There are three main ways to have hormone therapy for prostate cancer. These are:
- injections or implants to stop your testicles making testosterone
- tablets to block the effects of testosterone
- surgery to remove the testicles or the parts of the testicles that make testosterone. This is called an orchidectomy.
The type you have will depend on whether your cancer has spread, any other treatments you’re having, and your own personal choice. You may have more than one type of hormone therapy at the same time.
Injections or implants
These work by stopping your brain from telling your body to make testosterone. Injections or implants are as good at controlling prostate cancer as surgery to remove the testicles.
Injections and implants are both given using a needle. Injections are given in a similar way to having a vaccine, where a small amount of liquid is injected under the skin or into the muscle. If you have injections, you will have them in your arm, abdomen (stomach area), thigh or bottom (buttock),depending on which type you’re having. Ask your doctor or nurse whether you will have injections or implants. Implants are given using a larger needle to place a tiny tube under the skin of your arm, which slowly releases the drug.
You will have the injections or implants at your GP surgery or local hospital – once a month, once every three months, once every six months, or once a year. How often you have them will depend on the type of hormone therapy.
LHRH agonists (luteinizing hormone releasing hormone agonists)are the most common type of injection or implant. There are several different LHRH agonists, including:
- goserelin (Zoladex® or Novgos®)
- leuprorelin acetate (Prostap® or Lutrate®)
- triptorelin (Decapeptyl® or Gonapeptyl Depot®)
- buserelin acetate(Suprefact®).
LHRH agonists cause the body to produce more testosterone for a short time after the first injection. This temporary surge in testosterone could cause the cancer to grow more quickly for a short time, which might make any symptoms you have worse – this is known as a flare.
If you’re having an LHRH agonist, you’ll be given a short course of anti-androgen tablets to stop any problems caused by this surge of testosterone. You’ll usually start taking the anti-androgen tablets before having your first injection or implant and continue taking them for a few weeks.
GnRH antagonists (gonadotrophin releasing hormone antagonists) are used less often than LHRH agonists.You may also hear these called GnRH blockers. At the moment, there is only one type of GnRH antagonist available in the UK, called degarelix (Firmagon®). This isn’t available in every hospital. Degarelix can be used as a first treatment for advanced prostate cancer that has spread to the bones. It may help to prevent metastatic spinal cord compression (MSCC) which can happen if cancer cells grow in or near the spine and press on the spinal cord.
When you first start this treatment, you will have two injections on the same day – one on each side of your abdomen (stomach area). You will then have a single injection once a month, or switch to an LHRH agonist.
Unlike LHRH agonists, degarelix doesn’t cause a temporary surge in testosterone with the first treatment so you won’t need to take anti-androgen tablets. Instead your testosterone levels will start to drop straight away and symptoms, such as bone pain, should start to improve quickly
Tablets to block the effects of testosterone (anti-androgens)
You may be offered tablets to block testosterone from getting to the cancer cells. These tablets are called anti-androgens. They can be used:
- on their own
- before having injections or implants
- together with injections or implants
- after surgery to remove the testicles.
Ask your doctor how long you will need to take anti-androgens for, and whether you’re having them with another treatment or on their own.
Anti-androgens taken on their own 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 pain and swelling.
If your cancer has spread to other parts of your body (advanced prostate cancer), anti-androgens will be less effective at controlling the cancer than other types of hormone therapy. So if you have advanced prostate cancer, your doctor will usually recommend an LHRH agonist instead.
There are several different anti-androgens, including:
- bicalutamide (for example Casodex®)
- flutamide (for example Drogenil®)
- cyproterone acetate (for example Cyprostat®).
You may be offered an operation to remove the testicles, or the parts of the testicles that make testosterone. This is called an orchidectomy. It’s not used as often as other types of hormone therapy.
Surgery is very effective at reducing testosterone levels, which should drop to their lowest level very quickly – usually in less than 12 hours. It also means that you won’t need to have regular injections, and there’s no risk that you’ll miss an injection.
Surgery can’t be reversed, so it’s usually only offered to men who need long-term hormone therapy. If you're thinking about having surgery, your doctor may suggest trying injections or implants for a while first to see how you deal with the side effects of low testosterone.
Short-term side effects include swelling and bruising of the scrotum (the skin containing the testicles).
Some men find the thought of having an orchidectomy upsetting, and worry about how they’ll feel once their testicles are removed. Speak to your doctor about any concerns you might have. If you don’t want an orchidectomy, you can usually have a different type of hormone therapy instead.