Video: Hormone Therapy for High-Risk Prostate Cancer

The Staging Guide Video Series | Transcription

Hi, I’m Dr. Scholz. Let’s talk about prostate cancer.

This video is going to cover hormone blockade for prostate cancer for men in the Azure stage of prostate cancer. Azure is the high-risk more consequential type of prostate cancer. Men in Azure are going to get some form of hormone blockade in most cases. There is a higher risk of spots spreading outside the gland and this necessitates some sort of intervention or therapy that can circulate throughout the blood and can attack the cancer in other parts of the body. Hormone therapy is ideally suited for this approach because the side effects are reversible and the treatment is very effective. So men in the Azure stage are routinely administered hormonal therapy in conjunction with other therapies. So hormone therapy is a remarkable form of systemic therapy. If you compare to chemotherapy, for example, it has higher response rates and in general fewer side effects. So men with prostate cancer are very fortunate to have a form of therapy with reversible side effects that has such potent anti-cancer effects.

Hormone therapy we call testosterone inactivating pharmaceuticals (medicines to block testosterone) consist of three broad categories. We have a milder type of hormonal blockade called the Anti-Androgens—Casodex and Nilutamide for example. The sort of standard hormone therapy is the LHRH Agonists (Lupron, Trelstar, Eligard) that block testosterone coming from the testicles. And now in the last five years we’ve had some more enhanced stronger hormonal therapies that actually block testosterone within the cancer cell—medicines like Erleada, Xtandi, and Zytiga. There’s a role for all three of these categories in the management of Azure, and we’re going to go through and discuss the different approaches that are used because you don't want to use more hormone therapy than is absolutely necessary. The longer you administer it and the larger number of medicines you use the more you’re going to run into side effects, and we will be talking about how to correct some of these side effects in a separate video. There’s a whole art to minimizing the side effects of hormonal therapy.

So when we’re talking about Azure, we’re looking at the three subtypes of Azure: Low-Azure, Basic, and High-Azure. And I contend (and many experts contend) that radiation is sort of the backbone for treating Azure, resulting in higher cure rates than surgery does, but when you give radiation for Azure you’re going to be administering hormonal therapy some TIP concomitantly with the radiation. This is why it’s so important to know your subtype. Men in Low-Azure can get away with just 4-6 months of Casodex plus Lupron type approach. Men that have Basic-Azure need a longer time period—studies seem to indicate about 18 to 24 months of Casodex plus Lupron in conjunction with the radiation and seed implants as we’ve gone into or will go into in other videos. Men that are in High-Azure (and you can find these different categories at the PCRI website—High-Azure is a PSA over 40, a Gleason 9, and other factors such as seminal vesicle invasion) men that are in the High-Azure category should strongly consider adding some of these more potent agents such as Erleada, Xtandi, or Zytiga to the Casodex and Lupron, and then continue that for about 18-24 months. So how much hormonal therapy you get and how long the treatment is continued is dependent on the subtype—how serious the Azure stage prostate cancer is—and a number of studies have shown that men in Low-Azure can get away with a short course of TIP, men with Basic-Azure require 18-24 months, and men in High-Azure should strongly consider adding some of these newer stronger hormonal agents to enhance and to optimize their cure rates.