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Surgical castration by orchidectomy
Surgical castration is the simplest and cheapest way to treat
metastatic prostate cancer. The obvious disadvantage is the
psychological effect of the loss of the testicles.
LHRH-analogues
LHRH-analogues and oestrogen achieve a "medical castration" by
stopping the testicular production of testosterone.
LHRH-analogues are injections that have to be given monthly or
three monthly for the rest of the patient's life. They are
effective but very expensive.
Oestrogen
Oestrogen can be taken orally on a daily basis. It has a high
incidence of thrombotic complications such as stroke and
myocardial infarction.
Anti-androgens
Anti-androgens oppose the action of testosterone by blocking the
androgen receptors. The incidence of erectile dysfunction is
less than with surgical or medical orchidectomy because
testosterone levels
are maintained in the bloodstream.
Anti-androgens alone are probably not adequate treatment for
metastatic disease. Total androgen blockade by a combination of
steroidal anti-androgens and LHRH-analogues or orchidectomy has
not been shown to be better than LHRH-analogues or orchidectomy
alone. However, non-steroidal anti-androgens yields slightly
better results than castration alone.
Locally advanced disease without metastases.
The overall results of treatment of patients with disease beyond
the prostate are not good. Some patients with early disease
beyond the prostatic capsule, and no evidence of metastases,
benefit from radical treatment. The most widely used treatment
regimens consist of a combination of radiotherapy and hormonal
treatment. Treatment options for locally advanced and metastatic
disease.
Early hormonal treatment · Watchful waiting with hormonal
treatment once symptoms
develop Disease that has spread to the
seminal vesicles and beyond is not really curable.
Prostate cancer is dependent on the male hormone testosterone.
80% of patients will respond to hormonal treatment that deprives
the tumor of testosterone. This response usually involves the
shrinkage of metastases and symptomatic improvement for the
patient. The response to hormonal treatment is not a cure but
can last for many years in some patients. The average duration
of response is 2 years. Most cancers eventually escape hormonal
manipulation. This is referred to as hormone independent disease
and is usually followed by death within a few months.
Controversy exists regarding the timing of hormonal treatment.
Most studies indicate a survival benefit for early rather than
late hormonal maneuver. Testosterone deprivation has side
effects like erectile dysfunction, breast enlargement and
osteoporosis. The earlier hormonal treatment is instituted the
greater the chance of complications. Once again treatment has to
be individualized to the needs of the specific patient.
Fritz Frei
About the author:
Fritz Frei works since more than 25 years in the health and
hospital business as a consultant. To receive more information's
about all prostate cancer -questions - Links and last research
NEW's - visit the http://www.cancer-info.info
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