Hormone Therapy Question...

Likely a dumb question....
Drugs like Lupron....what do they actually do to prostate cells? Do they actually cause the cells to die? Or do they allow them to live, but not duplicate? Only cancerous prostate cells, or normal too?

Hi Gibson.
Your second post is what the drug does in your body. Through the pituitary gland your body is told it has enough testosterone so it shuts down production. And as you said the drugs (LHRH Agonists) do not work at the cellular levels of prostate cancer. Prostate cancer feeds on testosterone in the early stages. LHRH Agonists make testosterone unavailable so once the tumor(s) are deprived of it they either need to learn to survive without it or they begin to shrink. When I asked my oncologist if this kills the cancer he said absolutely ~ but not entirely. This is why hormonal therapies are effective early on but you are not cured.

There is another therapy that many of us took with our LHRH agonists ~ bicalutamide or Casodex. This drug DOES work at the cellular level of prostate cancer. This drug is an antiandrogen. It clings to the testosterone receptors in the cell wall and reduces the ability of the cell to consume testosterone. So Lupron does in fact reduce testosterone but it does not stop it entirely, and Casodex blocks whatever is left behind from being used.

A third agent is sometimes used as well ~ a 5ARI (alpha reductase inhibitor) such as Proscar (finasteride) or Avodart (dutasteride). This when combined with the other two is commonly called ADT3. There has not been any studies completed that show that these are effective against prostate cancer per se but there is compelling evidence that they may be. The 5ARI's can shrink the prostate and it could stand to reason then that they can also reduce prostate cancer.

I hope this helps.

Tony

Gibson,
I believe that Lupron by itself cause a flare up. Taking Casodex first for few weeks eliminates the flareup.

Dr. Walsh, chief of Urology at Johns-Hopkins, has this viewpoint..He thinks a certain usually large percentage of PC and normal prostate cells depend on testosterone to grow and survive. He also thinks there is almost always a small percentage that are not dependent on "T" for their growth and survival. He does not think all PC cells become "hormone refractory" after a period of time..He feels the the small percentage of cells that never required "T" and don't respond to HT are the ones that finally overwhelm the patient..He feels HT causes a massive die-off of the hormone-dependent cells, drops PSA to very low or undetectable levels and puts the patient in complete remission. It then takes a period of time ranging from 1 to 10 years before the cells that are not hormone dependent multiply to the point symptoms appear..He says survival depends on what percentage of cells were hormone independent at the beginning and how aggressive (doubling time) the cancer is..This is all detailed in his book..

The logic and science he uses to back his theory up are impressive..Of course, there are many others who disagree with him and who feel ALL PC cells respond to HT to a certain extent which varies considerably among different men..