Hormone therapy profoundly influences prostate cancer in aging men by targeting the cancer’s dependence on male hormones, primarily testosterone, which fuels its growth. Prostate cancer cells typically require androgens like testosterone and dihydrotestosterone (DHT) to grow and survive. Hormone therapy, often called androgen deprivation therapy (ADT), works by reducing androgen levels or blocking their effects on cancer cells, thereby slowing or halting tumor progression.
In aging men, prostate cancer is frequently hormone-sensitive at diagnosis, meaning the cancer cells rely heavily on androgens. Hormone therapy reduces circulating testosterone either surgically (orchiectomy) or more commonly through medications such as luteinizing hormone-releasing hormone (LHRH) agonists and antagonists. These drugs lower testosterone production by the testes, leading to a state called castration-level testosterone, which starves the cancer cells of their growth signals. This approach can significantly shrink tumors, delay disease progression, and alleviate symptoms, especially in advanced or metastatic prostate cancer.
However, hormone therapy is not curative. Over time, many prostate cancers adapt and become resistant, progressing to a state called castration-resistant prostate cancer (CRPC), where cancer cells grow despite low testosterone levels. This resistance arises because cancer cells can activate androgen receptor pathways even with minimal hormone presence or produce their own androgens locally. To combat this, newer hormone therapies have been developed that more effectively block androgen receptor signaling. These include androgen receptor pathway inhibitors (ARPIs) such as enzalutamide, apalutamide, and darolutamide, which prevent the androgen receptor from activating cancer-promoting genes. Another drug, abiraterone acetate, inhibits androgen production not only in the testes but also in the adrenal glands and tumor tissue by blocking a key enzyme in steroid synthesis.
For aging men, the impact of hormone therapy extends beyond cancer control. Lowering testosterone can cause side effects such as reduced libido, erectile dysfunction, hot flashes, fatigue, loss of muscle mass, bone thinning, and metabolic changes like weight gain and insulin resistance. These effects can influence quality of life and complicate management, especially in older patients who may have other health conditions. Therefore, treatment decisions often balance the benefits of hormone therapy in controlling cancer against these potential adverse effects.
The timing and combination of hormone therapy with other treatments also matter. In metastatic hormone-sensitive prostate cancer, combining ADT with ARPIs or chemotherapy has improved survival outcomes compared to ADT alone. This multimodal approach aims to delay resistance and extend the period during which the cancer remains controllable by hormone manipulation. In non-metastatic or localized disease, hormone therapy may be used alongside radiation to enhance effectiveness.
In summary, hormone therapy affects prostate cancer in aging men by depriving cancer cells of androgen stimulation, thereby controlling tumor growth and spread. While initially effective, resistance often develops, necessitating advanced therapies that more comprehensively block androgen receptor activity. The therapy’s systemic effects require careful management to maintain quality of life in older patients, making personalized treatment planning essential.
