Prostate cancer, a leading cause of cancer in men, is generally fueled by androgens (male sex hormones) including testosterone. Most prostate cancer treatments involve testosterone deprivation, using drugs to block testosterone, in order to slow the growth of tumors. Hormone therapy may prove to be a beneficial treatment for men with castration-resistant prostate cancer (PCa). Limited studies suggest this particular therapy, known as bipolar androgen therapy (BAT), cycles testosterone hormones through peaks and valleys.
Bipolar Androgen Therapy
The prostate needs androgens to function properly. Prostate cancer generally needs normal levels of testosterone to grow; treatments that decrease or block androgen levels can inhibit tumor growth. Typical hormone treatments block the body’s production of androgens (medical castration), which generally results in tumor suppression. However, over time some prostate cancers become resistant to the treatments. Commonly called castration-resistant prostate cancers, they are different because they can keep growing even with low or imperceptible levels of testosterone in the body.
In recent years medical researchers have begun to investigate whether large amounts of testosterone, more than typically produced by the body, can stop the progression of prostate cancer. This concept seems contradictory to standard practice but is showing promise. BAT uses controlled fluctuation of hormone levels to attack metastatic prostate cancer. An injection, given every 4 weeks, combined with androgen suppressing drugs, result in very high levels of testosterone that peter out over the course of each month; creating a bipolar cycle.
According to Dr. Michael Schweizer, a clinical researcher at Fred Hutchinson Cancer Research Center, BAT is being tested in men who have had long-term testosterone deprivation that resulted in changes in tumor cells. Over time these tumor cells have developed sensitivity to high dose testosterone combined with androgen blocking therapy.1
Unexpected positive benefits
Some men reported feeling better after undergoing BAT, their energy improved, regaining their appetite and some muscle mass. Some reported being able to resume having sex. They experienced relief from the negative effects of past treatments. As described by Dr. Samuel Denmeade of Johns Hopkins, there may not be a cure for metastatic prostate cancer, but improving the patients’ quality of life is an unexpected benefit and unusual in the treatment of cancer.1
Looking ahead in research
Future research is aiming to examine and confirm the safety and efficacy of bipolar androgen therapy. Before embarking on this new approach to treating this subset of aggressive prostate cancer, scientists need to evaluate the therapy on a larger population so as to better understand the impact of the therapy on cancer, and create a suitable clinical treatment for prostate cancer.1
The goal is to identify the potential therapeutic possibility for bipolar androgen therapy to be used in treating castration-resistant prostate cancer. Part of the process will be to define the strategy for fluctuating between polar levels so the impact maximizes therapeutic benefit.
Tompa, R. Bipolar’ therapy: Treating advanced prostate cancer with high-dose testosterone. Published January 7, 2015. https://www.fredhutch.org/en/news/center-news/2015/01/high-dose-testosterone-for-advanced-prostate-cancer.html. Accessed online June 14, 2018
Stenger, M. Bipolar Androgen Therapy after Progression on Enzalutamide in Metastatic Castration-Resistant Prostate Cancer. Published January 9, 2018. http://www.ascopost.com/News/58427. Accessed online June 14, 2018