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This information is about a hormonal therapy called leuprorelin acetate, which is also commonly called Prostap®. It is used in the treatment of advanced prostate cancer|. The information should ideally be read with our general information about prostate cancer.
Hormonal therapies interfere with the production or action of particular hormones in the body. Hormones are substances produced naturally in the body. They act as chemical messengers and help to control the activity of cells and organs.
Most prostate cancers need supplies of the male hormone testosterone to grow. Testosterone is produced by the testes and the adrenal glands.
Prostap lowers the level of testosterone in the body. The testes only make testosterone if told to do so by luteinising hormone. This luteinising hormone is produced by a part of the brain known as the pituitary gland. Prostap reduces the production of leuteinising hormone, and in turn the levels of testosterone are lowered. This may result in shrinkage of the tumour or a slowing down of its growth. There may be a brief increase in testosterone levels in the first few days or weeks of starting treatment.
Prostap is given as an injection either under the skin (subcutaneously) of the abdomen or arm, or sometimes into a muscle (intramuscularly) in the buttocks or thigh. It can be given as a monthly injection (Prostap® SR) or as a longer-acting preparation every three months (Prostap® 3). The injections will usually be given by your GP or practice nurse at the surgery. If you are not able to visit the surgery, a district nurse can give you the injection at home. Some people can be taught to give themselves the injection, if they wish to do so.
Sometimes people may find the injection slightly uncomfortable, and may notice an area of redness or darkening at the injection site afterwards. Most people do not find the injection painful, as the needle is very fine. If you do find the injection painful, you can have a tiny amount of local anaesthetic to numb the area before the Prostap is given.
Each person's reaction to any medicine is different. Many people have very few side effects with Prostap while others may experience more. Most of the side effects of Prostap occur because of a change in hormone levels. We have outlined the most common side effects. However, we have not included those that are very rare and therefore unlikely to affect you. If you notice any effects that you think may be due to the drug, but which are not listed in this information, you should discuss them with your doctor or nurse.
You will probably see your doctor regularly while you have this treatment so that they can monitor the effects. This information should help you to discuss any queries about your treatment and its side effects with your doctor or nurse, who are in the best position to help and advise you.
Some people may have some of the following side effects:
Tumour flare There may be a temporary increase in testosterone levels for the first few days or weeks after starting leuprorelin. Some men may have an increase in symptoms such as bone pain, or have problems passing urine. Rarely, other problems due to a temporary increase in the size of the tumour may occur. This is known as tumour flare. If you experience any problems, you will need to let your doctor know. Other types of hormonal therapy drugs such as cyproterone acetate|, flutamide| or bicalutamide| may be given for the first few weeks after starting Prostap to prevent tumour flare from occurring.
Hot flushes These can be quite common but many people find that hot flushes| wear off after a period of time. There are a number of ways to help reduce hot flushes and sweats. It can be useful to avoid or cut down on tea, coffee, nicotine and alcohol. Let your doctor know if hot flushes are causing you any problems, as recent research suggests that progestogen or some anti-depressants may be helpful in controlling this side effect. Your nurse or doctor can discuss this with you.
Some men find that complementary therapies| help. Your GP may be able to give you details about obtaining these on the NHS.
Sexual effects Loss of sex drive (libido) and erection difficulties (impotence) can occur. These effects| often return to normal after stopping the drug. Some men may find that these problems carry on after treatment is over. Talk to your doctor if these effects are a problem as there are drugs which can be prescribed to help this. Your doctor or nurse can discuss this with you.
Bone thinning (osteoporosis) This may happen if you are taking Prostap for longer periods of time. Your doctor can give you advice on how this can be monitored or treated, if needed. Let them know if you have any discomfort in your bones or joints.
Breast tenderness or fullness Occasionally some men notice slight breast swelling or tenderness known as gynaecomastia. Your doctor can advise you about how this can be prevented or treated.
Weight gain You may notice that you gain a few pounds in weight. This usually decreases again if the Prostap treatment is stopped.
Tiredness and fatigue You may find that you have less energy| than usual. This should wear off after you finish Prostap treatment.
Feeling sick (nausea), being sick (vomiting) and diarrhoea Nausea, vomiting| and diarrhoea| are rare effects. They are usually mild and easy to control. Tell your doctor if you have any of these side effects as medicines can be prescribed to help.
Headaches Some people find that Prostap causes headaches. These are usually mild and easily controlled by medicines.
Change in blood-sugar levels If you are diabetic, your blood-sugar levels may be slightly higher than usual and may need more regular monitoring. Your GP or diabetes doctor should be able to help you to manage this. Your blood-sugar levels should return to normal after you finish treatment with Prostap.
What if I miss an injection? Missing an injection by a few days should not make a great difference. However, it is important to remember that the benefits of the injections are designed to last one or three months, depending on which preparation you are prescribed, so you should have them as regularly as possible.
Length of treatment Your doctors will discuss the length of treatment that they feel is appropriate for your situation. Prostap is often given for several months or even years. Treatment with Prostap may continue for as long as it is effective in controlling your cancer.
This section has been compiled using information from a number of reliable sources, including:
British National Formulary (56th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2008.
For further references, please see the general bibliography|.
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