Hormone Therapy for High-Risk Prostate Cancer | Prostate Cancer Staging Guide

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07/07/23

PCRI’s Executive Director, Mark Scholz, MD, discusses the use of hormone therapy for men with Azure (High-Risk) prostate cancer. He covers why it is necessary for men with high-risk disease and talks about the three categories of hormone therapy.

0:28 Men with Azure are generally given hormone therapy because there is a higher risk of spread outside the prostate. Hormone therapy is a systemic treatment that acts on the entire body, not just the prostate. It is effective, and its side effects are reversible. Compared to chemotherapy, another systemic treatment, it is more effective and has far fewer side effects.

1:23 The three categories of hormone therapy. Hormone therapy, also known as testosterone inactivating pharmaceuticals (TIP) comes in three different strengths. The first and least potent category of hormone therapy is the “anti-androgens.” Common examples of these drugs are Casodex and Nilutamide. The second category and the most commonly used type of hormone therapy are the “LHRH Agonists” drugs such as Lupron, Eligard, and Trelstar. The last category is the second generation hormonal agents that operate differently than the previous categories. Examples of these are Erleada, Xtandi, and Zytiga. You don’t want more hormone therapy than what is necessary because of added side effects.

2:43 Hormone therapy for the different subtypes of Azure. Each subtype of azure requires different amounts of hormone therapy. High-risk prostate cancer should be treated with a combination of radiation, seed implants, and hormone therapy, but the amount of hormone therapy can differ depending on the subtype. Low-Azure only requires 4-6 months of Lupron and Casodex. Basic-Azure needs between 18-24 months for optimal cure rates. And High azure needs 18-24 months possibly with the addition of a second generation TIP such as Erleada, Xtandi, or Zytiga.

4:12 Summary. The amount of hormone therapy depends on the subtype of prostate cancer. Many studies have shown that Low-Azure only requires a short course of hormone therapy and High-Azure can benefit from adding second generation hormone therapy.

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