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Prostate cancer| is often treated with hormonal therapies| that may be used on their own or combined with radiotherapy|. These treatments can cause side effects, which are usually described as hormonal symptoms.
The symptoms can vary depending on the type of hormonal treatment| you're having and will range from being mild to severe. This information is about these symptoms and gives you suggestions about how to cope with them.
Testosterone is a male sex hormone produced by the testicles. Hormones are substances that occur naturally in the body. They control the growth and activity of normal cells.
Testosterone is responsible for:
The testicles are stimulated to produce testosterone by another hormone called luteinising hormone (LH), which is produced by the pituitary gland in the brain.
Prostate cancer needs testosterone to grow. Hormonal therapies for prostate cancer work by lowering the level of testosterone in the body, or by preventing it from attaching to the cancer cells. This can help slow down or stop the growth of the prostate cancer cells.
The levels of testosterone in the body can be lowered using hormonal therapy drugs (given either by injection or as tablets) or by a simple operation.
These are widely used in the treatment of prostate cancer.
Some drugs 'switch off' the production of testosterone by the testicles by reducing the levels of luteinising hormone produced by the pituitary gland. These drugs are called pituitary down-regulators, or GnRH (gonadotrophin-releasing hormone) analogues, and they're given by injecting a pellet or a liquid under the skin. The injections can be given monthly or every three months.
Commonly used GnRH analogues are:
Another type of hormonal therapy works by blocking the messages from the brain that tell the testicles to produce testosterone. These are known as GnRH (gonadotrophin-releasing hormone) antagonists. They’re also called GnRH blockers. The only GnRH blocker currently available is degarelix| (Firmagon®), which is given as an injection under the skin once a month.
Other hormonal therapy drugs work by attaching themselves to proteins (receptors) inside the cancer cells. This blocks the action of testosterone on the cancer cells. They're called anti-androgens and are often given as tablets.
Commonly used anti-androgens are:
Oestrogen treatment (diethylstilbestrol|) can also be used to reduce testosterone levels in some men but other hormonal therapies may be used first because of the increased risk of circulation problems, including blood clots. However, it may be suitable for men who have prostate cancer that is no longer responding to other hormonal therapy drugs.
A newer approach to hormonal treatment for prostate cancer is a drug called abiraterone acetate| (Zytiga ®). It works by blocking an enzyme necessary for the body to make testosterone, and so stops the hormone being produced.
This operation removes the part of the testicles that produces testosterone. It's a simple operation that can be done as a day patient. Some men find the idea of this operation distressing but others don't find it a problem. It causes the same hormonal symptoms that treatment with hormonal therapies cause.
Reducing the level of testosterone can cause a number of symptoms. These may include:
There are a number of different ways in which hormonal symptoms can be managed. You may find some of the following suggestions helpful.
Hormonal therapies often cause the inability to have an erection, known as erectile dysfunction or ED, and loss of sex drive. This will continue for as long as the treatment is given.
If the treatment is stopped, sexual problems may improve after a period of time. However, some men find that these problems carry on after treatment is over. When men have both testicles removed ED is always permanent.
If you have problems getting or keeping an erection there are treatments that may help. However, they don't work for everyone and won't necessarily increase your desire to have sex (libido).
Tablets such as sildenafil (Viagra ®), vardenafil (Levitra ®) and tadalafil (Cialis ®) can help produce an erection by increasing the flow of blood to the penis. These tablets can be prescribed by your doctor. They may not be recommended for you if you have heart problems and/or are taking certain drugs, such as nitrates.
It's possible to buy these types of tablets on the internet, but this is not recommended. It can be unsafe to take these drugs without first being seen by a doctor who can check that they are suitable for you. It can also be difficult to know if a website selling these drugs is actually selling the correct drugs and not substitutes that look the same.
You may be able to buy Viagra tablets from certain high street stores or chemists that have specially trained pharmacists. Before they can give you Viagra you will need to have a health check and fill out a health questionnaire.
Sometimes a pellet can be inserted into the penis, or drugs injected into it (with a small needle), to help give an erection. These can be prescribed by your GP.
Vacuum pumps can be used to produce an erection by drawing blood into the penis. A ring is then placed around the base of the penis, trapping the blood, to help maintain an erection.
Coping with sexual difficulties| can be distressing. Talk to your nurse or doctor if you're having problems. Many men find it difficult to talk about sexual issues because they feel embarrassed. But your doctor or nurse will be used to talking about this kind of thing and can give you information and support.
