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