You might have hormone therapy for prostate cancer that has spread to another part of your body. You can have it as an injection, tablets or more rarely surgery. Find out about when you have it.
What is advanced prostate cancer?
Advanced prostate cancer is a cancer that started in the prostate that has now spread to another part of the body, such as the bones or lungs.
What is hormone therapy?
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 usually depends on testosterone to grow. Hormone therapy blocks or lowers the amount of testosterone in the body.
Hormone therapy on its own doesn't cure prostate cancer. But it 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.
What hormone therapy does
Hormone therapy can control or shrink the cancer and reduce symptoms. It can help you feel better and improve your quality of life for a time but it can’t cure the cancer.
Most men with advanced prostate cancer have hormone therapy. If your cancer has spread when it is diagnosed, you might start hormone therapy straight away.
If you don’t have symptoms, your doctor might suggest monitoring your symptoms and then starting treatment when needed. They call this watchful waiting.
Your doctor might offer you a choice of treatment. And you might have more than one type of hormone therapy at the same time.
Before you start hormone treatment
You need to have blood tests before starting treatment. Your doctor will examine you and ask about your symptoms.
Sometimes it’s helpful to keep a symptom diary of how you feel, for example if you have bone pain that is worse at night but gets better with painkillers.
How you have it
There are 3 main ways of having hormone therapy. This includes:
The injections work by blocking messages from a gland in the brain that tell the testicles to produce testosterone.
Luteinising hormone-releasing hormone agonists (LHRH agonists)
- 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 gives you an anti androgen tablet to take for the first 4 to 6 weeks of your treatment to stop the tumour flare.
Gonadotrophin-releasing hormone antagonist
This is the other type of injection. It is also called GnRH blocker. 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's 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 or after 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.
Abiraterone is usually a possible treatment for people who have had other types of hormone therapy or after chemotherapy with docetaxel.
It is a tablet you take every day.
Surgery to remove the testicles
Removing the testicles (orchidectomy) lowers testosterone very quickly and can shrink a prostate cancer very quickly. Your doctors might suggest this if you don't want to have treatment with medicines, but this is rare.
How often you have hormone therapy
You usually have hormone therapy that you take all the time (continuous therapy). Or you may have a few months of treatment and then a break (intermittent therapy). It's thought that having intermittent therapy might reduce the side effects you get, but more research needs to be done to look into this.
You might have:
- one hormone therapy drug on its own
- two hormone therapies together
- hormone therapy with chemotherapy, such as docetaxel
Your doctor will talk to you about which hormone therapy they recommend and for how long you might have take it for.
Where you have treatment
You might have your hormone treatment:
- at your GP’s surgery
- at home
- in the chemotherapy day unit
Your team will let you know where you will have your treatment.
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
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.
When hormone therapy stops working
After some months or years the hormone treatment usually stops working and the cancer starts to grow again. Your doctor might recommend stopping or changing hormone treatment at this stage.
If you're having anti androgens and your PSA level has started to rise again your doctor might get you to stop taking them. In some cases this can cause the cancer to shrink and stop growing for some time. This is called anti androgen withdrawal response (AAWR).
There are different treatment options for when hormone therapy stops working, such as chemotherapy or steroids.
Research and clinical trials
Researchers are interested in different ways of treating advanced prostate cancer. They are using combinations of treatments and hormone therapy in clinical trials.