Written by: Lennard M. Goetze, Ed.D | Clinical Field Review by: Dr. Robert L. Bard 1-25-2026
Prostate cancer is fundamentally a hormone-driven disease. From its earliest stages through advanced progression, the growth and survival of most prostate cancer cells are fueled by androgens—primarily testosterone and its more potent derivative, dihydrotestosterone (DHT). This biological dependence makes hormone therapy, also known as androgen deprivation therapy (ADT), one of the most effective and widely used treatments in prostate cancer care. While hormone therapy is not considered curative on its own, it plays a critical role in controlling disease progression, alleviating symptoms, enhancing the effectiveness of other treatments, and extending survival across multiple stages of prostate cancer.
Understanding
Hormone Therapy (Androgen Deprivation Therapy)
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Types of Hormone Therapy Used in Prostate
Cancer
LHRH Agonists and Antagonists
Luteinizing hormone–releasing hormone (LHRH) agonists and antagonists are among the most commonly used forms of hormone therapy in prostate cancer. These injectable or oral agents suppress testosterone production by acting on the hypothalamic–pituitary–gonadal axis. LHRH agonists may cause a transient testosterone “flare” at treatment initiation, whereas antagonists achieve more rapid suppression without this effect. While testosterone suppression is generally reversible with short-term use of LHRH agents, long-term therapy may result in prolonged or permanent testosterone suppression, particularly in older men or those treated for extended durations. These therapies are typically administered on monthly, quarterly, or annual schedules and require individualized monitoring based on patient age, treatment duration, and overall health status.
Anti-Androgens
Anti-androgen medications block testosterone from binding to androgen receptors
on prostate cancer cells. Older agents were often used alongside LHRH drugs,
while newer, second-generation anti-androgens such as enzalutamide and
apalutamide provide more potent receptor inhibition. These drugs are
increasingly used in both advanced and earlier stages of disease due to their
improved efficacy.
Androgen Synthesis Inhibitors
Some prostate cancers continue to thrive despite low circulating testosterone
by producing androgens locally or utilizing adrenal sources. Androgen synthesis
inhibitors, such as abiraterone acetate, block testosterone production
throughout the body. These medications are commonly used in metastatic or
castration-resistant prostate cancer and are typically combined with low-dose
steroids to manage side effects.
Surgical Hormone Therapy
(Orchiectomy)
Orchiectomy, the surgical removal of the testes, provides permanent
testosterone suppression. While effective and cost-efficient, it is less
commonly chosen today due to its irreversible nature and psychological impact.
However, it remains a valid option in select cases.
When
Hormone Therapy Is Used
Benefits
and Clinical Outcomes
Hormone therapy consistently lowers
PSA levels and can significantly shrink tumors or slow their growth. In
metastatic disease, it often provides rapid symptom relief, particularly for
bone pain and urinary obstruction. Numerous studies have demonstrated improved
survival when ADT is appropriately combined with radiation or systemic
therapies, underscoring its central role in prostate cancer management.
Side
Effects and Quality-of-Life Considerations
Despite its benefits, hormone
therapy is associated with a range of side effects. Common issues include hot
flashes, fatigue, reduced libido, erectile dysfunction, weight gain, and muscle
loss. Long-term therapy may increase the risk of osteoporosis, metabolic
syndrome, diabetes, and cardiovascular disease. Cognitive changes and mood
disturbances have also been reported. These effects highlight the importance of
proactive monitoring, lifestyle interventions, bone health management, and
patient education to preserve quality of life during treatment.
The
Role of Personalization and Monitoring
Conclusion:
Hormone Therapy as Part of an Integrated Strategy
Hormone therapy remains one of the most powerful tools in prostate cancer treatment. When thoughtfully applied and carefully monitored, it offers meaningful disease control and survival benefit. The most successful outcomes arise from an integrated approach—combining hormone therapy with imaging, supportive care, and personalized treatment planning—ensuring patients receive not only longer life, but better quality of life as well.
References
American Cancer Society. (2024). Hormone
therapy for prostate cancer. https://www.cancer.org
Attard, G., Parker, C., Eeles, R.
A., Schröder, F., Tomlins, S. A., Tannock, I., & de Bono, J. S. (2016).
Prostate cancer. The Lancet, 387(10013), 70–82.
https://doi.org/10.1016/S0140-6736(14)61947-4
National Cancer Institute. (2024). Prostate
cancer treatment (PDQ®)–patient version. https://www.cancer.gov
Nguyen, P. L., Alibhai, S. M. H.,
Basaria, S., D’Amico, A. V., Kantoff, P. W., Keating, N. L., & Penson, D.
