Treatment options after your first hormone therapy

This page is for anyone with prostate cancer that is no longer responding so well to their first type of hormone therapy. The page will describe other treatments that may help. You may hear these called second-line therapy. Your partner, family or friends might also find this information helpful. 

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How does hormone therapy work?

Hormone therapy can work in two ways - either by stopping your body from making testosterone, or by stopping testosterone from reaching cancer cells. Prostate cancer cells usually need testosterone to grow. So if testosterone is taken away or blocked, the cancer will usually shrink, wherever in the body. 

Hormone therapy on its own won't cure your prostate cancer. If you have hormone therapy on its own, the treatment will aim to control your cancer and delay or manage any symptoms. 

Read more about hormone therapy, including the types of hormone therapy you may have already had. 

How will I know if my first hormone therapy is not working so well?

While you're having hormone therapy you will have regular PSA (prostate specific antigen) tests to check how well the hormone therapy is working.

A continuous rise in your PSA level may be the first sign that the hormone therapy is no longer working so well. If this happens, you might have more PSA tests to confirm this. Your doctor or nurse will also ask you about any symptoms you may have developed, such as urinary problems or bone pain. You may have scans, which will give your doctor a better idea of how the cancer is growing and which treatments might help.

Your doctor will talk to you about other possible treatment options if you need them. If your PSA level is only rising very slowly and you don't have any symptoms, you might not need to start a new treatment straight away. Your doctor will keep an eye on you with regular PSA tests and scans, as well as asking about your symptoms. They will talk to you about how often you should have these check-ups and if you need to book the appointments yourself.

Why is my first hormone therapy not working so well?

The first hormone therapy you have may keep your cancer under control for several months or years. But over time, the behaviour of your cancer cells may change and your cancer could start to grow again. This can happen even though the hormone therapy is still lowering your testosterone levels.

Although your prostate cancer is no longer responding so well to your first hormone therapy, it may respond well to other types of hormone therapy or a combination of treatments.

What further treatments are available?

The aim of treatment is to control your cancer and delay or manage any symptoms you might have. You will probably continue with your first type of hormone therapy – even though it's not working so well. This is because it will still help to keep your testosterone level low.

Further treatment options may include:

Which treatments will I have?

When your cancer stops responding to your first hormone therapy, there is no best treatment or best order to have treatments in. You might have more than one treatment, while some treatments might not be suitable for you.

The treatments you have will depend on lots of thing, including:

  • where your cancer has spread to
  • if you have any symptoms
  • how long your cancer responded to your first hormone therapy for
  • your general health and any other health problems you have
  • the possible side effects of each treatment
  • what your doctor thinks will work best for you
  • your own thoughts and feelings – for example, how you feel about the possible side effects and how a treatment would fit in with your daily life.


Since my father-in-law was diagnosed, we've always asked questions and armed ourselves with facts. Knowing where we stand helps us move onwards and upwards - it's become our family mantra
A personal experience


Anti-androgens, such as bicalutamide (Casodex®), are a type of hormone therapy that stop testosterone from reaching the prostate cancer cells. They may be an option if you've already had hormone therapy with injections, implants or surgery (an orchidectomy), which will have lowered the amount of testosterone in your blood.

If you're having LHRH agonist injections, you will probably start taking anti-androgens as well. You may hear this called combined androgen blockade, dual androgen blockade or maximal androgen blockade. It may be slightly more effective than using an LHRH agonist on its own if your PSA level is rising, or if your cancer has spread to other parts of the body (advanced prostate cancer).

If you are already having injections and anti-androgen tablets and your PSA level is rising, your doctor may suggest that you stop taking the anti-androgen for a little while to see if your PSA level falls. You may hear this called a ‘withdrawal response’. Some men find that their PSA level falls for a few months, or sometimes longer.

The side effects of anti-androgens can be similar to the side effects of other types of hormone therapy and can include breast swelling and breast tenderness.

Read more about the side effects of hormone therapy.


Abiraterone (Zytiga®) is a type of hormone therapy for men with advanced prostate cancer. It's most commonly given to men whose cancer has stopped responding to other types of hormone therapy. It is taken as tablets and works by stopping the production of testosterone. It helps some men to live longer and can help treat or delay symptoms. 

