When women and their doctors talk about “hormone therapy” they are most commonly referring to the (now) highly controversial issue of whether hormonal supplements (estrogen and progesterone) should be used at and after menopause to prevent the symptoms of menopause and/or later risks related to heart disease and osteoporesis.
By contrast, when men talk about “hormone therapy” with their doctors, they are most commonly referring to the application of agents that induce a chemical (medical) form of castration, i.e., the reduction of serum testosterone levels from a normal level of about 500 to 600 ng/ml down to below 50 ng/dl (and ideally below 20 ng/dl).
In other words, the term “hormone therapy” is used to mean two utterly different things in the two very different contexts. It is not exactly a surprise, however, to discover that an awful lot of people are under the impression that “hormone therapy” for men with prostate cancer is actually some form of hormone supplement, and do not understand that it is designed as a replacement for surgical castration (orchiectomy), i.e., a form of hormone deprivation. This includes many men who are actually receiving “hormone therapy” as treatment for prostate cancer … and their wives or partners.
A recent study by Rot et al. (and an associated “Beyond the abstract” commentary by Wassersug on the UroToday web site) argue that it is high time to reconsider the use of “hormone therapy” as an appropriate term in the treatment of prostate cancer.
In their paper, published in the European Journal of Cancer Care, Rot et al. report data from an on-line survey of 690 male and female cancer patients and non-patients. They show that:
- “A large proportion” of those surveyed did not understand the terminology used to describe prostate cancer treatments.
- Most did not appreciate that terms like “chemical castration,” “hormone therapy,” and “androgen deprivation” all mean the same thing.
- Male respondents
- Were more likely to agree to “hormonal therapy” than to “castration” as a treatment for prostate cancer
- Felt more strongly than women about how androgen deprivation therapy (regardless of how it was described) affected masculinity
- The men and the women had very different views about the impact of androgen deprivation.
They go on to conclude that if men with prostate cancer and their partners are to make well-informed decisions about treatment and to cope well with the side effects of androgen deprivation, their healthcare practitioners need to be offering accurate information using language that is unambiguous.
Wassersug expands on this issue in his commentary on the UroToday web site.
Now we all know how hard it is to change the habits of a lifetime. Rot, Wassersug, and their colleagues are probably correct; it would almost certainly be better if we stopped usen the term “hormone therapy” in talking about the treatment of prostate cancer and used the term “androgen deprivation therapy, which is a medical form of castration”. Getting everyone to do this, however, will be challenging.
Having said that, The “New” Prostate Cancer InfoLink is going to try to be more precise in the use of appropriate terminology in the future and only use the terms “hormone therapy” and “androgen deprivation” together with a clear explanation that these are medical forms of castration. Please feel free to tell us if we forget!