Some men find the side effects that cause the most problems are hot flushes and sweats. The length of time they last for and their intensity can vary.
Hot flushes and sweats get easier to deal with after a period of time. They usually stop completely a few months after your treatment finishes.
It's difficult to stop hot flushes and sweats, but their frequency and intensity can often be reduced.
For some men, certain situations, drinks or foods may bring on a flush or sweat. Try to keep a note of anything that triggers flushes so that you can avoid them. Here are some other tips which may help you:
Hormonal treatment can make you feel very tired|, both mentally and physically. The tiredness gets better if the drug treatment is stopped. If you do get very tired, it can help to plan your day so that you have time to rest and do the things you want.
There may be things that you can't manage to do, such as housework or gardening. Ask others for help with tasks that you find too demanding. Exercise| can also help relieve the symptoms of tiredness.
Exercise can help keep your weight stable if you have put on weight because of your hormonal therapy. Even regular short walks can help. It's also important to eat a healthy balanced diet|. Your doctor or nurse can give you further advice about managing weight gain|, or could refer you to a dietitian.
Having both testicles removed, or being on long-term GnRH analogue treatment, will increase your risk of developing osteoporosis.
Regular weight-bearing exercises such as walking, dancing, hiking or gentle weight-lifting can help keep your bones healthy. Swimming is not so helpful, as your bones aren't supporting your weight.
It's important to make sure that you get enough calcium and vitamin D (which helps the body use calcium effectively) in your diet. Dairy products are a good source of calcium but you can get calcium from eggs, green leafy vegetables, nuts and fish such as whitebait, sardines and pilchards.
A well-balanced diet will normally give you all the calcium and vitamin D you need, but your doctor may advise you to take calcium and vitamin D supplements to help protect your bones. Cutting down on caffeine, alcohol and stopping smoking can also help lower your risk of osteoporosis.
Drugs called bisphosphonates| can be used to treat osteoporosis. Your doctor can give you more information about them.
You could also try to reduce your chances of having a fall by making sure that your environment is safe.
The National Osteoporosis Society| can give you more information about preventing and treating osteoporosis.
Warm baths can help to relax stiff, aching joints and regular exercise will keep your muscles supple. Let your doctor know if you have sore joints. They can prescribe you painkillers if needed.
Some drugs, most commonly flutamide and bicalutamide, may cause breast swelling and tenderness. The drug tamoxifen| (a tablet) can help reduce this.
Giving a low dose of radiation to the breast tissue before or soon after the start of treatment may also help to avoid this. If you do have breast tenderness, your doctor can prescribe medicines to reduce any discomfort.
You may experience sleeplessness| due to hot flushes, sweats or anxiety|, which can make it harder to cope during the day.
The following tips may help you relax and sleep better:
This can sometimes happen with hormonal therapies for prostate cancer. We have more information about coping with hair loss|.
The psychological effects of hormonal symptoms can be hard to cope with when you may already be dealing with the physical and emotional effects of cancer.
The symptoms may be distressing for you and your partner| (if you have one) to deal with. You may feel anxious, angry| or frustrated at having more problems to cope with. You may also experience mood changes and feel emotional or anxious without knowing why.
Some men may find it helpful to talk| about their feelings to their family and friends. Others may find it easier to get help from people outside of their situation. Talk to your doctor or nurse if you're having emotional difficulties. They can support you and, if appropriate, refer you to a specially trained counsellor|.
We have more information about the emotional effects of cancer|, which you may find helpful.
To reduce the risk of side effects, it may be possible to have the hormonal therapy for a few months and then stop for a time before restarting it some time later. This is known as intermittent therapy. A recent study has suggested that in some situations this is as effective as continuous hormone therapy.
The British Complementary Medicine Association| is an umbrella organisation for complementary medicine organisations. Can provide contact details for practitioners and therapists in your area.
The British Wheel of Yoga| is the governing body of yoga in the UK. The BWY can provide a list of yoga teachers and classes in your area.
The National Osteoporosis Society| is an independent charity which offers advice and information to the general public and health care professionals. Provides support for people with osteoporosis via its helpline, resources and a network of local groups.
The Prostate Cancer Charity| offers support and information to anyone affected by prostate cancer. The helpline is staffed by experienced nurses. Also funds research and can put men in touch with others affected by prostate cancer.
The information in this section has been compiled using a number of reliable sources, including:
Content last reviewed: 1 January 2013
Next planned review: 2015
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.
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© Macmillan Cancer Support 2013
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