Hormone therapy is the standard first treatment for men with advanced prostate cancer. Prostate cancer needs the male hormone testosterone to grow. Hormone therapy works by stopping testosterone from reaching prostate cancer cells. This causes the cancer cells to shrink, wherever they are in the body.
Hormone therapy will be a life-long treatment for many men with advanced prostate cancer. It won’t cure your cancer, but it can keep it under control, sometimes for several years, before you need further treatment. Hormone therapy can also help to control the symptoms of advanced prostate cancer, such as bone pain.
Like all treatments, hormone therapy can cause side effects. These are caused by lowered testosterone levels. There are a lot of possible side effects, but hormone therapy affects men in different ways. Some men get few side effects and others don’t get any at all. The chances of getting each side effect depend on which type of hormone therapy you’re on and how long you’re on it for. There are ways to manage side effects, so speak to your doctor or nurse.
Read more about hormone therapy and its side effects.
Watchful waiting is a way of monitoring prostate cancer that isn’t causing any symptoms or problems. The aim is to keep an eye on the cancer and avoid treatment unless you get symptoms. This means you will avoid or delay the side effects of treatment. If you do get symptoms, you’ll be offered hormone therapy to control the cancer and help manage symptoms.
Watchful waiting isn’t usually recommended for men with advanced prostate cancer. But it may be an option if you don’t have symptoms and you want to avoid the side effects of treatment. If you’d prefer not to have treatment, speak to your doctor. They can help you think about the pros and cons of watchful waiting.
Read more about watchful waiting.
What happens if my cancer starts to grow again?
The first hormone therapy you have may keep your cancer under control, sometimes for several years. But over time, the cancer may change and your treatment may stop working so well. This means your cancer may start to grow again. But there are other treatments available that can help to control the cancer and manage any symptoms you might have.
More hormone therapy
You will usually stay on the first type of hormone therapy, but you may be offered another type of hormone therapy as well.
Read more about other types of hormone therapy in our Tool Kit fact sheet, Second-line hormone therapy and further treatment options.
Chemotherapy uses anti-cancer drugs to kill the cancer cells. It is an option for men whose prostate cancer is no longer responding to hormone therapy.
Chemotherapy doesn’t get rid of prostate cancer, but aims to shrink it and slow its growth. It may help some men with advanced prostate cancer to live longer. Chemotherapy can also help to improve symptoms.
Read more about chemotherapy.
This is a type of hormone therapy for men with advanced prostate cancer that has stopped responding to other hormone therapy treatments.
Abiraterone is available on the NHS for men whose cancer has stopped responding to hormone therapy and the chemotherapy drug docetaxel.
Abiraterone is also suitable for men whose cancer has stopped responding to hormone therapy, but who haven't yet had chemotherapy. If you live in England, Wales or Scotland, you should be able to have abiraterone before chemotherapy. If you live in Northern Ireland, you may not be able to get abiraterone before chemotherapy.
Getting abiraterone might depend on whether you’ve had a drug called enzalutamide (see below) in the past.
Read more about abiraterone.
This is a new type of hormone therapy for men with advanced prostate cancer that has stopped responding to other hormone therapy treatments.
Enzalutamide is available on the NHS for men whose cancer has stopped responding to hormone therapy and the chemotherapy drug docetaxel. It is also available on the NHS for men who haven’t yet had chemotherapy.
Getting enzalutamide might depend on whether you’ve had abiraterone in the past. Early research has shown that enzalutamide only has a small effect in men who have previously had abiraterone. But we need more research into this.
Read more about enzalutamide.
A clinical trial is a type of medical research. Clinical trials aim to find new and improved ways of preventing, diagnosing, treating and controlling illnesses. There are clinical trials looking at new treatments for men with advanced prostate cancer. You can ask your doctor or nurse if there are any clinical trials you could take part in, or call our Specialist Nurses. You can also find details of clinical trials for prostate cancer at www.cancerhelp.org.uk/trials
Read more about clinical trials.
Treatments to help manage symptoms
If you have advanced prostate cancer, you may have symptoms such as bone pain. Hormone therapy and chemotherapy may help to relieve or reduce these. There are also specific treatments to help manage symptoms. Speak to your doctor or nurse if you have symptoms.
Treatments to control pain include mild pain-relieving drugs such as paracetamol and non-steroidal anti-inflammatory drugs such as ibuprofen. There are also stronger drugs called opioids, which include codeine and morphine, so speak to your doctor or specialist nurse if you’re having problems with pain.
Read more about ways to control pain in advanced prostate cancer.
Radiotherapy can help control symptoms by slowing down the growth of the cancer. This is sometimes called palliative radiotherapy.
There are two types of radiotherapy to reduce symptoms.
- External beam radiotherapy - this is where radiation is directed at the area of pain from outside the body.
- Radioisotopes - this involves an injection of a very small amount of a radioactive liquid.
Read more about radiotherapy for advanced prostate cancer.
These are drugs that treat pain caused by cancer that has spread to the bones. Cancer can damage the bones and make them weaker. Bisphosphonates bind to damaged areas of bone, slowing down the breakdown of the bone and relieving pain.
Read more about bisphosphonates.