How does hormone therapy treat prostate cancer?

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?

Listen to a summary of this page:

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.

What types of hormone therapy are there?

There are three main types of hormone therapy for prostate cancer. These are:

  • injections or implants to stop your testicles making testosterone
  • surgery, called an orchidectomy, to remove the testicles, or the part of the testicles that makes testosterone
  • tablets to block the effects of testosterone.

The type you have will depend on the stage of your cancer, any other treatments you’re having, and your own personal situation and preferences. You may have more than one type of hormone therapy at the same time.

Injections or implants

These work by stopping the message from the brain that tells the testicles to make testosterone. Prostate cancer cells need testosterone to grow.

The most common injection or implant is LHRH agonists (luteinizing hormone-releasing hormone agonists). You might be offered GnRH antagonists (gonadotrophin-releasing hormone antagonists), but they are used less often.

Injections or implants are as good at controlling prostate cancer as surgery to remove the testicles.

LHRH agonists

You might also hear these called GnRH agonists (not to be confused with GnRH antagonists - see below).

LHRH agonists are the most common type of injection used. There are several different LHRH agonists available and they all work in the same way.

They’re given by an injection into your arm, stomach area (abdomen), thigh or bottom (buttock). Some LHRH agonists are available as a small pellet which is injected under your skin.

You will have the injections at your GP surgery or local hospital – either once a month, once every three months, or once every six months, depending on the dose.

Some of the common LHRH agonist drugs are:

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

One type of LHRH agonist, called histrelin (Vantas®), is available as an implant. It’s inserted under the skin of your arm once a year. The doctor will numb your arm, make a small cut, and put the implant under the skin. They will give you some stiches and use surgical tape so the cut can heal. The implant releases a constant dose of the drug. 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. The anti-androgen tablets help to stop this flare from happening.

You will usually start taking the anti-androgen tablets a week or two before the first injection and continue taking them for a couple of weeks afterwards.

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

You may also hear these called GnRH blockers, or LHRH antagonists (not to be confused with LHRH agonists – see above).

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

You will have an injection of degarelix just under the skin of your stomach area (abdomen) once a month. When you first start this treatment, you will have two injections on the same day.

Unlike LHRH agonists, 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 is very effective at reducing testosterone levels, which will usually drop to their lowest level 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 an orchidectomy, your doctor may suggest trying injections or implants for a while first to see how you deal with the side effects of lowered testosterone levels.

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 about themselves afterwards. If you don’t want to have an orchidectomy, you can always have a different type of hormone therapy instead. If you’re thinking about having an orchidectomy, speak to your doctor about any concerns you might have.

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
  • before having injections or implants
  • together with injections or implants
  • after surgery to remove the testicles (orchidectomy).

Ask your doctor how long you will need to take anti-androgens for.

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 swelling and tenderness.

Anti-androgens may be less effective than other types of hormone therapy at controlling cancer that has spread to other parts of the body (advanced prostate cancer). If you have advanced prostate cancer and don’t want the sexual side effects of hormone therapy, speak to your doctor about whether anti-androgens might be an option for you.

There are several different anti-androgens, including:

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

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.

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. Ask your doctor or nurse how often you will have a PSA test.

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.

You’ll generally keep having the hormone therapy, even if your PSA level falls. This is because the hormone therapy is controlling the cancer and if you stop having it, the cancer might grow more quickly.

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.

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.

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 how hormone therapy affects you.

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.

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 long will my treatment be monitored for?
  • How long will it be before we know if the hormone therapy is working?
  • What are the possible side effects?
  • How long might the side effects last?
  • What other treatments are available if my cancer starts to grow again?
  • What will happen if I decide to stop my treatment?
  • Are there any clinical trials that I could take part in?

References

  • Full list of references used to produce this page  

    Alibhai SMH, Gogov  S, Alllibhai Z. Long-term side effects of androgen deprivation therapy in men with non-metastatic prostate cancer: a systematic literature review. Critical reviews in Oncology/Hematology 60 (2006) 201-215

    Azoulay L, Yin H, Benayoun S et al. Androgen-Deprivation Therapy and the Risk of Stroke in Patients With Prostate Cancer. Eur Urol. 2011

    Couper, JW, Bloch S, Love A, Duchesne G, Macvean M and Kissane DW. The psychosocial impact of prostate cancer on patients and their partners. Medical Journal of Australia. 2006;185(8): 428-432

    Di Lorenzo G, Autorino R, Perdona S et al. Management of gynaecomastia in patients with prostate cancer: a systematic review. Lancet Oncology. 2005;6:972-79.

