June 2014, Vol 3, No 4

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Hormonal Therapy for Prostate Cancer: An Oncologist’s Perspective

Winston Tan, MD, FACP

Prostate Cancer

Over the past few years there has been notable progress in hormonal therapy for prostate cancer. First is the development of drugs that avoid tumor flare, eg, the development of degarelix.1 These drugs decrease the level of testosterone very efficiently in a very short period (3 days). The use of degarelix is of clear clinical benefit in patients with overt symptomatic metastatic disease who are at risk for urinary obstruction or spinal cord compression. Further studies are required to determine its benefit over standard strategies such as leuprolide, goserelin, and other antiandrogens in different clinical situations.

We have witnessed a change in the paradigm of treatment by changing the term hormone-refractory disease to castration-resistant disease…

Second, we have witnessed a change in the paradigm of treatment by changing the term hormone- refractory disease to castration-resistant disease due to the recognition that, despite being hormone refractory, the disease is still sensitive to hormonal interventions, and further suppression of testosterone could still lead to better control of disease and prolonged survival. Testosterone still feeds the cancer, thus leading to the development of antiandrogen agents that block the function of testosterone more effectively, including abiraterone and enzalutamide. Abiraterone is currently approved for the treatment of metastatic castration-resistant prostate cancer (mCRPC) in both the prechemotherapy and postchemotherapy arena. In both situations, abiraterone has been shown to improve survival.2 Enzalutamide is approved for the treatment of mCRPC that has progressed on chemotherapy treatment.3 Other hormonal agents are currently being studied for treatment of this disease process.

Third, we have begun to recognize the side effects of hormone treatment, including osteoporosis, anemia, and such hormonal changes as hot flashes, loss of sexual function, testicular atrophy, gynecomastia, and metabolic syndrome. At this stage, clinicians are more cognizant of testing for these conditions to prevent the painful consequences of treatment.4 We are currently in an era where further hormonal manipulation of prostate cancer has led to improvement in quality of life and survival in patients with terminal prostate cancer. I truly believe that we are making a difference in the lives of these patients.

References

1. Rick FG, Block NL, Schally AV. An update on the use of degarelix in the treatment of advanced hormone-dependent prostate cancer. Onco Targets Ther. 2013;6:391-402.
2. Pinto A. Beyond abiraterone: new hormonal therapies for metastatic castration-resistant prostate cancer. Cancer Biol Ther. 2014;15:149-155.
3. Sanford M. Enzalutamide: a review of its use in metastatic, castration-resistant prostate cancer. Drugs. 2013;73:1723-1732.
4. Grossmann M, Cheung AS, Zajac JD. Androgens and prostate cancer; pathogenesis and deprivation therapy. Best Pract Res Clin Endocrinol Metab. 2013;27:603-616.

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