Hormone therapy for prostate cancer (2024)

Hormone therapy is often used to treat prostate cancer. Hormone therapy for prostate cancer works by reducing the amount of androgens (male hormones) or blocking androgens from being used.

Androgens, such as testosterone, help prostate cancer cells to grow. Androgens control the development of male physical traits, such as a deep voice and the growth of hair on the body and face. Androgens are made mainly by the testicl*s.

Drugs or surgery can be used to block the production or effects of androgens like testosterone. Hormone therapy alone can't cure prostate cancer, but it can shrink tumours, slow the growth of cancer cells and help you live longer.

You may have hormone therapy to:

• treat cancer that has spread outside of the prostate (called locally advanced or metastatic prostate cancer)
• treat prostate cancer that comes back after treatment (called recurrent prostate cancer)
• treat prostate cancer by itself or along with radiation therapy for cancer that has a higher risk of coming back
• shrink a tumour before other treatments (called neoadjuvant therapy), such as surgery or radiation therapy

Your healthcare team will consider your personal needs to plan your hormone therapy. You may start hormone therapy soon after you are diagnosed. Or you may not start treatment until the symptoms of prostate cancer get worse. You may be on hormone therapy longer than others. You may start and stop hormone therapy (called intermittent hormone therapy), while others will take it continuously for a long time.

Hormone therapy can stop working over time so that prostate cancer begins to grow again (called castration-resistant prostate cancer). When this happens, doctors may offer other hormone therapies or other treatments. They can't predict how long hormone therapy will work, so you will have regular blood tests to check prostate-specific antigen (PSA) and testosterone levels. If the PSA level starts to rise and the testosterone level is low, it may mean that the cancer has started to grow again.

Luteinizing hormone–releasing hormone (LHRH) agonists are drugs that stop the testicl*s from making testosterone. LHRH agonists are also called LHRH analogs or gonadotropin-releasing hormone (GnRH) agonists.

The most common LHRH agonists used to treat prostate cancer are:

• leuprolide (Lupron, Lupron depot, Eligard)
• goserelin (Zoladex)
• triptorelin (Trelstar)

These drugs are given either as an injection or as an implant placed under the skin. Different drugs are given on schedules that vary from once a month to once a year.

When you first take LHRH agonists, they cause a temporary rise in testosterone that lasts for about a week. This rise may cause symptoms to worsen for a few weeks. This is called a tumour flare reaction. Your doctor will likely prescribe another type of hormone therapy called an anti-androgen to help prevent a tumour flare reaction. Anti-androgens are usually started at the same time as LHRH agonists and are taken for a few weeks.

LHRH antagonists (also called GnRH antagonists) are drugsthat stop the pituitary gland from making LH. This causes the testicl*s to stopmaking testosterone. LHRH antagonists usually lower testosterone levels morequickly than LHRH agonists. They also don't cause a tumour flare reaction.

The LHRH antagonist used to treat prostate cancer isdegarelix (Firmagon). It is given as a monthly injection.

Androgen synthesis inhibitors block enzymes that the bodyneeds to make testosterone.

Androgen synthesis inhibitors include abiraterone (Zytiga). Theymay be used to treat advanced prostate cancers. Because these drugs can alsoblock the production of cortisol, you will need to take a corticosteroid suchas prednisone, methyl-prednisone or hydrocortisone.

Anti-androgens block the use of testosterone. They attach toandrogen receptors on prostate cancer cells and prevent them from usingtestosterone to grow.

Anti-androgen drugs usually aren't given alone to treatprostate cancer. They may be used along with an orchiectomy or an LHRH agonistor LHRH antagonist (called combined androgen blockade, or CAB) as the maintreatment for prostate cancer. Anti-androgens can also be given if the cancerstarts to grow after an orchiectomy or while you are taking an LHRH agonist or LHRHantagonist (called castration-resistant prostate cancer). These drugs can alsobe used to prevent a tumour flare reaction if you are taking LHRH agonists.Because these drugs can also block the use of cortisol, you will need to take acorticosteroid such as prednisone or hydrocortisone.

Anti-androgens are given by mouth in pill or liquid form.The anti-androgens that are most commonly used be to treat prostate cancer are:

• bicalutamide (Casodex)
• flutamide
• nilutamide (Anandron)
• apalutamide (Erleada)
• enzalutamide (Xtandi)
• darolutamide(Nubeqa)

If prostate cancer stops responding to anti-androgens andthe cancer begins to grow again, anti-androgen therapy is stopped. Sometimes prostatecancer stops growing when anti-androgens are stopped, but doctors aren't surewhy this happens. This is called an anti-androgen withdrawal effect.

Side effects can happen with any type of treatment for prostate cancer, but everyone's experience is different. Some people have many side effects. Other people have few or none at all.

If you develop side effects, they can happen any time during, immediately after or a few days or weeks after hormone therapy. Sometimes late side effects develop months or years after hormone therapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of hormone therapy will depend mainly on the type of hormone therapy, the dose of a drug or combination of drugs, if any other treatments are given and your overall health. Some common side effects of hormone therapy for prostate cancer are:

• sexual problems (low sex drive, erectile dysfunction or shrinkage of the testicl*s and penis)
• hot flashes
• mood swings
• breast tenderness and growth of breast tissue (called gynecomastia)
• loss of muscle and physical strength
• bone thinning (called osteoporosis) and bone fractures
• fluid retention
• joint or muscle pain
• fatigue
• diarrhea
• constipation
• high blood pressure
• headache
• upset stomach
• nausea
• depression, trouble concentrating and memory problems
• increased cholesterol
• heart problems

Tell your healthcare team if you have these side effects or others you think might be from hormone therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Find out more about hormonal therapy and side effects of hormonal therapy. To make the decisions that are right for you, ask your healthcare team questions about hormonal therapy.