You might have hormone therapy for prostate cancer. Find out about when you have it and the possible side effects.
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.
When do you have hormone therapy?
Hormone therapy with radiotherapy
You have this if:
- your cancer hasn’t spread to other parts of the body but is at a high risk of coming back, eg the cancer has grown through the covering (capsule) of your prostate
- 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.
Hormone therapy alone
You might also have hormone 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 breaks from treatment and have 3 monthly tests to check your PSA. You restart treatment again if your PSA rises above a certain level.
With intermittent therapy, it's thought you might have fewer side effects. But there needs to be more research into this.
Hormone therapy is a treatment for cancers that have spread to another part of the body. You might have it with chemotherapy such as docetaxel.
If your cancer comes back after treatment
Hormone therapy is also a treatment if your cancer comes back after having radiotherapy.
Types of hormone therapy
There are 3 main ways of having hormone therapy. They include:
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.
Anti androgen tablets
These tablets stop testosterone made by 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
- cyproterone acetate (Cyprostat) - 2 to 3 times a day
Flutamide and bicalutamide are less likely to cause erection problems 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.
Surgery to remove the testicles (orchidectomy)
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 might also suggest surgery as an option if you don't want to have injections or tablets.
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