The Common Vein Copyright 2010
Introduction
Prostate cancer grows in response to testosterone. The goal of androgen deprivation is to reduce the amount of testosterone that hormone sensitive cancer cells are exposed to. Androgen deprivation therapy is used to control symptoms and slow the rate of growth of metastatic disease. There are three main ways to achieve this:
1) castration: simple orchiectomy is easy, inexpensive, well-tolerated, and almost free of complications. Issues around body image are of greatest concern with this option
2) LHRH agonist: These agents stimulate LH release causing an initial flare of serum testosterone followed by a drop to castrate levels after receptor downregulation. Examples in this drug class include goserelin acetate, leuprolide acetate, triptorelin pamoate.
3) Antiandrogens: these medications block the dihydrotestosterone receptor they are not as effective as castration or LHRH therapy. They do not lower serum testosterone so they generally do not cause a loss of libido or impotence. Medications in this class include biclutamide, flutamide, megestrol, nilutamide.