Leuprorelin acetate (Prostap ® SR, Prostap ® 3)
This information is about a hormonal therapy drug called leuprorelin acetate, which is also called Prostap ®. It is used to treat prostate cancer. Throughout this information we refer to it by its more commonly used name, Prostap.
Prostap is a type of hormonal therapy that is used to treat prostate cancer.
Hormones are substances produced naturally in the body. They act as chemical messengers and help control the activity of cells and organs. Hormonal therapies work by interfering with the production or action of particular hormones in the body.
You will see your doctor regularly while you have this treatment so they can monitor its effects. This information should help you discuss any queries about your treatment and its side effects with your doctor or specialist nurse.
Most prostate cancers need supplies of a hormone called testosterone to grow. Testosterone is produced by the testes and the adrenal glands.
Production of testosterone by the testes is stimulated by another hormone called luteinising hormone. This is produced by the pituitary gland, which is situated in the brain. Prostap stops the pituitary gland producing luteinising hormone. This leads to a reduction in testosterone levels, which may help to shrink the tumour or slow its growth.
Prostap is given to treat prostate cancer that has spread into the tissues around the prostate gland (locally advanced cancer). It may also be used to control the growth of prostate cancer in men whose cancer has spread to other parts of the body (advanced or metastatic prostate cancer). It may be used after surgery or radiotherapy for early or locally advanced prostate cancer.
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 DCS) or as a longer-acting preparation every three months (Prostap ® 3 DCS).
The injections will usually be given by your GP or practice nurse at the surgery. If you’re 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.
Some 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 it painful, you can have a tiny amount of local anaesthetic to numb the area before the Prostap is given.
Your doctors will discuss the length of treatment 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.
Each person's reaction to any medicine is different. Some people have very few side effects, 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 but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that are not listed here, discuss them with your doctor or nurse.
You may have some of the following side effects, to varying degrees.
There may be a temporary increase in testosterone levels for the first few days or weeks after starting Prostap. 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 and is normal. It should improve in a few weeks but if you experience any problems, 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.
These can be 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. Some men find it helps to cut down on tea, coffee, nicotine and alcohol. Research shows that hormones called progestogens or some antidepressants may be helpful in controlling hot flushes. 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 having these on the NHS.
Loss of sex drive (libido) and erection difficulties (impotence) can occur. These often return to normal after you stop taking the drug. Some men may find that these problems carry on after treatment is over. Talk to your doctor or nurse if these effects are a problem as they can prescribe drugs to help.
You might find it helpful to see our section on sexuality and cancer.
Bone thinning (osteoporosis)
You may be at a higher risk of osteoporosis if you’re taking Prostap for long periods of time. Your doctor can give you advice on how this can be monitored and treated. Let them know if you have any discomfort in your bones or joints.
We have more information on keeping your bones healthy.
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.
You may notice that you gain a few pounds in weight. This usually decreases again if the Prostap treatment is stopped.
You may find that you have less energy than usual. This should wear off after you finish treatment.
Feeling sick (nausea), being sick (vomiting) and diarrhoea
Nausea, vomiting and diarrhoea are rare effects, but if they do occur 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.
Some men find that Prostap causes headaches. These are usually mild and easily controlled with medicines.
Risk of heart disease and diabetes
There may be an increased risk of developing heart disease or diabetes when taking Prostap. However, the benefits of hormonal treatment generally outweigh the possible risks. You can discuss the possible risks and benefits in your situation with your specialist.
Always let your doctor or nurse know about any side effects you have. There are usually ways that they can be controlled or improved.
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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.
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 manage this. Your blood-sugar levels should return to normal after you finish treatment with Prostap.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you’re having hormonal treatment. You should tell them the name of your cancer specialist so they can ask them for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your doctor or specialist nurse will be able to provide you with details of who to contact for advice.
This section has been compiled using information from a number of reliable sources, including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
British National Formulary. 63rd edition. 2012. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed September 2012).
Thanks to Kavita Kantilal, E-Prescribing Pharmacist, Debbie Wright, Oncology Pharmacist, and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.