Treatment of advanced prostate cancer

Hormone therapy

When the cancer has spread away from the prostate, going to either the lymph nodes or bones, hormone therapy may be effective at shrinking the tumour and reducing the side effects of the disease. It does not provide a cure, but will often keep the cancer in check for a number of years. This may also be beneficial if the cancer has spread outside the confines of the gland, but has not yet metastasised (spread further). Hormones are often used in conjunction with external beam radiotherapy and you may expect to be on hormones for between three months and two years.

The prostate gland and prostate cancer are under the influence of testosterone, the male sex hormone, which drives the tumour to grow and spread. By blocking the body's production of testosterone, or blocking its action, the growth of the tumour may be greatly reduced.

Tablets to block the effects of testosterone (anti-androgens i.e. Casodex, Cyproterone acetate) or implants to prevent the production of testosterone by the testicles (LH-RH analogues, i.e. Prostap, Zoladex) are used. Sometimes oestrogen (the female hormone) may be used as an additional hormone when altering the levels of male hormone has not been effective.

There may be side-effects from the treatment with hormones. It may lead to weight gain, so watching your diet and taking more exercise is important. Bothersome hot flushes, tiredness, mood change may be experienced at frequent intervals and some breast enlargement may occur. Reduced sex drive and loss of erection may also happen.

Chemotherapy

Chemotherapy, usually in tablet form, involves powerful drugs to attack the cancer cells and try to prevent them growing. It is a second line of defence for patients with advanced prostate cancer no longer controlled by hormone therapy. There are a number of different agents currently available, and there are drugs under trial that may be effective in controlling the disease even in its later stages.