Find out about hormone treatment for prostate cancer, when you have it and possible side effects.
What it is
Hormones occur naturally in your body. They control the growth and activity of normal cells. Testosterone is a male hormone mainly made by the testicles.
Prostate cancer depends on testosterone to grow. Hormone therapy blocks or lowers the amount of testosterone in the body. This can lower the risk of an early prostate cancer coming back when you have it with other treatments. Or it can shrink an advanced prostate cancer or slow its growth.
When you have it
Hormone therapy with radiotherapy
You have this if:
- your cancer hasn’t spread but is at a high risk of coming back, e.g. the cancer has grown through the covering (capsule) of your prostate (stage 3)
- you have a very high prostatic specific antigen (PSA) level
- you have a high Gleason score
You might have hormone therapy before, during and after radiotherapy. Doctors usually recommend that you have the treatment for between 3 months and 3 years. How long depends on the risk of your cancer coming back and how many side effects you get.
You might have it with other treatments such as high frequency ultrasound treatment or internal radiotherapy.
Hormone therapy alone
Hormone treatment is also a treatment if:
- the cancer is too advanced to have treatment with the aim to cure it
- you can’t have surgery or radiotherapy because of other health problems
- you don’t want radiotherapy or surgery
You normally carry on taking hormone therapy for as long as it is working.
Your doctor might suggest you have intermittent therapy. This is when you have treatment for 6 to 12 months and then have a break for a few months. You then start treatment again and have another break
With intermittent therapy, you may have fewer side effects. At present the evidence is that intermittent treatment is not worse than having hormone treatment all the time. Talk to your doctor about this.
Hormone therapy is also a treatment for cancers that have spread to another part of the body. You might have it with chemotherapy such as docetaxel.
Treatment if your cancer comes back
Hormone therapy is also a treatment if your cancer comes back after having radiotherapy.
Types of hormone treatment
Drugs you have as injections
The injections work by blocking messages from a gland in the brain that tell the testicles to produce testosterone.
There are two types:
- luteinising hormone (LH) blocker (agonists) for example leuprorelin (Prostap) and goserelin acetate (Zoladex)
- gonadotrophin releasing hormone (GnRH) blockers, for example degarelix (Firmagon)
You have these as injections, they include:
- leuprorelin (Prostap) – you have this every 4 weeks or 12 weeks
- goserelin acetate (Zoladex) – you have this every 4 weeks or 12 weeks
- buserelin (Suprefact) – you have this as an injection 3 times a day for 7 days and then a nasal spray 6 times a day
- triptorelin (Decapeptyl) – you have this once a month, 3 monthly or 6 monthly
At first, the injections may make your symptoms worse. This is called tumour flare. Your doctor will give you an anti androgen tablet to take for the first 4 to 6 weeks of your treatment with the LH blocker to stop the tumour flare.
This is the other type of injection. There is currently only one type called degarelix (Firmagon). When you first start treatment, you have 2 injections on the same day. Then you have one injection a month. There is no risk of tumour flare with this treatment.
Anti androgen tablets
These tablets stop testosterone from your testicles getting to the cancer cells. Examples of anti androgens include:
- bicalutamide (Casodex) – you take it once a day
- flutamide (Drogenil) – 3 times a day
- enzalutamide (Xtandi) – once a day
Flutamide and bicalutamide are less likely to cause erection problems and other side effects than leuprorelin (Prostap) or goserelin (Zoladex). But they are more likely to cause breast swelling and tenderness.
Enzalutamide is a treatment for men who have already had other types of hormone therapy and chemotherapy with docetaxel (Taxotere) that is no longer working.
The trade name for abiraterone is Zytiga. It is a type of hormone therapy that blocks an enzyme called cytochrome p17. Without this enzyme, the testicles and other body tissue can't make testosterone.
It is a tablet you take every day.
You might have abiraterone if you have advanced prostate cancer and have already had other types of hormone therapy and chemotherapy with docetaxel (Taxotere) that is no longer working.
There are two main ways to stop the body producing testosterone:
- drug treatment
Drug treatment is the usual way to stop your body producing testosterone. You have drug treatment as tablets or injections.
Surgery to remove your testicles (orchidectomy) isn’t a common way of lowering the amount of testosterone you produce.
You usually only have surgery to remove your testicles if you need your testosterone reduced urgently. For example if your cancer has spread to your bones and is pressing on your spinal cord, your doctors might want to reduce the amount of testosterone quickly.
Your doctors may also suggest surgery as an option if you don't want to have treatment with medicines.
Checking your hormone therapy is working
You’ll have regular blood tests to check the level of a protein called prostate specific antigen (PSA). PSA is a protein made by both normal and cancerous prostate cells. It is in the blood in small amounts in all men, unless they have had their prostate gland completely removed.
While the hormone therapy is working, the level of PSA should stay stable or may go down. But if prostate cancer cells are starting to grow and develop, the level of PSA may go up. Then your doctor may need to change your treatment. They will discuss this with you.
Side effects of hormone therapy are due to the low levels of testosterone in your body. Some are common to all hormone therapies for prostate cancer. Some effects vary from drug to drug.
The main side effects are:
- erectile problems (impotence)
- hot flushes and sweating
- feeling tired and weak
- breast tenderness
- tumour flare
Side effects of long term treatment are:
- weight gain
- memory problems
- mood swings and depression
- bone thinning (osteoporosis)
- risk of early heart failure