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Testosterone replacement therapy may be required for prostate cancer patients who have undergone androgen deprivation therapy (ADT) to treat prostate cancer. ADT blocks the production or effects of androgens, such as testosterone and dihydrotestosterone (DHT), which are the male sex hormones that promote male characteristics such as facial hair, sexual function and muscle mass.
Though androgens ensure that the prostate grows and functions normally, androgens can lead to prostate cancer because they bind to and activate a protein (androgen receptor) that is produced by the cells in the prostate gland. Once these androgen receptors bind to androgen, they stimulate certain genes that cause prostate cells to grow. Prostate cancer cells can also produce testosterone.
ADT is most often used to treat cancer that has spread outside the prostate, a recurrence of prostate cancer after another therapy has been used, or men who are at high risk of experiencing cancer recurrence after surgery or radiation therapy. ADT methods are used in three different ways to treat prostate cancer:
- Primary treatment: ADT is used as the single first-line treatment.
- Neo-adjuvant: ADT is used before local treatment to reduce tumor size.
- Adjuvant: ADT is used used directly after surgery or radiation as a precautionary measure.
ADT can be administered via the following treatments and/or drugs:
- Orchiectomy (surgical castration), though rarely used because it is irreversible, involves removal of the testicles, where most testosterone is produced. This treatment can reduce the level of testosterone by 90-95%.
- Luteinizing hormone-releasing hormone (LHRH) analogs, sometimes called chemical or medical castration, lower the amount of testosterone produced by the testicles. LHRH analogs are injected or placed as small implants under the skin from once a month to once a year.
- Degarelix (Firmagon) reduces testosterone levels more quickly than LHRH and is used to treat advanced prostate cancer. It is given as a monthly injection under the skin.
- Abiraterone (Zytiga) blocks an enzyme called CYP17, which helps prostate cells to stop producing androgens.
- Anti-androgens block androgens from attaching to androgen receptors in cancer cell proteins. Anti-androgens are usually combined with traditional ADT treatments.
- Enzalutamide (Xtandi) blocks the signal from androgens already bound to the androgen receptor to prevent growth and division.
- Estrogen, which is a female hormone, triggers the body to stop producing androgens.
- Ketoconazole (Nizoral) blocks androgen production.