| Surgical castration by orchidectomy | | | | the prostatic capsule, and no evidence of |
| | | | metastases, benefit from radical treatment. |
| Surgical castration is the simplest and | | | | The most widely used treatment regimens |
| cheapest way to treat metastatic prostate | | | | consist of a combination of radiotherapy and |
| cancer. The obvious disadvantage is the | | | | hormonal treatment. |
| psychological effect of the loss of the | | | | |
| testicles. | | | | Treatment options for locally advanced and |
| | | | metastatic disease. |
| LHRH-analogues | | | | |
| | | | Early hormonal treatment |
| LHRH-analogues and oestrogen achieve a | | | | |
| "medical castration" by stopping the | | | | Watchful waiting with hormonal treatment once |
| testicular production of testosterone. | | | | symptoms develop |
| LHRH-analogues are injections that have to be | | | | |
| given monthly or three monthly for the rest | | | | Disease that has spread to the seminal |
| of the patient's life. They are effective but | | | | vesicles and beyond is not real curable. |
| very expensive. | | | | |
| | | | Prostate cancer is dependent on the male |
| Oestrogen | | | | hormone testosterone. 80% of patients will |
| | | | respond to hormonal treatment that deprives |
| Oestrogen can be taken orally on a daily | | | | the tumor of testosterone. This response |
| basis. It has a high incidence of thrombotic | | | | usually involves the shrinkage of metastases |
| complications such as stroke and myocardial | | | | and symptomatic improvement for the patient. |
| infarction. | | | | The response to hormonal treatment is not a |
| | | | cure but can last for many years in some |
| Anti-androgens | | | | patients. The average duration of response is |
| | | | 2 years. Most cancers eventually escape |
| Anti-androgens oppose the action of | | | | hormonal manipulation. This is referred to as |
| testosterone by blocking the androgen | | | | hormone independent disease and is usually |
| receptors. The incidence of erectile | | | | followed by death within a few months. |
| dysfunction is less than with surgical or | | | | |
| medical orchidectomy because testosterone | | | | Controversy exists regarding the timing of |
| levels are maintained in the bloodstream. | | | | hormonal treatment. Most studies indicate a |
| Anti-androgens alone are probably not | | | | survival benefit for early rather than late |
| adequate treatment for metastatic disease. | | | | hormonal maneuver. Testosterone deprivation |
| Total androgen blockade by a combination of | | | | has side effects like erectile dysfunction, |
| steroidal anti-androgens and LHRH-analogues | | | | breast enlargement and osteoporosis. The |
| or orchidectomy has not been shown to be | | | | earlier hormonal treatment is instituted the |
| better than LHRH-analogues or orchidectomy | | | | greater the chance of complications. Once |
| alone. However, non-steroidal anti-androgens | | | | again treatment has to be individualized to |
| yields slightly better results than | | | | the needs of the specific patient. |
| castration alone. | | | | |
| | | | With our next information - we will inform |
| Locally advanced disease without metastases. | | | | you about the Staging and grading of prostate |
| | | | cancer - so you should have a look on this |
| The overall results of treatment of patients | | | | site in the next 2 weeks! If you have any |
| with disease beyond the prostate are not | | | | question sends us your e-mail. |
| good. Some patients with early disease beyond | | | | |