor and established themselves in new locations, such as the bone), a radioactive substance called strontium-89, which is specially tailored to treat bone pain, and a whole host of powerful pain medications, their is no reason for any man with prostate cancer to live in excruciating pain. Aggressive pain management is not only beneficial—it’s been shown that men who aren’t in terrible pain live longer—it’s your right as a patient. Help is available; take it.

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