Other hormonal therapy for advanced prostate cancer

Once the cancer is no longer responding to either LH blockers, GnRH blockers or anti-androgens (or a combination of these), many men can have further periods of remission with other hormonal treatments.

Abiraterone (Zytiga®)

Abiraterone is a newer type of hormonal therapy. It is used when other types of hormonal therapy are no longer working. Doctors can give it to men who haven’t had any chemotherapy, or when the cancer has continued to grow after docetaxel chemotherapy.

You take abiraterone as tablets once a day. It has some side effects, which include high blood pressure and tiredness. Your doctor or specialist nurse can tell you more about this.

The National Institute for Health and Care Excellence (NICE) gives advice on which new drugs or treatments should be available on the NHS in England and Wales. The Scottish Medicines Consortium (SMC) is an organisation similar to NICE for the NHS in Scotland. Both NICE and the SMC recommended abiraterone as a treatment after docetaxel chemotherapy. However, neither of them recommends its use before chemotherapy and, because of this, it may not be widely available in this situation.

If you live in Northern Ireland, you can speak to your hospital team to find out if this drug is available for you.

Enzalutamide (Xtandi®)

Enzalutamide is another new hormonal therapy that is used to treat men when other types of hormonal therapy are no longer working. It can also be used before chemotherapy, or when the cancer has continued to grow after docetaxel chemotherapy.

Enzalutamide is taken as capsules once a day. The side effects of this hormonal therapy can include hot flushes, feeling tired and weakness. Your doctor or specialist nurse will be able to give you more information about this.

Both NICE and the SMC recommend enzalutamide as a treatment after docetaxel chemotherapy, but have not looked at its use before chemotherapy.

Steroids

You may be offered steroids called prednisolone or dexamethasone. These are also taken as tablets. They may cause some weight gain and your appetite may increase, but are usually tolerated well. You may sometimes be given steroids with chemotherapy.

Occasionally, they can cause mood swings, difficulty sleeping and irritability. Let your doctor know if you get any of these side effects. Difficulty sleeping may be helped by taking the steroids earlier in the day, but check this with your doctor first.

Stilboestrol

Stilboestrol is a drug that is very similar to the female hormone oestrogen. It reduces the amount of testosterone in the body and is taken as a tablet once a day.

The side effects of stilboestrol can include loss of sex drive and loss of facial hair. It may also cause some breast tenderness and swelling. Stilboestrol can also increase the risk of getting a blood clot (deep vein thrombosis or DVT). You may be prescribed aspirin to reduce this risk. Talk to your doctor or specialist nurse if you are worried about these side effects.

Sometimes a drug called ethinylestradiol is used instead of stilboestrol. The side effects are similar to those of stilboestrol.

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.