Treatment

Hormone therapy

Hormone therapy works by stopping the hormone testosterone from reaching prostate cancer cells. It treats the cancer, wherever it is in the body.

Testosterone controls how the prostate gland grows and develops. It also controls male characteristics, such as erections, muscle strength, and the growth of the penis and testicles. Most of the testosterone in your body is made by the testicles, and a small amount by the adrenal glands which sit above your kidneys.

Testosterone doesn’t usually cause problems, but if you have aggressive prostate cancer, it can make the cancer cells grow faster. In other words, testosterone feeds the prostate cancer. If testosterone is taken away, the cancer will usually shrink, wherever it is in the body.

Hormone therapy alone won’t cure your prostate cancer but it can keep it under control, sometimes for several years, before you need further treatment. It is also used with other treatments, such as radiotherapy, to make them more effective.

What other treatments are available?

Contents

Who can have hormone therapy?

What types of hormone therapy are there?

What are the advantages and disadvantages of hormone therapy?

What does treatment involve?

What happens next?

What are the side effects?

Questions to ask your doctor or nurse

References

 

Who can have hormone therapy?

Hormone therapy is an option for many men with prostate cancer, but it’s used in different ways depending on whether your cancer has spread. Speak to your doctor or nurse about your own treatment options.

Localised prostate cancer

If you have localised prostate cancer, you might have hormone therapy alongside your main treatment.

Hormone therapy is not usually suitable for you if you’re having surgery (radical prostatectomy).

Locally advanced prostate cancer

If you have locally advanced prostate cancer, you may have hormone therapy along with radiotherapy. Some men might have hormone therapy on its own if radiotherapy isn’t suitable for them.

Advanced prostate cancer

Hormone therapy will be a life-long treatment for many men with advanced prostate cancer. It can control the cancer and manage symptoms such as bone pain.

Prostate cancer that has come back

If your cancer has come back after treatment, hormone therapy will be one of the treatments available for you.

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What types of hormone therapy are there?

Injections or implants

These work by stopping the message from the brain that tells the testicles to make testosterone. They are as good at controlling prostate cancer as surgery to remove the testicles.

LHRH agonists

These are the most common type of injection. There are several different types. Some of the common LHRH agonists are:

  • goserelin (Zoladex® or Novgos®)
  • leuprorelin acetate (Prostap®)
  • triptorelin (Decapeptyl® or Gonapeptyl Depot®).

There is also an implant available called histrelin (Vantas®). It’s inserted under the skin of your arm once a year. It’s used less often than some of the other LHRH agonists.

Before you have your first injection of an LHRH agonist, you may have a short course of anti-androgen tablets. This is to stop your body’s normal response to the first injection, which is to produce more testosterone. If you have advanced prostate cancer, this temporary surge in testosterone could make any symptoms you have worse for a short time – this is known as a flare.

Some men have aches and pains when they start LHRH agonists. This isn’t a flare, but is caused by the lack of testosterone and the effect this has on the body.

GnRH antagonists

There’s currently only one GnRH antagonist available in the UK, called degarelix (Firmagon®). It may not be available in every hospital.

Degarelix does not cause a temporary rise in testosterone with the first treatment so you won’t need to take anti-androgen tablets. It starts to lower testosterone levels within the first day of treatment.

Surgery to remove the testicles (orchidectomy)

An orchidectomy is an operation to remove the testicles, or the parts of the testicles that make testosterone. It’s used less often than other types of hormone therapy.

Surgery usually reduces testosterone levels to their lowest level in less than 12 hours. And you won’t need to have regular injections. But it can’t be reversed so it’s usually only offered to men who need long-term hormone therapy.

Some men find the thought of having an orchidectomy upsetting. If you don’t want an orchidectomy, you can have a different type of hormone therapy. But if you’re thinking about having one, speak to your doctor about any concerns.

Tablets to block the effects of testosterone (anti-androgens)

Anti-androgens stop testosterone reaching the prostate cancer cells. They’re taken as a tablet. They can be used on their own or together with other types of hormone therapy.

