Hormonal therapies for advanced prostate cancer

Hormonal therapy is the main treatment for men with advanced prostate cancer. It can shrink the cancer, delay its growth and reduce symptoms.

Prostate cancer depends on the hormone testosterone in order to grow. Testosterone is produced by the testicles, and a small amount is also produced by the adrenal glands. Hormonal therapies work by reducing the amount or activity of testosterone in the body.

Hormonal therapies can be given as:

  • injections
  • tablets
  • nasal sprays.

Another way of reducing the amount of testosterone in the body is to remove the part of the testicles that produces the hormone. This is a simple operation called a subcapsular orchidectomy. It’s not common for surgery to be done these days because hormonal therapy treatments are usually very effective.

Hormonal treatment works well for most men with advanced prostate cancer, and the cancer can often be controlled for some time. Your doctor or specialist nurse will check how well the cancer is responding to treatment by checking your symptoms and examining you. They will check your PSA level as this is usually a good guide to how effective treatment is.

Side effects

Erection problems

Most hormonal therapies cause erection difficulties (erectile dysfunction – ED) and loss of sexual desire (libido) for as long as the treatment is given and for some time after. Some drugs (such as goserelin and leuprorelin) often completely stop erections during treatment. Others (such as bicalutamide) stop erections in most but not all men. Once hormone treatment is stopped, the problem may improve with time or treatment. You will be offered treatment for erection problems that do not improve.

Bone thinning

Hormonal therapy can cause bone thinning (osteoporosis). This can sometimes lead to tiny cracks in the bone (fractures).The risk of bone thinning increases if you are taking hormonal therapy for long periods. Your doctors may arrange for you to have a DEXA scan (dual-energy x-ray absorptiometry scan) if you are due to start long-term hormone treatment. This scan allows doctors to monitor the bones for any areas of weakness or fractures.

If your bones are thinning your doctor may advise you to take calcium and vitamin D tablets. You may also be asked to take bone-strengthening drugs called bisphosphonates or a drug called denosumab (Prolia®). We have more information about bone health.

Hormonal effects

Most men experience hot flushes and sweating. Your doctor can give you medicines to help relieve this side effect while you’re having treatment. The flushes and sweats will gradually stop if treatment is stopped. We have more information on side effects of hormonal therapies.

Other effects

Hormonal treatment can also make you put on weight – often around the tummy area – and feel constantly tired. Some drugs (most commonly flutamide and bicalutamide) may also cause breast swelling and breast tenderness. We have more information about managing breast swelling.

Different drugs have different side effects. It’s important to discuss these effects with your doctor or specialist nurse before you start treatment so that you know what to expect.

Some men may experience emotional effects, such as mood changes or anxiety.


Advantages of hormonal therapy

  • Hormonal therapy can shrink the cancer, delay its growth and relieve symptoms for many months or years.

Disadvantages

  • Hormonal therapy can cause a range of side effects that include erection difficulties (ED), a lowered sex drive, hot flushes, weight gain, breast swelling and fatigue.

Back to Hormonal therapies explained

Types of hormonal therapy

There are different types of hormonal therapy used to treat advanced prostate cancer. You may have more than one type.

Ways of giving hormonal therapy

There are different ways of having hormonal therapy for advanced prostate cancer. Your doctor will discuss with you which they think is best for your situation.

Subcapsular orchidectomy

Some men may have an operation to remove the part of the testicles that produces testosterone. This is a type of hormonal therapy for advanced prostate cancer.