You may be able to have abiraterone either before or after chemotherapy, but it isn’t usually given to men who’ve already had enzalutamide.

Possible side effects of abiraterone include:

  • a build-up of fluid in your body (fluid retention), which can cause swelling in your legs or feed
  • a drop in the level of potassium in your blood, which can cause weakness or twitches in your muscles, or a fast, pounding heartbeat - speak to your doctor straight away if you notice these symptoms
  • liver problems
  • high blood pressure.

You will need to take a steroid called prednisolone or prednisone with abiraterone to lower the risk of some side effects.

Read more about abiraterone.


Enzalutamide (Xtandi®) is another type of hormone therapy for men with advanced prostate cancer. It's most commonly given to men whose cancer has stopped responding to other types of hormone therapy. It is taken as capsules and works by blocking the effect of testosterone on prostate cancer cells. It may help some men to live longer and can help treat or delay symptoms.

Enzalutamide can be given before or after chemotherapy. But it isn’t usually given to men who’ve already had abiraterone.

Possible side effects of enzalutamide include:

  • extreme tiredness (fatigue)
  • headaches
  • hot flushes
  • high blood pressure
  • feeling nervous
  • problems with memory and concentration
  • dry or itchy skin
  • breast swelling (gynaecomastia)
  • an urge to move a part of your body, usually your legs (restless leg syndrome)

Read more about enzalutamide, including the possible side effects.


Chemotherapy uses anti-cancer drugs to kill cancer cells, wherever they are in the body. It can help some men to live longer, and improve and delay symptoms such as pain.

In the UK, docetaxel (Taxotere®) is the most common type of chemotherapy for men with advanced prostate cancer.

If you’ve already had docetaxel and your cancer has started to grow again, you might be offered a different chemotherapy drug called cabazitaxel (Jevtana®).

If you're having chemotherapy, you will be given steroid tablets, such as prednisolone or dexamethasone. This can help make the treatment more effective and reduce the side effects.

Chemotherapy isn't suitable for everyone as the side effects can be difficult to deal with. Side effects include a increased risk of infection and feeling more tired than usual. Some men get a lot of side effects, while others only have a few. Your doctor will check your general health to make sure you're fit enough for chemotherapy.

Read more about chemotherapy.


Steroids are sometimes used to treat prostate cancer that is no longer responding to other types of hormone therapy. Steroids can stop the adrenal glands producing as much testosterone, which can help to control your cancer. They can also improve your appetite, make you feel more energetic, and help with symptoms such as pain.

You might have steroids alone or in combination with other treatments, including chemotherapy and abiraterone. Common steroids include dexamethasone, prednisolone and hydrocortisone.

Steroids can cause side effects. But because they are given in a low dose to treat prostate cancer, most men don’t get many side effects and some men don't get any.

Before you start taking steroids, talk to your doctor or nurse about the possible side effects.

They can include:

  • indigestion and irritation of the stomach lining – take steroids after a meal and ask your doctor about medicines that could help
  • a bigger appetite – try to eat a healthy, balanced diet to keep your weight under control
  • having more energy and a more active mind, which could make you feel irritable or anxious or give you trouble sleeping – take steroids before 4pm and tell your doctor or nurse if this is a problem
  • water retention, which can cause swollen hands and feet
  • a slightly higher risk of getting infections – tell your GP if you have a high temperature or other signs of infection
  • bruising more easily
  • raised blood sugar levels – tell your doctor if you need to urinate (wee) more often or get very thirsty, as these can be signs of high blood sugar
  • weak bones – you might need to take medicines or supplements such as calcium and vitamin D.

Don’t suddenly stop taking steroids as this can make you ill.

You'll be given a steroid treatment card that says you're taking steroids. You should carry this with you at all times and show it to anyone treating you (such as a doctor, nurse or dentist). It’s important that they know you're taking steroids.


Radium-223 (Xofigo®) is a treatment for men whose prostate cancer  has stopped responding to hormone therapy and is causing bone pain. It helps some men live longer. It can also help to reduce bone pain and delay some symptoms.

Radium-223 is a type of internal radiotherapy called a radioisotope. A very small amount of radioactive liquid is injected into a vein in your arm. You will normally have an injection every four weeks, for up to six injections. 

