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. You may hear this called many things, but on this webpage we say hormone-relapsed prostate cancer.
We describe other treatments that may help. This is sometimes called second-line therapy. Your partner, family or friends might also find this information helpful.
Treatment options after your first hormone therapy fact sheet
This fact sheet is for anyone with prostate cancer that is no longer responding so well to their first type of hormone therapy. It describes treatments that may help and other sources of support.
How does hormone therapy work?
Hormone therapy can work in two ways:
- by stopping your body from making testosterone
- by stopping testosterone from reaching the cancer cells.
Prostate cancer cells usually need testosterone to grow. So if testosterone is taken away or blocked, the cancer will usually shrink, wherever it is in the body.
Hormone therapy on its own won't cure your prostate cancer. But it can help keep it under control and delay symptoms, sometimes for several years.
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 isn't working so well?
While you're having hormone therapy, you will have regular prostate specific antigen (PSA) blood tests to check how well it's working.
A continuous rise in your PSA level may be the first sign that your hormone therapy isn't working (hormone-relapsed prostate cancer). If this happens, you might have more PSA blood tests to confirm this. Your doctor or nurse will also ask if you have developed any symptoms. These may include urinary problems or bone pain. You may also have scans to give your doctor a better idea of how the cancer is growing, and what other treatments might help.
If your PSA level is rising very slowly and you don't have any symptoms, then you might not need to start a new treatment straightaway. Your medical team will keep an eye on the cancer with regular PSA blood tests and scans, and they’ll keep asking about your symptoms. You’ll be told how often you should have check-ups, and if you need to book them yourself.
Why is my first hormone therapy not working so well?
Your first hormone therapy may keep your cancer under control for several months or years. But over time, the behaviour of the cancer cells can change, and they may start to grow again. This can happen even if 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 to another type 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 different types of hormone therapy can have different effects on the cancer cells.
You may feel frustrated or worried that your first hormone therapy has stopped working, but this is a normal part of the treatment pathway. There are other treatments to try.
Further treatment options may include:
- anti-androgens
- androgen receptor pathway inhibitors (ARPIs)
- chemotherapy
- steroids
- radium-223
- oestrogen
- olaparib
- clinical trials and new treatments
- other treatments to manage symptoms
Which treatments will I have?
When your prostate cancer stops responding to your first hormone therapy, there is no best treatment or best order to have your next 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 things, including:
- where your cancer has spread to
- if you have any symptoms
- how long your cancer responded to your first hormone therapy
- which type of hormone therapy you had first
- your general health and any other health problems you may have
- the possible side effects of each treatment
- what your doctor thinks will work best for you
- your own thoughts and feelings – for example, about the possible side effects and how a particular 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
Anti-androgens
Anti-androgen tablets, such as bicalutamide (Casodex®), are a type of hormone therapy that stop testosterone from reaching the prostate cancer cells. Anti-androgens are also a further treatment option for hormone-relapsed prostate cancer.
Anti-androgens may be an option if you've already started lowering the amount of testosterone in your blood with LHRH (luteinising hormone-releasing hormone) agonist injections or surgery to remove the testicles (orchidectomy). You may hear this called combined androgen blockade, dual androgen blockade or maximal androgen blockade. This may be 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 your PSA starts rising again while you’re taking anti-androgens and hormone therapy, then your doctor may suggest you stop taking them. In some men, this can cause PSA levels to fall and improve symptoms for a few months, sometimes longer. This is called a withdrawal response or anti-androgen withdrawal syndrome.
The side effects of anti-androgens can be similar to the side effects of other types of hormone therapy.
Androgen receptor pathway inhibitors (ARPIs)
Androgen receptor pathway inhibitors (ARPIs) are a newer type of hormone therapy. They are sometimes called new or second-generation hormone therapy. ARPIs block the effect of testosterone in a different way, so they may be able to shrink the cancer cells that are no longer responding to your first hormone therapy.
ARPIs are usually taken as tablets. They are:
You can only have one type of ARPI on your treatment pathway. This is because ARPIs work in a similar way to each other, so if your cancer stops responding to one, it probably won’t respond to another.
Chemotherapy
Chemotherapy uses anti-cancer (cytotoxic) drugs to kill cancer cells, wherever they are in the body.
In the UK, docetaxel is the most common type of chemotherapy. If you’ve already had docetaxel and your cancer has started to grow again, then your doctor may offer you a different type of chemotherapy called cabazitaxel. If you’re having chemotherapy, you might also be given steroid tablets, such as prednisolone or dexamethasone. This can help the chemotherapy to work, and reduce its side effects.
Chemotherapy isn't suitable for everyone as the side effects can be difficult to deal with. Your doctor will check your general health to make sure you're fit enough for chemotherapy.
Read more about chemotherapy.
Steroids
Steroids are a further treatment for hormone-relapsed prostate cancer because they can stop the adrenal glands from producing as much testosterone. This can help to control your cancer. They can also improve your appetite, make you feel more energetic, and help with some symptoms.
