Medical and pharmacological therapy

The cure of prostate tumors depends on the phase of the illness, the general state of health and the age of the patient. Elderly patients with secondary symptoms due to the pervasiveness of the tumor, or initial tumors, can be cured in a conservative manner.

Watchful waiting
This Anglo-Saxon term indicates an attitude of attentive waiting. It is a line of conduct that is reasonable for elderly patients, in a health condition that is not very good, or with a tumor in the initial phase. The Prostate tumor not treated can require years before becoming symptomatic, but it can not be left to itself. During this period of attentive waiting, the doctor controls the state of the patient to detect a significant or progressive development of the illness, which can signal the need to begin treatment.

Hormone therapy
Hormone therapy can include the administering of medicines, the so-called “LHRH agonists”, that block the production of testosterone, a hormone necessary for the development of the prostate tumor cells. The medicines available in Italy are the following:
* Goserelin (Zoladex®)
* Leuprolide (Enantone®)
* Triptorelin (Decapeptyl®)
* Bicalutamide (Casodex®)
* Flutamide (Eulexin®)
In some cases, to treat the prostate tumor, to the injections of the LHRH Agonists are added the Antiandrogen medicines. These medicines, compared to injections, can block the attack sites of the testosterone Flutamide (Eulexin®), Bicalutamide (Casodex®) and Nilutamide (Nilandron®).
Patients who take antiandrogens must be subjected to periodic examinations of the functions of the liver. In addition, they must immediately notify their doctor of symptoms such as: nausea or vomiting, stomach pains, extreme tiredness, loss of appetite, the appearance of dark urine and yellowing of the eyes.

The collateral effects associated with the hormonal therapy can be:
* Depression
* Hot flashes, perspiration (menopause syndrome)
* Asthenia (weakness)
* Enlargement of breast tissue (gynaecomastia)
* Local reaction to injections
* Hyperglycemia
* Urinary obstruction
* Osteoporosis
* Migraines
* Blood in urine (haematuria)

Patients who begin hormonal therapy can experience, for about 2 weeks, an increase of the symptoms of the prostate tumor, due to a temporary increase in the levels of testosterone. Patients with an advanced illness (tumor extended to bones, bladder, etc.) cannot tolerate this increase in testosterone. For this reason it is advisable to begin with the antiandrogens and pass on to the LHRH agonists .
If this method to lower the level of testosterone does not function over time, it is possible to use female estrogen. The secondary effects of taking estrogen include more possibility of bleeding, hypertension, enlargement of the breast (ginecomastia), and an increased risk of thromboembolism.
In some cases, the tumor cells of the prostate in an advanced state can survive and develop despite the hormone therapy. There has been recent approval for Docetaxel (Taxotere®), a medicine used in chemotherapy to treat this type of tumor, which is called hormone-insensitive.

The collateral effects of this medicine are:
* Tiredness
* Loss of hair
* Anemia, netropenia
* Nausea

Therapy for bone metastasis
Zoledronic acid (Zometa®) is a biphosphonate used in treating hypercalcaemia – an excess of calcium in the bolood – in patients with a prostate tumor who have metastasis of the bone (secondary tumors in the bone). Patients with hypercalcaemia suffer from dehydration, tiredness, nausea, vomiting, confusion and, if not treated, the illness can result in a coma.
As a result of the metastasis, the calcium released by the bone altered and weakened by the metastasis increases in the circulation of the blood. The zoledronic acid increases the density of the bone and reduces the risk of spontaneous fracture.
The collateral effect usually are rather light and temporary and can be the following:
* Anemia
* Constipation or diarrhea+
* Tiredness
* Insomnia
* Pains in the bones, muscles and ligaments
* Nausea
* Dypsnea
* Vomiting