Radium-223 travels around the body in the blood and is drawn towards the bones that have been damaged by the cancer. It collects in these parts of the bones and kills the cancer cells there. It doesn't damage many healthy cells so it doesn't cause may side effects. Possible side effects include:

  • feeling or being sick (nausea or vomiting)
  • diarrhoea (loose and watery bowel movements)
  • low levels of blood cells, which can cause bruising or bleeding.

In England, Wales and Northern Ireland, you can only have radium-223 if you've already had chemotherapy, or if chemotherapy isn't suitable for you. In Scotland, you can have radium-223 before or after chemotherapy.

Read more about radium-223.


Oestrogens are a type of hormone therapy that can be used to treat prostate cancer that's no longer responding to other types of hormone therapy. They aren't used very often and may not be suitable if you have other health problems. Oestrogen is a hormone that's naturally found in both men and women, but women usually produce more.

Oestrogens can be given as a tablet called diethylstilbestrol (Stilboestrol®) or through a patch that sticks to your skin like a plaster.

The side effects can be similar to the side effects of other types of hormone therapy.

Clinical trials and new treatments

A clinical trial is a type of medical research. It helps researchers and medical teams to find new and improved ways of preventing, diagnosing, treating and managing health problems such as prostate cancer. Clinical trials often test new medicines, medical procedures or medical equipment. There are clinical trials looking at new treatments for prostate cancer and new ways of using existing treatments. If you decide to take part in a clinical trial, you may be able to have a newer treatment that isn't yet widely available.

To find out more about taking part in a clinical trial, ask your doctor or nurse, or speak to our specialist Nurses.

Read more about clinical trials or speak to your doctor or nurse.

Clinical trials gave us hope and my dad felt that he was doing some good too
A personal experience

Other treatments to manage symptoms

If your prostate cancer has spread to the bones or other parts of your body, you may get symptoms such as pain.

Or if the cancer inside your prostate is pressing on your urethra (the tube you urinate through), you may get urinary problems. There are treatments to help manage symptoms. These are sometimes called palliative treatments. They include:

  • pain-relieving drugs such as paracetamol, ibuprofen, codeine or morphine
  • radiotherapy to slow down the growth of the cancer and reduce symptoms
  • drugs called bisphosphonates to treat bone problems such as pain
  • medicines or surgery to make it easier to urinate.

Who will be involved in my treatment?

You may see different health professionals depending on the treatment you have. For example, if you have chemotherapy you may see an oncologist (a doctor who specialises in treating cancer with treatments other than surgery) and a chemotherapy nurse. You may also see a pharmacist, who will check you're having the right medicines at the right doses.

You may be offered a referral to community services, such as district nurses and palliative care nurses who can help control symptoms. 

Read more about the different health and social care professionals you might see. 

Ask your doctor or nurse anything, including things that may seem small. This can save confusion later.
A personal experience

How will I know how well my treatment is working?

During and after your treatment your doctor or nurse will check how well your treatment is working.

You may have regular PSA tests, and other tests such as MRI scans or CT scans. Your PSA levels alone aren't always enough to know if your treatment is working. So your doctor will use your PSA level and any other test results, along with information about how you're feeling, to check how well the treatment is working.

If you are feeling better this could be a sign that the treatment is working. If the treatment isn't controlling the cancer, then you and your doctor can discuss which treatment to try next.

One aim of your treatment will be to help manage any symptoms from your cancer, so that your daily life is as good as possible. But treatments can cause side effects. Let your doctor or nurse know how you are feeling and about any symptoms or side effects. If you have symptoms in between check-ups, tell your doctor or nurse as soon as possible. Your doctor will talk you through the advantages and disadvantages of each treatment, whether or not they are suitable for you. 

