Hormone therapy for metastatic prostate cancer
Hormone therapy is a common treatment for metastatic prostate cancer. It is also sometimes called anti hormone therapy.
Metastatic prostate cancer is a cancer that has spread from the prostate to other parts of the body.
This page is about hormone therapy for metastatic prostate cancer .
Prostate cancer that has not spread is called localised prostate cancer. Or locally advanced prostate cancer. We have separate information about hormone therapy for prostate cancer that hasn't spread.
What is hormone therapy?
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 doesn't cure prostate cancer. But it can control or shrink the cancer and reduce symptoms. It can help you feel better and improve your quality of life for a time.
When you might have hormone therapy for metastatic prostate cancer
Most men with metastatic prostate cancer have hormone therapy. You usually have hormone therapy together with:
- different hormone therapy drugs
chemotherapy such as docetaxel- both a different hormone therapy drug and chemotherapy
Hormone therapy with chemotherapy often controls metastatic prostate cancer for many months. But the cancer usually starts to grow again. You might hear your doctor calling this castration resistant prostate cancer. We have more information about this further down the page.
Types of hormone therapy
There are 2 main types of hormone therapy. These are:
-
injections
-
tablets
Injections
The injections work by blocking messages from a gland in the brain. This tell the testicles to produce testosterone.
Luteinising hormone-releasing hormone agonists (LHRH agonists or LH blockers)
A gland in the brain called the makes the luteinising hormone (LH). This controls the amount of testosterone made by the testicles. LH blockers stop the production of luteinising hormone. So the testicles stop making testosterone.
At first, the injections may make your symptoms worse. This is called tumour flare. Your doctor might recommend you take an anti androgen tablet to stop the tumour flare. For example, bicalutamide. You usually take bicalutamide for the first 4 to 6 weeks of your hormone treatment.
Types of LH blockers include:
-
leuprorelin (Prostap) – you have this every 4 weeks or 12 week
-
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
Gonadotrophin-releasing hormone antagonist or GnRH blocker
This is another type of hormone injection. It stops messages from a part of the brain called the hypothalamus that tells the pituitary gland to produce luteinising hormone. Luteinising hormone tells the testicles to produce testosterone, so GnRH blockers stop the testicles from making testosterone.
Your doctor may suggest you have a GnRH blocker called degarelix (Firmagon). When you 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.
Tablets
Hormone therapy tablets are usually anti androgen tablets. Or you might take a drug called abiraterone.
Anti androgen tablets
These tablets stop testosterone from your testicles from getting to the cancer cells. Examples of anti androgens include:
- bicalutamide (Casodex) – you take it once a day
- flutamide (Drogenil) – you take it 3 times a day
- enzalutamide (Xtandi) – you take it once a day
- apalutamide (Erleada) – you take it once a day
- darolutamide (Nubeqa) – you take it twice a day
Abiraterone tablets
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 treatment for people who have had other types of hormone therapy or docetaxel. It is a tablet you take every day.
Finding out more about hormone treatment drugs
Check what is the name of the hormone treatment with your doctor or nurse, then take a look at our A to Z list of cancer drugs.
Surgery to remove the testicles (orchidectomy)
Surgery to remove your testicles is a type of hormone therapy for prostate cancer. But it is not a common treatment. You're more likely to have injections or tablets to reduce the level of testosterone in your blood.
The testicles produce testosterone, which can help prostate cancer grow. So removing the testicles can help to control the growth of prostate cancer. After this surgery, the level of testosterone in the blood falls quickly.
Your doctors might suggest surgery as an option if you don't want to have injections or tablets.
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 often you have hormone therapy
You usually have hormone therapy all the time (continuous therapy). Or you may have a few months of treatment and then a break (intermittent therapy).
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 take it.
Where you have treatment
You might have your hormone treatment:
-
at your GP’s surgery
-
at home as tablets
-
in the chemotherapy day unit
Your team will let you know where you will have your treatment.
Checking your hormone therapy is working
You have regular blood tests to check the level of . Both normal and cancerous prostate cells make PSA. All men have a small amount of PSA in their blood, unless you had surgery to completely remove your prostate gland.
You may have some scans during your treatment. These include scans such as a , and . Your doctor will also ask you about any symptoms you have such as bone pain.
While the hormone therapy is working, your PSA level should stay stable. Or it may go down. But if prostate cancer starts to grow and develop, your PSA level may go up. This is usually called either:
- hormone resistant prostate cancer
- castration resistant prostate cancer
If this happens, your doctor may need to change your treatment. They will discuss this with you.
When hormone therapy stops working
After some months or years, hormone treatment usually stops working. The cancer starts to grow again.
Your might continue with your first type of hormone therapy, even if it isn't working very well. Your doctor might recommend adding in different treatments.
If you're having anti androgens, your doctor might ask 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.
There are different treatment options for when hormone therapy stops working. You might have one or more of these treatments. Options include:
- a different type of hormone therapy
- chemotherapy with or without
steroids - an extra hormone therapy drug
radioisotope therapy such as Radium-223 - a
targeted cancer drug called Olaparib
Side effects
Side effects of hormone therapy are due to the low levels of testosterone in your body. Many men find that the side effects are often worse at the start of treatment. They usually settle down after a few weeks or months.
Some side effects are common to all hormone therapies for prostate cancer. Others vary from drug to drug. You might not have all of these side effects. Talk to your doctor or nurse about any side effects you have. They can often suggest ways of reducing the side effects and make you feel better.
The main side effects are:
-
changes to your sex life such as difficulty getting an erection and less desire for sex (low libido)
-
hot flushes and sweating
-
feeling tired and weak
-
breast tenderness and swelling
-
tumour flare
Side effects of long term treatment are:
-
weight gain
-
loss of muscle strength
-
memory problems
-
mood swings and depression
-
bone thinning (osteoporosis)
-
risk of heart problems and diabetes
Research and clinical trials
Researchers are interested in different ways of treating prostate cancer. They are using combinations of treatments and hormone therapy in clinical trials.