You might have steroids alone or in combination with other treatments, including chemotherapy or abiraterone. Common steroids include dexamethasone, prednisolone and hydrocortisone.
Steroids can cause side effects. But a low dose is used to treat prostate cancer, so most men don’t get many side effects and some don’t get any.
Before you start taking steroids, talk to your doctor or nurse about the possible side effects. They can include the following.
- 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. This 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.
- Swollen hands and feet (fluid retention).
- 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 (hyperglycaemia). Tell your doctor if you need to urinate (wee) more often or feel very thirsty, as these can be signs of diabetes.
- Weakening bones (osteoporosis). You might need to take medicines or supplements, such as calcium and vitamin D.
- Eye conditions. For example, glaucoma and cataracts.
Don’t suddenly stop taking steroids as this could make you ill.
You should be given a steroid treatment card that says you’re taking steroids. Carry this with you at all times. Show it to anyone giving you treatment (such as a doctor, nurse or dentist). It’s important they know because steroids can affect how well other medicines work.
Radium-223
Radium-223 (Xofigo®) is a treatment for men with hormone-relapsed advanced prostate cancer that is causing bone pain.
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 many side effects.
Read more about radium-223.
Oestrogen
Oestrogen is a type of hormone therapy that can be used to treat hormone-relapsed prostate cancer. It is usually offered to men who can’t have other treatments. Oestrogen isn’t used very often and may not be suitable if you have other health problems, such as heart disease. Oestrogen is a hormone that’s naturally found in both men and women, but women usually produce more.
Oestrogen can be given as a tablet called diethylstilbestrol (Stilboestrol®). It can also be given via a patch that sticks to your skin like a plaster, but patches are only available in clinical trials at the moment. Oestrogen works by reducing the amount of testosterone made in the body.
The side effects can be similar to the side effects of other types of hormone therapy. But oestrogen is less likely to cause bone thinning compared with other hormone therapies.
Olaparib
Olaparib (Lynparza®) is a type of drug called a PARP inhibitor. It works by blocking the effect of a protein called PARP, which repairs damaged DNA in prostate cancer cells.
Olaparib won’t cure your prostate cancer. But it has been shown to help some men live longer, and delay some symptoms of advanced prostate cancer.
Read more about olaparib.
Clinical trials and new treatments
A clinical trial is a type of medical research. It helps researchers and healthcare professionals find new and improved ways of preventing, screening, 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 different ways of using existing treatments. If you decide to take part in a clinical trial, you may be able to have a treatment that isn't 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.
Clinical trials gave us hope and my dad felt that he was doing some good too
Other treatments to manage symptoms
If your prostate cancer has spread to your bones or other parts of your body, you may get symptoms such as pain. 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 these 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 strengthen your bones and help with bone pain
- medicines or surgery to make it easier to urinate.
Who will be involved in my treatment?
You may see different healthcare professionals depending on the treatment you have. For example, if you have chemotherapy, you may see an oncologist (a doctor who specialises in cancer 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.
How will I know if my treatment is working?
During and after your treatment, your doctor or nurse will check how well it is working. You might have regular tests, such as a PSA blood test, CT (computerised tomography) scan and bone scan. Your PSA level isn’t always enough to know if your treatment is working. Your doctor will look at this and any other test results, and ask how you're feeling. If you’re feeling better, this could be a sign that the treatment is working.
If the treatment isn't controlling your cancer, then you and your doctor can discuss which treatment to try next. Your doctor will explain the advantages and disadvantages of each treatment.
One of the aims of further treatment is to improve your symptoms so that daily life is as good as possible. But treatments can cause side effects too. At your check-up, it’s important to tell your doctor about any symptoms or side effects. If you have symptoms or side effects between check-ups, tell your doctor or nurse as soon as possible.
I'm certainly a lot weaker than I was, although I can still enjoy a round of golf.
Dealing with prostate cancer
Being diagnosed and living with prostate cancer can change how you think and feel about life. If you or your loved one is dealing with prostate cancer, it’s normal to feel scared, stressed or even angry. Lots of men with prostate cancer can get these kinds of thoughts and feelings. But there is no ‘right’ way to feel and everyone reacts in their own way. You may find it helpful to read our information on advanced prostate cancer.
Our Wellbeing Hub has information to support you in looking after your emotional, mental and physical wellbeing.
If you are close to someone with prostate cancer, find out more about how you can support them and where to get more information.
References and reviewers
Updated: March 2025 | Due for review: March 2028
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This publication was written and edited by our Health Information team.
It was reviewed by:
- Maggie Bingle, Prostate Cancer Clinical Nurse Specialist, East Suffolk and North Essex NHS Foundation Trust
- Louisa Fleure, Consultant Nurse, Guy’s and St Thomas’ NHS Foundation Trust
- Philip Reynolds, Consultant Therapeutic Radiographer, The Clatterbridge Cancer Centre
- Alastair Thomson, Consultant Clinical Oncologist, Royal Cornwall Hospital
- Deborah Victor, Uro-oncology Clinical Nurse Specialist, Royal Cornwall Hospitals NHS Trust
- our Specialist Nurses
- our volunteers.