I'm certainly a lot weaker than I was, although I can still enjoy a round of golf.
A personal experience


Updated: November 2020 | Due for review: November 2023

  • Allott EH, Masko EM, Freedland SJ. Obesity and Prostate Cancer: Weighing the Evidence. Eur Urol. 2013 May;63(5):800–9.
  • Bahl A, Oudard S, Tombal B, Ozguroglu M, Hansen S, Kocak I, et al. Impact of cabazitaxel on 2-year survival and palliation of tumour-related pain in men with metastatic castration-resistant prostate cancer treated in the TROPIC trial. Ann Oncol. 2013 May 30;24(9):2402–8.
  • Basch E, Autio K, Ryan CJ, Mulders P, Shore N, Kheoh T, et al. Abiraterone acetate plus prednisone versus prednisone alone in chemotherapy-naive men with metastatic castration-resistant prostate cancer: patient-reported outcome results of a randomised phase 3 trial. Lancet Oncol. 2013 Nov;14(12):1193–9.
  • Beer TM, Armstrong AJ, Rathkopf D, Loriot Y, Sternberg CN, Higano CS, et al. Enzalutamide in Men with Chemotherapy-naïve Metastatic Castration-resistant Prostate Cancer: Extended Analysis of the Phase 3 PREVAIL Study. Eur Urol. 2017 Feb;71(2):151–4.
  • Bourke L, Smith D, Steed L, Hooper R, Carter A, Catto J, et al. Exercise for Men with Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol. 2016 Apr;69(4):693–703.
  • Cao Y, Ma J. Body Mass Index, Prostate Cancer-Specific Mortality, and Biochemical Recurrence: a Systematic Review and Meta-analysis. Cancer Prev Res (Phila Pa). 2011 Jan 13;4(4):486–501.
  • Collins R, Trowman R, Norman G, Light K, Birtle A, Fenwick E, et al. A systematic review of the effectiveness of docetaxel and mitoxantrone for the treatment of metastatic hormone-refractory prostate cancer. Br J Cancer. 2006 Aug 1;95(4):457–62.
  • Davies NJ, Batehup L, Thomas R. The role of diet and physical activity in breast, colorectal, and prostate cancer survivorship: a review of the literature. Br J Cancer. 2011 Nov 8;105:S52–73.
  • de Bono JS, Oudard S, Ozguroglu M, Hansen S, Machiels J-P, Kocak I, et al. Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: a randomised open-label trial. Lancet. 2010 Oct 2;376(9747):1147–54.
  • Discacciati A, Orsini N, Wolk A. Body mass index and incidence of localized and advanced prostate cancer--a dose-response meta-analysis of prospective studies. Ann Oncol. 2012 Jan 6;23(7):1665–71.
  • Dorff TB, Crawford ED. Management and challenges of corticosteroid therapy in men with metastatic castrate-resistant prostate cancer. Ann Oncol. 2013 Jan 1;24(1):31–8.
  • Electronic Medicines Compendium. Xtandi 40mg soft capsules - Patient Information Leaflet [Internet]. 2018. Available from:
  • Electronic Medicines Compendium. ZYTIGA 500 mg film-coated tablets [Internet]. 2017. Available from:
  • Fizazi K, Scher HI, Molina A, Logothetis CJ, Chi KN, Jones RJ, et al. Abiraterone acetate for treatment of metastatic castration-resistant prostate cancer: final overall survival analysis of the COU-AA-301 randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol. 2012 Oct;13(10):983–92.
  • Fizazi K, Tran N, Fein L, Matsubara N, Rodriguez-Antolin A, Alekseev BY, et al. Abiraterone plus Prednisone in Metastatic, Castration-Sensitive Prostate Cancer. N Engl J Med [Internet]. 2017 Jun 4 [cited 2017 Jun 5]; Available from:
  • Galletti G, Leach BI, Lam L, Tagawa ST. Mechanisms of resistance to systemic therapy in metastatic castration-resistant prostate cancer. Cancer Treat Rev. 2017 Jun;57:16–27.
  • Gardner JR, Livingston PM, Fraser SF. Effects of Exercise on Treatment-Related Adverse Effects for Patients With Prostate Cancer Receiving Androgen-Deprivation Therapy: A Systematic Review. J Clin Oncol. 2014 Feb 1;32(4):335–46.
