Many commonly prescribed second-line hormone therapies are not formally approved for advanced prostate cancer, but many doctors believe that they can control PSA and perhaps extend life for many men. However, each of the second-line therapies has unique side effects themselves.
Use an experienced prostate cancer oncologist so they are familiar with the potential “off label” uses of some treatments.
- Antiandrogen withdrawal [AAW] (stopping the drug) is considered an excellent first option for men who have been taking an anti-androgen drug such as Casodex, Eulexin, Nilutamide or Androcur. There are no side effects associated with AWW, but its response is often short-lived and PSA begins rising again.
- For those men who have not taken antiandrogen drugs, adding them to the ADT protocol can help suppress the cancer because they block cells from metabolizing the androgens. Possible side effects of antiandrogens can include liver damage, hot flashes, breast growth and tenderness, loss of ejaculate, breast cysts, and the loss of libido. Men who only took an antiandrogen drug (antiandrogen mono-therapy) can add a GnRH agonist [Firmagon].
- Estrogens can also control testosterone levels in the blood, and may even directly kill castrate resistant cancer cells. Problems with estrogen therapy include risk of developing blood clots, increased