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Hormone Treatment for Prostate Cancer (Androgen Ablation)


This form of treatment has many different descriptions, including androgen suppression, ablation or deprivation, or the even more descriptive “chemical castration”. However, they all mean the same thing, and it works by starving the prostate cancer of its fuel supply, testosterone. The main medication used is an injection called Zoladex, and is given every 3 months. An oral medication, Bicalutamide is often used around the time of the first Zoladex injection.

This treatment does not cure prostate cancer, but shrinks it, and usually brings the PSA down to low levels, indicative of the degree of effect.


Who is suitable for androgen ablation?


There are several reasons to use androgen deprivation for prostate cancer. These include;

-men not suitable for, or would not benefit from radical treatment
-when cancer has returned after radical treatment
-before treatment with radiotherapy


When should androgen ablation be started?


In the past, androgen deprivation was started soon after the diagnosis of cancer was made (if other options were not appropriate). However, we now have a more balanced approach, as starting treatment early has no benefit in the long run. If there are no symptoms or complications of prostate cancer, we would not start androgen deprivation until the PSA was greater than 30, and often much higher than this. This threshold is often lower for those men with cancer recurrence after previous surgery or radiotherapy.


How effective is androgen ablation ?


Androgen deprivation is a very effective treatment; more than 90% of men will get benefit from it, and this compares well to any form of cancer treatment. Very few men will have no response to this treatment.


What are the risks of androgen ablation ?


Androgen deprivation is a very well tolerated treatment. It is not chemotherapy, and the side effects are usually mild. Very few men have to stop treatment because of unbearable side effects. However, there can be effects on cardiovascular, bone and liver functions, and these are monitored at our nurse led monitoring clinics.


What if my PSA starts rising during androgen ablation ?


Your PSA may rise after being on Zoladex injections; when this occurs varies considerably. The PSA can rise if some prostate cancer cells become resistant to Zoladex. If this occurs, there are several potential options. These include starting bicalutamide, Abiraterone, or sometimes chemotherapy. Options will be discussed according to what is the best option for you


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