  • Gerdtsson A, Poon JB, Thorek DL, Mucci LA, Evans MJ, Scardino P, et al. Anthropometric Measures at Multiple Times Throughout Life and Prostate Cancer Diagnosis, Metastasis, and Death. Eur Urol. 2015 Dec;68(6):1076–82.
  • Hechtman LM. Clinical Naturopathic Medicine [Internet]. Harcourt Publishers Group (Australia); 2014 [cited 2015 Jul 21]. 1610 p. Available from:
  • Henson CC, Burden S, Davidson SE, Lal S. Nutritional interventions for reducing gastrointestinal toxicity in adults undergoing radical pelvic radiotherapy. Cochrane Database Syst Rev [Internet]. 2013 [cited 2014 Nov 18];(11). Available from:
  • Ho T, Gerber L, Aronson WJ, Terris MK, Presti JC, Kane CJ, et al. Obesity, Prostate-Specific Antigen Nadir, and Biochemical Recurrence After Radical Prostatectomy: Biology or Technique? Results from the SEARCH Database. Eur Urol. 2012 Nov;62(5):910–6.
  • Hu M-B, Xu H, Bai P-D, Jiang H-W, Ding Q. Obesity has multifaceted impact on biochemical recurrence of prostate cancer: a dose-response meta-analysis of 36,927 patients. Med Oncol Northwood Lond Engl. 2014 Feb;31(2):829.
  • Husson O, Mols F, Poll-Franse LV van de. The relation between information provision and health-related quality of life, anxiety and depression among cancer survivors: a systematic review. Ann Oncol. 2010 Sep 24;mdq413.
  • Isbarn H, Pinthus JH, Marks LS, Montorsi F, Morales A, Morgentaler A, et al. Testosterone and Prostate Cancer: Revisiting Old Paradigms. Eur Urol. 2009 Jul;56(1):48–56.
  • Keilani M, Hasenoehrl T, Baumann L, Ristl R, Schwarz M, Marhold M, et al. Effects of resistance exercise in prostate cancer patients: a meta-analysis. Support Care Cancer. 2017 Jun 10;
  • Keogh JWL, MacLeod RD. Body Composition, Physical Fitness, Functional Performance, Quality of Life, and Fatigue Benefits of Exercise for Prostate Cancer Patients: A Systematic Review. J Pain Symptom Manage. 2012 Jan;43(1):96–110.
  • Keto CJ, Aronson WJ, Terris MK, Presti JC, Kane CJ, Amling CL, et al. Obesity is associated with castration-resistant disease and metastasis in men treated with androgen deprivation therapy after radical prostatectomy: results from the SEARCH database. BJU Int. 2011;110(4):492–8.
  • Larkin D, Lopez V, Aromataris E. Managing cancer-related fatigue in men with prostate cancer: A systematic review of non-pharmacological interventions. Int J Nurs Pract. 2014 Oct;20(5):549–60.
  • Lin P-H, Aronson W, Freedland SJ. Nutrition, dietary interventions and prostate cancer: the latest evidence. BMC Med [Internet]. 2015 Dec [cited 2017 Oct 30];13(1). Available from:
  • Litwin MS, Tan H-J. The Diagnosis and Treatment of Prostate Cancer: A Review. JAMA. 2017 Jun 27;317(24):2532.
  • Matsuoka T, Kawai K, Kimura T, Kojima T, Onozawa M, Miyazaki J, et al. Long-term outcomes of combined androgen blockade therapy in stage IV prostate cancer. J Cancer Res Clin Oncol. 2015 Apr;141(4):759–65.
  • Menichetti J, Villa S, Magnani T, Avuzzi B, Bosetti D, Marenghi C, et al. Lifestyle interventions to improve the quality of life of men with prostate cancer: A systematic review of randomized controlled trials. Crit Rev Oncol Hematol. 2016 Dec;108:13–22.
  • Mohamad H, McNeill G, Haseen F, N’Dow J, Craig LCA, Heys SD. The Effect of Dietary and Exercise Interventions on Body Weight in Prostate Cancer Patients: A Systematic Review. Nutr Cancer. 2015 Jan 2;67(1):43–60.
  • Mottet N, Van den Bergh RCN, Briers E, Cornford P, De Santis M, Fanti S, et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer. European Association of Urology; 2019.
  • National Institute for Health and Care Excellence. Abiraterone for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated. Technology appraisal guidance 387. 2016.
  • National Institute for Health and Care Excellence. Cabazitaxel for hormone-relapsed metastatic prostate cancer treated with docetaxel. Technology appraisal guidance 391. 2016.
