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hormonal therapy

Since this is an advanced metastatic prostate cancer then surgery is not an option and you go with supportive therapy which is usually in the form of hormonal therapy.

Hormonal therapy can either be performed with removal of the testicles (orchiectomy) or with drugs

Most patient prefer drugs.

The most commonly used are Leuprolide (LHRH analogue) and Flutamide (Antiandrogen)

Don't confuse these two drugs with Finasteride (5 alpha reductase inhibitor) which is used in BPH only.

There's a nice thread about prostate CA therapy here
http://www.usmle-forums.com/usmle-step-1-forum/1034-prostate-ca-rx.html
 

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If we have to choose between the drugs used for hormonal therapy. Then the single drug of choice should be GnRH analogs (Nafaralin, Gosereline, Leuprolide, Histrelin, and Buserelin)

As the pt has spinal metastasis
When you give flutamide (which is an androgen receptor blocker) you will after some time inhibit the negative feedback that Testosterone has on the pituitary ----> Increased LH ----->Leydig cell stimulation ----> Increased gonadal Testosterone secretion.
This increase in testosterone can increase the tumor size which can further complicate the neurological symptoms caused by the tumor.

I hope this answers your question....
 
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