Treating prostate cancer, Part VI: Androgen deprivation and beyond
Hormonal therapy for prostate cancer dates back to 1941 when Drs. Charles Huggins and C.V. Hodges reported that androgens (male hormones) fuel the growth of prostate cancers and that androgen-deprivation therapy could slow or halt that growth. It was a groundbreaking discovery, important enough to earn a 1966 Nobel Prize for Dr. Huggins, and it remains the basis for the treatment of advanced prostate cancer more than half a century later. Despite the seniority of androgen-deprivation therapy, however, it shares two features common to all prostate cancer treatments: uncertainty and debate. While doctors agree that hormonal therapy has an important place in treating advanced prostate cancer, they disagree on which of the available hormonal therapies is best, when it should be started, and what to do about side effects. As in all areas of prostate cancer treatment, the choice among options for hormonal therapy requires an individualized decision by the patient and his doctors.
Hormones and the prostate: A lengthy chain
Drs. Huggins and Hodges discovered that androgens stimulate the growth of prostate cells, both benign and malignant, but those brilliant scientists might be surprised to learn how complex the process has turned out to be.
It all begins in the brain, where the hypothalamus produces the hormone that starts things off; although it's a single protein, it has two names, gonadotropin-releasing hormone (GnRH) and luteinizing hormone–releasing hormone (LHRH). Hormones are chemicals that are produced in one part of the body before traveling to another part, where they do their work. LHRH is a true hormone, but it doesn't have to travel very far to do its job; it acts on another part of the brain, the pituitary gland, where it stimulates the release of two additional hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH).