What is Hormone-Sensitive Prostate Cancer?

Hormone-sensitive prostate cancer (HSPC) means the cancer still responds to lowering testosterone (androgens). Many men are initially shocked by a diagnosis—especially if metastases are present—but it’s important to know that with modern therapies, many live long, fulfilling lives, often with minimal symptoms. Stage 4 disease does not automatically mean a poor prognosis in the era of advanced treatments.

Androgen Deprivation Therapy (ADT) Options

Medical ADT

  • LHRH Agonists (leuprolide, goserelin, triptorelin) – injections every 1–6 months.
  • LHRH Antagonists (degarelix, relugolix) – rapid testosterone suppression without flare.
  • Intermittent ADT – cycles of treatment/rest in select cases.

Surgical ADT

  • Bilateral orchiectomy – outpatient procedure, immediate testosterone drop.
  • Rarely chosen today due to reversibility preference of medical ADT.

Androgen Pathway Inhibitors

  • Abiraterone – blocks androgen production; taken with prednisone.
  • Enzalutamide – blocks androgen receptor signaling.
  • Apalutamide – similar to enzalutamide; well-tolerated in many.
  • Darolutamide – fewer CNS side effects; good for active patients.

These agents, when added to ADT, reduce risk of progression and extend survival. Choice depends on comorbidities, tolerance, and patient lifestyle priorities.

Monitoring and Imaging

  • Blood Work: PSA, testosterone, metabolic panel every 3–6 months.
  • Bone Health: DEXA scan every 1–2 years, calcium/vitamin D, possible bisphosphonates or denosumab.
  • Imaging: Baseline PSMA PET, MRI or CT for follow-up as needed.

Lifestyle and Supportive Care

  • Resistance training 2–3x/week to preserve muscle mass.
  • Aerobic exercise 150 minutes/week to support heart health.
  • High-protein diet (1.2–1.5 g/kg/day).
  • Bone-supportive foods (leafy greens, dairy, fortified products).
  • Sleep optimization and stress management techniques.
  • Smoking cessation and alcohol moderation.
  • Social engagement and support groups.
  • Regular follow-up with oncology/urology team.