    Eastham JA. Bone health in men receiving androgen deprivation therapy for prostate cancer. J Urol 2007; 177:17-24

    Grossman M, Hamilton EJ, Gilfillan C et al. Bone and metabolic health in patients with non-metastatic prostate cancer who are receiving androgen deprivation therapy. MJA. 2011;194(6):301-306.

    Haliloglu A, Baltaci S,  and Yaman O. Penile Length Changes in Men Treated With Androgen Suppression Plus Radiation Therapy for Local or Locally Advanced Prostate Cancer. The Journal of Urology 2007:77,128-130

    Haseen F, Murray LJ, Cardwell CR, O'Sullivan JM, Cantwell MM. The effect of androgen deprivation therapy on body composition in men with prostate cancer: systematic review and meta-analysis. J Cancer Surviv. 2010;4(2):128-39.

    Heidenreich A, Bastian PJ, Bellmunt J et al. Guidelines on prostate cancer. European Association of Urology. 2013

    Husson O, Mols F & van de Poll-Franse LV. The relation between information provision and health-related quality of life, anxiety and depression among cancer survivors: a systematic review. Annals of Oncology. 2011;22(4):761-72

    Irani J, Salomon L, Oba R et al. Efficacy of venlafaxine, medroxyprogesterone acetate, and cyproterone acetate for the treatment of vasomotor hot flushes in men taking gonadotropin-releasing hormone analogues for prostate cancer: a double-blind, randomised trial. Lancet Oncol. 2010;11:147-154.

    Jamadar RJ, Winters MJ & Maki PM. Cognitive changes associated with ADT: a review of the Literature. Asian Journal of Andrology. 2012;14:232–238

    Klotz L, Boccon-Gibod L, Shore N D, Andreou C  P, Bo-Eric C, Jensen J, Olesen T K, Schroder F H. The efficacy and safety of degarelix: a 12-month, comparative, randomized, open-bale, parallel-group phase III study in patients with prostate cancer. BJU International. 2008 102, 1531-1538.

    Kumar S, Shelley M, Harrison C et al. Neo-adjuvant and adjuvant hormone therapy for localised and locally advanced prostate cancer. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD006019

    Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev. 2012;8:CD008465

    National Institute for Health and Care Excellence. Prostate cancer: diagnosis and treatment. Clinical guideline. Full guideline. January 2014.

    Nelson CJ, Lee JS, Gamboa MC et al. Cognitive effects of hormone therapy in men with prostate cancer: a review. Cancer 2008;113:1097-106.

    Parahoo K, McCaughan E, Noyes J, McDonough S. The effectiveness of psychosocial interventions for men with prostate cancer: a systematic review. Intervention Protocal. Cochrane Database of Systematic Reviews. 2010, Issue 12. Art No.: CD008529. DOI: 10.1002/14651858.CD008529.pub3.

    Schmitt B, Bennett C, Seidenfeld J et al. Maximal androgen blockade for advanced prostate cancer. Cochrane Database of Systematic Reviews 1999, Issue 2.

    Schroder F, Crawford ED, Axcona K, et al. Androgen deprivation therapy: Past, present and future. BJU International. 2012;109(6):1-12

    Shahinian VB, Kuo YF, Freeman JL, Goodwin JS. Risk of the androgen deprivation syndrome in men receiving androgen deprivation for prostate cancer. Archives of internal medicine 2006;166(4):465-71.

    Shore ND, Abrahamsson P-A, Anderson J, Crawford ED, Lange P. New considerations for ADT in advanced prostate cancer and the emerging role of GnRH antagonists. Prostate Cancer Prostatic Dis. 2013 Mar;16(1):7–15

    Stone P, Hardy J, Huddart R et al. Fatigue in patients with prostate cancer receiving hormone therapy. European journal of cancer 2000;36(9):1134-41.

    Warde P, Mason M, Ding K et al. Combined androgen deprivation therapy and radiation therapy for locally advanced prostate cancer: a randomised, phase 3 trial. The Lancet, Early Online Publication, 3 November 2011 doi:10.1016/S0140-6736(11)61095-7

    Widmark A, Klepp O, Solberg A et al. Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial. The Lancet 2008, Volume 373, Issue 9660, Pages 301 - 308, 24

    Wilkins D. Untold problems: A review of the essential issues in the mental health of men and boys. Men’s Health Forum. 2010.

Personal stories

Bruce's story

Bruce, 51, is on hormone therapy for advanced prostate cancer. He describes some of the side effects he's had including how it has affected his sex life.

Watch Bruce's story