Anti-androgens taken on their own may be less effective than other types of hormone therapy at controlling advanced prostate cancer. They are less likely to cause sexual problems and bone thinning than other types of hormone therapy. But they may be more likely to cause breast swelling and tenderness.

There are several anti-androgens, including:

  • bicalutamide (for example Casodex®)
  • flutamide
  • cyproterone acetate (for example Cyprostat®)

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What are the advantages and disadvantages of hormone therapy?

Advantages

  • Hormone therapy is an effective treatment for prostate cancer.
  • It can treat prostate cancer wherever it is in the body.
  • It can be used alongside other treatments to make them more effective.
  • It can help to reduce some of the symptoms of advanced prostate cancer, such as urinary symptoms.

 Disadvantages

  • It can cause side effects that might have a big impact on your daily life.
  • Used by itself, hormone therapy won’t cure the cancer, but it can keep it under control, sometimes for several years.

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What does treatment involve?

You will have treatment at the hospital or your GP surgery. You will also have regular PSA blood tests. If your PSA level falls, this usually suggests your treatment is working. How quickly your PSA level falls, and how low, will vary from man to man.

Tell your doctor, nurse or GP about any side effects or symptoms.

Intermittent hormone therapy

If you are on life-long hormone therapy and having side effects, you might be able to have intermittent hormone therapy. This involves stopping treatment when your PSA level is low and stable, and starting treatment again when your PSA starts to rise. Some of the side effects may improve while you’re not having treatment, but it can take several months for them to wear off.

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What happens next?

If you have hormone therapy alongside another treatment, speak to your doctor or nurse about how long you will have it for. You will have regular appointments  after your finish treatment to check how well it’s working.

If you have advanced prostate cancer, hormone therapy is likely to be a life-long treatment. Your hormone therapy may keep your cancer under control for several months or years. But over time the behaviour of the cancer cells may change and your cancer might start to grow again.

Although the prostate cancer is no longer responding as well to one type of hormone therapy, it may still respond to other types of hormone therapy or a combination of treatments. And there are other treatments you might be able to have. These include chemotherapy, and new types of hormone therapy, such as abiraterone (Zytiga®) and enzalutamide (Xtandi®). Read more about second-line hormone therapy and further treatments.

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What are the side effects?

Like all treatments, hormone therapy can cause side effects. It might seem like there are a lot, but you may not get all of them. Hormone therapy affects men in different ways. Some men have few side effects or don’t get any at all.

Side effects include:

  • hot flushes
  • changes to your sex life including loss of libido and erection problems
  • tiredness (fatigue)
  • weight gain
  • strength and muscle loss
  • breast swelling and tenderness
  • loss of body hair
  • bone thinning
  • risk of diabetes, heart disease and stroke
  • memory and concentration problems
  • changes to your mood.

There are treatments and support to help manage side effects. Some men find that they get better or become easier to deal with over time. Read more about these side effects and how to manage them on our side effects page.

How long will side effects last?

The side effects are caused by lowered testosterone levels. They usually last for as long as you’re on hormone therapy. If you stop your hormone therapy, your testosterone levels will gradually rise and the side effects should improve. But this might take several months – your side effects won’t stop as soon as you finish hormone therapy.

Surgery to remove the testicles (orchidectomy) can’t be reversed, so the side effects can’t be reversed. But there are treatments to help manage them.  

If you are worried about your side effects, or you get any new symptoms, speak to your doctor or nurse, or call our Specialist Nurses.

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Questions to ask your doctor or nurse

  • What is the aim of treatment?
  • What type of hormone treatment are you recommending for me and why?
  • How often will I have follow-up appointments?
  • How long will it be before we know if the hormone therapy is working?
  • What are the possible side effects?
  • What other treatments are available if the cancer starts to grow again?
  • What will happen if I decide to stop my treatment?

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References

You can find a full list of references used to produce this page in our online fact sheet.

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