  • National Institute for Health and Care Excellence. Degarelix for treating advanced hormone-dependent prostate cancer. Technology appraisal guidance 404 [Internet]. 2016. Available from:
  • National Institute for Health and Care Excellence. Docetaxel for the treatment of hormone-refractory metastatic prostate cancer. NICE technology appraisal guidance 101. 2006.
  • National Institute for Health and Care Excellence. Enzalutamide for metastatic hormone-relapsed prostate cancer previously treated with a docetaxel-containing regimen. Technology appraisal guidance 316. 2014.
  • National Institute for Health and Care Excellence. Enzalutamide for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated. Technology appraisal guidance 377. 2016.
  • National Institute for Health and Care Excellence. Prostate cancer: diagnosis and management. NICE guideline 131. 2019.
  • National Institute for Health and Care Excellence. Prostate cancer: diagnosis and management. NICE clinical guideline 175 [Internet]. 2014 [cited 2013 Apr 25]. Available from:
  • National Institute for Health and Care Excellence. Radium-223 dichloride for treating hormone-relapsed prostate cancer with bone metastases. Technology appraisal guidance 412 [Internet]. 2016 [cited 2016 Oct 26]. Available from:
  • National Institute for Health and Clinical Excellence. Abiraterone for castration-resistant metastatic prostate cancer previously treated with a docetaxel-containing regimen. NICE technology appraisal guidance 259. 2012.
  • Ndibe C, Wang CG, Sonpavde G. Corticosteroids in the Management of Prostate Cancer: A Critical Review. Curr Treat Options Oncol. 2015;16(2).
  • Parker C, Nilsson S, Heinrich D, Helle SI, O’Sullivan JM, Fosså SD, et al. Alpha Emitter Radium-223 and Survival in Metastatic Prostate Cancer. N Engl J Med. 2013;369(3):213–23.
  • Pettersson A, Johansson B, Persson C, Berglund A, Turesson I. Effects of a dietary intervention on acute gastrointestinal side effects and other aspects of health-related quality of life: A randomized controlled trial in prostate cancer patients undergoing radiotherapy. Radiother Oncol. 2012 Jun;103(3):333–40.
  • Reis LO, Zani EL, García-Perdomo HA. Estrogen therapy in patients with prostate cancer: a contemporary systematic review. Int Urol Nephrol. 2018 Jun 1;50(6):993–1003.
  • Richman EL, Kenfield SA, Stampfer MJ, Paciorek A, Carroll PR, Chan JM. Physical Activity after Diagnosis and Risk of Prostate Cancer Progression: Data from the Cancer of the Prostate Strategic Urologic Research Endeavor. Cancer Res. 2011 May 24;71(11):3889–95.
  • Ritch CR, Cookson MS. Advances in the management of castration resistant prostate cancer. BMJ. 2016 Oct 17;i4405.
  • Roviello G, Cappelletti MR, Zanotti L, Gobbi A, Senti C, Bottini A, et al. Targeting the androgenic pathway in elderly patients with castration-resistant prostate cancer: A meta-analysis of randomized trials. Medicine (Baltimore). 2016 Oct;95(43):e4636.
  • Ryan CJ, Smith MR, Fizazi K, Saad F, Mulders PFA, Sternberg CN, et al. Abiraterone acetate plus prednisone versus placebo plus prednisone in chemotherapy-naive men with metastatic castration-resistant prostate cancer (COU-AA-302): final overall survival analysis of a randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol. 2015 Feb;16(2):152–60.
  • Sartor O, Coleman R, Nilsson S, Heinrich D, Helle SI, O’Sullivan JM, et al. Effect of radium-223 dichloride on symptomatic skeletal events in patients with castration-resistant prostate cancer and bone metastases: results from a phase 3, double-blind, randomised trial. Lancet Oncol. 2014 Jun;15(7):738–46.
