Endocrine therapy is a relatively common treatment for prostate cancer, especially for patients with locally advanced prostate cancer.
Endocrine therapy approaches
The main approaches of endocrine therapy are divided into depot therapy and anti-androgen therapy:
- Destructive therapy: includes the traditional surgical removal of the testes, as well as the modern use of drugs to inhibit androgen production by the testes, such as drugs such as luteinizing hormone-releasing hormone analogs (LHRH-a), to achieve the effect of removing the testes with drugs;
- Antiandrogen therapy: This is the use of drugs to achieve the effect of counteracting androgens in the body and blocking the effect of androgens on prostate cancer cells, commonly used drugs such as androgen receptor antagonists (bicalutamide) and newer anti-androgen therapy drugs such as abiraterone. The combination of the two approaches can achieve maximum androgen blockade.
Population for endocrine therapy
The endocrine therapy recommended by the prostate cancer treatment guidelines is primarily indicated for patients with the following:
- Advanced metastatic prostate cancer, including metastases in the lymph nodes and metastases in the bones of the organs;
- Patients with limited early prostate cancer or locally progressive prostate cancer but unable to undergo radical prostatectomy or radiation therapy;
- Neoadjuvant endocrine therapy prior to radical prostatectomy or prior to radical radiotherapy;
- adjuvant endocrine therapy in conjunction with radical prostatectomy or radiation therapy;
- Local recurrence after curative therapy, but no further local treatment is possible, or distant metastases after curative therapy;
- Patients in the androgen non-dependent phase who require continuous androgen suppression while undergoing other treatments such as chemotherapy.
Taken together, endocrine therapy has now become a fundamental and important treatment for prostate cancer, especially for advanced prostate cancer.
Most patients with prostate cancer can achieve significant symptom relief and tumor control after endocrine therapy, and a proportion of locally advanced prostate cancers have regained access to radical prostate surgery through endocrine therapy.