When the cancer has spread into the capsule of the prostate or through the prostate into the surrounding tissue it is called locally advanced Prostate Cancer. If it is has spread to other parts of the body it is called late Prostate Cancer.

In order to grown, Prostate Cancer needs the male hormone, ‘testosterone’. Then the cancer has spread beyond the prostate it can be treated most effectively by stopping testosterone from reaching it. This is called hormone manipulation therapy.

There are four ways of doing this:

• Surgical removal of the testicles (orchidectomy)
• Injections of LH-RH agonists drugs
• Tablets containing ‘anti-androgen’ drugs
• Tablets containing female hormone, oestrogen

Most men with late prostate cancer can respond to these therapies for an average of two years. If the cancer stops responding after this time you might be offered other forms of treatment.

Orchidectomy

Because testosterone is made in the testicles an orchidectomy is the simplest and most effective way of stopping production. Many men prefer this operation to taking medication over a long period.

Because an orchidectomy cannot be reversed, you must consider the following permanent side effects:

• You will be impotent
• You will lose your sex drive
• You will be infertile
• You will experience hot flushes (due to hormonal changes)
• You will be left with little tissue in your scrotum (you can have implants to overcome this).

LH-RH (Luteinising hormone-releasing hormone) Agonist Injections

These dugs stop the release of a hormone that sends signals to the testicles to produce testosterone. It is a roundabout way of switching off testosterone and therefore helps to stop the cancer from growing. This is as effective as an orchidectomy and the injection can be given by your GP. It should be pointed out that the side effects are similar as those experienced by men who have had an orchidectomy but can be reversed if you stop receiving the drug.

Anti-androgen drug therapy

These drugs do not stop the production of testosterone but help to reduce its effect of stimulating the Prostate Cancer. They are given as tablets and so offer an alternative to those patients who cannot face an operation or routine injections.

Side Effects:

Although there is still a risk of impotence the adverse sexual side effects are less severe that with orchidectomy and LH-RH agonists.

• Stomach upsets
• Diarrhoea
• May damage the liver.

You will require routine blood tests but most importantly, they are not felt to be as effective in controlling the cancer as the other therapies.

Oestrogen Therapy

This drug can be used if your prostate cancer does not respond to other hormone therapies. Oestrogen is a female hormone which suppresses the effects of testosterone. It is taken in tablet form.

Side Effects:

The most notable adverse side effect is the development of female characteristics.

• Loss of body hair and development of breasts
• Small chance of blood clots.
• Palliative Therapy

When these treatments are no longer effective in slowing down your Prostate Cancer you may develop pain elsewhere. Palliative therapy does not stop the growth of cancer but aims to reduce the pain caused by it.

• Radiotherapy, which is very effective in reducing prostate cancer pain
• Tablets containing steroid drugs: these can be effective but can cause stomach ulcers and fluid retention although other medication can be taken to reduce the side effects
• Chemotherapy: this involves taking drugs which cancer cells. Though seldom used for prostate cancer, it may be beneficial in some cases. Although chemotherapy can make you feel very sick there are effective drugs to deal with this adverse side effect.

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