Surgery versus Hormone Therapy in advanced Carcinoma Prostate.
- 20th November 2021
- Comments (12)
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Androgens mainly testosterone plays an important role in development of prostate cancer .Hence, Androgen deprivation therapy (ADT) is a corner stone therapy for this disease.
At the out set one needs to be informed that both surgery as well as Long term hormonal therapy are a part of hormonal treatment, hence we need to divide these modalities as Surgical castration or medical castration.
ADT includes:
- Bilateral orchiectomy ( surgical removal of the testicles), also called surgical castration.
- Luteinizing hormone-releasing hormone (LHRH) agonists are drugs that lower the body's production of testosterone by stopping the testicles from making testosterone also called as medical castration.
- Anti-androgen drugs.
- Combined androgen blockade (CAB) is a combination of an anti-androgen drug and either surgery or an LHRH agonist drug.
Some common side effects of hormone therapy may include:
- Psychological effects resulting from testicle removal
- Loss of sex drive
- Erectile dysfunction (inability to have erections)
- Hot flashes
- Tiredness
- Mood changes
- Muscle shrinkage
- Enlarged and/or tender breast
Now to answer to your question so as to which form of therapy is better between orchidectomy or LHRH therapy . There are certain points which need to be considered.
- If ADT is required for a certain period of time like for 2 years in adjuvant setting , LHRH agonist are used because they can be stopped after a certain time and the side effects can then wean off.
- However one has to realise that if we want a immediate release in testosterone levels surgical castration is the preferred choice.
- Whenever we use LHRH agonists there in a temporarily increase in symptoms called as FLAIR which can be devastating in case there is a impending neural compromise etc. In surgical castration there is no similar effect.
- And the last but most important factor in Indian scenario is cost . Orchidectomy is a simple one time procedure but LHRH agonists needs to be taken through out the duration of treatment.
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