When choosing a treatment for prostate cancer, doctors consider the following factors: phase of the illness, PSA levels, the Gleason score and life expectancy. Depending on these parameters and especially on the results expected, the treatment can be curative or palliative. Initially, the patient needs to be informed on the advantages and risks of various treatment options.

The use of ketoconazole for prostate cancer is common in the T3-T4 phases of the illness, namely slight extension around the prostate, but also in the metastasized phase of the illness, namely the phases N+ and M+.



For localized tumors

For this phase, treatment involves the removal of the prostate or radiotherapy. Long term survival is highly likely in both forms of treatment. The prostatectomy consists of the removal of the prostate and of the seminal vesicles and it is recommended for patients with a survival expectancy higher than 10 years. Complications that might occur include hemorrhaging and iatrogenic lesions of the obturator nerves, ureters and rectum. After surgery there could be some deep venous thrombosis, pelvic lymphocele, pulmonary embolism and urinary infection. In the long term, the most common complications – urinary incontinence and erectile dysfunction – are due to lesions of the striated sphincter and of the cavernous nerves. Radiotherapy is suited for patients with a life expectancy below 10 years and who are advised against surgery.

In the T3-T4 phase of the illness

For this phase, the optimal solution would be radiotherapy, because surgery cannot completely remove the tumor and it would favor systemic dissemination. Another therapeutic option is hormonal treatment alone or in association with radiotherapy. Here doctors could use ketoconazole for prostate cancer. Endoscopic resection is used for patients with urine retention.

In the N+ M+ phase of the illness

Standard treatment in this phase is hormonal. The favorable response in this form of treatment comes as a result of the destruction of the adenocarcinoma cells. The testosterone, 95% coming from the testicles, is transformed into dihydrotestosterone. On a prostate level, dihydrotestosterone favors the proliferation of normal as well as neoplastic cells. The object of the hormonal treatment is to decrease the level of testosterone and implicitly that of dihydrotestosterone. There is temporary regression in almost 80% of cases, but the life expectancy is greatly reduced.

One part of the hormonal treatment is the administration of antiandrogens by two ways: inhibiting the synthesis of androgens or preventing their action on a prostatic cell level through the competitive inhibition of the androgenic receptors. Ketoconazole is the mixture that quickly inhibits the synthesis of androgens in the testicle and the supra-renal gland. The inhibition of receptors is performed with medicine such as Flutamide which achieves medical castration when administered in 250 milligram doses three times per day in mono-therapy or in combination with an LHRH agonist. Other medicine that can be used include: cyproterone-acetate, bicalutamide 50 mg per day and milutamide (Milandron) 150mg per day.



The inhibition of the adrenal secretion of testosterone is obtained through a “medical adrenalectomy” which can be achieved with ketoconazole or with aminoglutethimide (cytadren). For these patients, steroidal hormone substitution with hydrocortisone is imposed.