F. (2015). Adverse effects of androgen deprivation therapy and strategies to
mitigate them. European Urology, 67(5), 825–836.
https://doi.org/10.1016/j.eururo.2014.07.010
Sharifi, N., Gulley, J. L., &
Dahut, W. L. (2010). Androgen deprivation therapy for prostate cancer. JAMA,
294(2), 238–244. https://doi.org/10.1001/jama.294.2.238
Part 2:
Imaging as the Unifying Force across Standard Therapies
Cancer Radiologist | Diagnostic Imaging Specialist
Prostate cancer care has evolved into a highly structured, evidence-based continuum—one that balances disease biology, patient risk stratification, and quality-of-life considerations. Across decades of clinical observation and imaging-based assessment, it is clear that no single therapy stands alone. Instead, modern prostate cancer management is defined by appropriate treatment selection, timely intervention, and objective monitoring, all anchored by diagnostic imaging.
As a cancer radiologist specializing in advanced diagnostic imaging, my role is not to replace standard therapies, but to corroborate, validate, and refine them. Imaging serves as the common language that links surveillance, intervention, and follow-up—ensuring that treatment decisions align with tumor behavior rather than assumptions alone.
Risk Stratification and the Foundation of Care
Imaging has become indispensable in this process. High-resolution ultrasound, multiparametric MRI, PET-based tracers, and Doppler vascular assessment now provide real-time insights into tumor location, aggressiveness, vascularity, and response to therapy—allowing clinicians to act with precision rather than excess.
Primary Treatments (Localized / Curative Intent)
Active Surveillance and Watchful Waiting: For patients with low-risk, slow-growing prostate cancer, active surveillance remains a clinically sound and patient-centered strategy. Imaging plays a critical role in this pathway by confirming disease stability, detecting subtle progression, and reducing unnecessary biopsies or premature treatment. Surveillance is not passive—it is data-driven vigilance.
Surgery: Radical Prostatectomy- Radical prostatectomy remains a cornerstone curative option, particularly for localized disease in otherwise healthy patients. Preoperative imaging assists in surgical planning, margin assessment, and lymph node evaluation, while postoperative imaging helps identify recurrence early, should PSA levels rise.
- External Beam Radiation Therapy (EBRT)
- Intensity-Modulated Radiation Therapy (IMRT)
- Brachytherapy (radioactive seed implantation)
In addition, proton therapy and CyberKnife® stereotactic radiosurgery represent highly refined radiation approaches. Proton therapy allows for targeted dose delivery with reduced collateral tissue exposure, while CyberKnife uses robotic X-ray guidance for sub-millimeter accuracy. Imaging is essential in treatment planning, targeting, and post-therapy assessment for all radiation modalities.
Advanced or Recurrent Disease Treatments
Hormone Therapy (Androgen Deprivation Therapy – ADT)
Hormone therapy remains foundational in advanced, recurrent, or metastatic prostate cancer. Agents such as Lupron®, Firmagon®, and Orgovyx® suppress testosterone signaling to slow disease progression. Imaging helps determine treatment response, detect castration-resistant changes, and guide escalation or combination strategies.
Chemotherapy: Systemic agents such as docetaxel and cabazitaxel are used when prostate cancer spreads or becomes resistant to hormone therapy. Imaging evaluates disease burden, tracks metastatic spread, and informs timing and effectiveness of chemotherapy interventions.
Targeted Therapy: The emergence of genetically targeted therapies, including PARP inhibitors like olaparib, has introduced a new level of personalization. Imaging complements genomic testing by demonstrating phenotypic response and guiding treatment continuation or adjustment.
Immunotherapy: Immunotherapeutic approaches such as Sipuleucel-T represent an important option for select patients. While immune response may not always be immediately reflected in PSA changes, imaging provides objective insight into disease stabilization or progression.
Radiopharmaceutical Therapy: Radium-223 is a targeted radiopharmaceutical used specifically for prostate cancer metastases to bone. Imaging is critical in identifying appropriate candidates, monitoring skeletal response, and distinguishing therapeutic benefit from disease-related bone changes.
Ablative and Supportive Treatment Modalities
Bone-Targeted Therapy: For patients with bone metastases, bisphosphonates and denosumab are essential for skeletal protection and pain management. Imaging tracks bone integrity, fracture risk, and therapeutic response.
Imaging as the Integrator of Prostate Cancer Care
The future of prostate cancer management lies not in choosing one therapy over another, but in intelligent integration—where surgery, radiation, hormone therapy, systemic agents, and emerging technologies are applied in harmony, guided by accurate, real-time diagnostic insight.
Closing Perspective
Modern prostate cancer care is robust, multidisciplinary, and continually advancing. Current standards—from active surveillance to proton therapy, CyberKnife, systemic treatments, and supportive care—are well-founded and effective when applied appropriately. Diagnostic imaging stands at the center of this ecosystem, ensuring that every decision is informed, justified, and aligned with the patient’s unique disease profile.
In prostate cancer, seeing clearly is not optional—it is essential.
Part 3:
Prostate Scan Now with Host: "Cousin Sal "Banchitta - Ret FDNY FF- presents BARRIE KOLSTEIN, PC Survivor
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