  • Scher HI, Fizazi K, Saad F, Taplin M-E, Sternberg CN, Miller K, et al. Increased survival with enzalutamide in prostate cancer after chemotherapy. N Engl J Med. 2012 Sep 27;367(13):1187–97.
  • Scottish Medicines Consortium. Abiraterone acetate 250mg tablets (Zytiga®). SMC No. 873/13 [Internet]. 2015. Available from:
  • Scottish Medicines Consortium. Abiraterone acetate 250mg tablets (Zytiga®) SMC No. (764/12) [Internet]. 2012. Available from:
  • Scottish Medicines Consortium. Cabazitaxel 60mg concentrate and solvent for solution for infusion (Jevtana®) SMC No. (735/11) [Internet]. 2016. Available from:
  • Scottish Medicines Consortium. Enzalutamide 40mg soft capsules (Xtandi®) SMC No. (911/13) [Internet]. 2013. Available from:
  • Scottish Medicines Consortium. Enzalutamide 40mg soft capsules (Xtandi®) SMC No. (1066/15) [Internet]. 2016. Available from:
  • Scottish Medicines Consortium. Radium-223 dichloride for the treatment of adults with castration-resistant prostate cancer, symptomatic bone metastases and no known visceral metastases. 2015.
  • Serpa Neto A, Tobias-Machado M, Kaliks R, Wroclawski ML, Pompeo ACL, Del Giglio A. Ten Years of Docetaxel-Based Therapies in Prostate Adenocarcinoma: A Systematic Review and Meta-Analysis of 2244 Patients in 12 Randomized Clinical Trials. Clin Genitourin Cancer. 2011 Dec;9(2):115–23.
  • Teleni L, Chan RJ, Chan A, Isenring EA, Vela I, Inder WJ, et al. Exercise improves quality of life in androgen deprivation therapy-treated prostate cancer: systematic review of randomised controlled trials. Endocr Relat Cancer. 2016 Jan 2;23(2):101–12.
  • Teply BA, Luber B, Denmeade SR, Antonarakis ES. The influence of prednisone on the efficacy of docetaxel in men with metastatic castration-resistant prostate cancer. Prostate Cancer Prostatic Dis. 2016;19(1):72–78.
  • Tillisch K. Complementary and alternative medicine for functional gastrointestinal disorders. Gut. 2006 May 1;55(5):593–6.
  • Wang LS, Murphy CT, Ruth K, Zaorsky NG, Smaldone MC, Sobczak ML, et al. Impact of obesity on outcomes after definitive dose-escalated intensity-modulated radiotherapy for localized prostate cancer. Cancer. 2015 Sep 1;121(17):3010–7.
  • Wedlake LJ, Shaw C, Whelan K, Andreyev HJN. Systematic review: the efficacy of nutritional interventions to counteract acute gastrointestinal toxicity during therapeutic pelvic radiotherapy. Aliment Pharmacol Ther. 2013 Jun;37(11):1046–56.
  • Wolin KY, Luly J, Sutcliffe S, Andriole GL, Kibel AS. Risk of Urinary Incontinence Following Prostatectomy: The Role of Physical Activity and Obesity. J Urol. 2010 Feb;183(2):629–33.
  • World Cancer Research Fund International. Continuous Update Project report: Diet, Nutrition, Physical Activity and Prostate Cancer [Internet]. 2014. Available from:
  • Yang Y, Chen R, Sun T, Zhao L, Liu F, Ren S, et al. Efficacy and safety of combined androgen blockade with antiandrogen for advanced prostate cancer. Curr Oncol. 2019 Feb;26(1):e39–47.
  • Zhang W, Wu T-Y, Chen Q, Shi X-L, Xiao G-A, Zhao L, et al. Indirect comparison between abiraterone acetate and enzalutamide for the treatment of metastatic castration-resistant prostate cancer: a systematic review. Asian J Androl [Internet]. 2017 [cited 2016 Jun 17]; Available from:

The following people helped to review this information:

  • Will Ince, Specialty Doctor in Oncology and General Practitioner, Norfolk
  • Helen Johnson, Macmillan Urology Oncology Clinical Nurse Specialist, The Christie NHS Foundation Trust
  • Patricia McClurey, Prostate Cancer Clinical Nurse Specialist, South Tees Hospitals NHS Foundation Trust
  • Alison Moorhouse, Urology Oncology Clinical Nurse Specialist, Nottingham University Hospitals NHS Trust
  • Alastair Thomson, Consultant Oncologist, Royal Cornwall Hospitals NHS Trust
  • Our Specialist Nurses
  • Our Volunteers.