Types of hormonal therapy

There are different types of hormonal therapies that can be used to treat advanced prostate cancer. You may be offered treatment with more than one type. If you’ve had hormone treatment before, you may be advised to try a different type.

Leutenising hormone (LH) blockers

Some drugs ‘switch off’ the production of male hormones from the testicles by reducing the levels of a hormone produced by the pituitary gland. They are known as leutenising hormone blockers or LHRH agonists.

The pituitary gland is a gland in the brain that produces hormones that control and regulate the other glands in the body.

LH blockers include:

How LH blockers are given

  • Goserelin is given as a small pellet that is injected under the skin of the tummy (subcutaneously).
  • Leuprorelin and triptorelin are given as liquids that are injected subcutaneously or into a muscle. The injections are given either monthly or every three months.
  • Buserelin is given as a subcutaneous injection three times a day for a week. From the eighth day, you take buserelin as a nasal spray six times a day in each nostril.

We have more information about the ways of giving hormonal therapy.

There may be a temporary increase in testosterone levels for the first few days of treatment, which can increase your symptoms. This is known as a tumour flare. To help prevent this your doctor will prescribe a short course of an anti-androgen tablet. If you have any problems, let your doctor know.

Another LH blocker called histrelin acetate (Vantas®) may sometimes be used to treat advanced prostate cancer. It’s given just once a year as an implant under the skin. It’s approved for use in the NHS in Scotland by the SMC (Scottish Medicines Consortium). However, it is not widely available on the NHS in England, Wales and Northern Ireland.

GnRH blockers

These work by blocking the messages from the brain to the testicles, telling them to make testosterone. The cancer cells then grow more slowly or stop growing altogether, and the cancer may shrink in size. GnRH blockers work more quickly than LH blockers and don’t cause tumour flare.

There is currently only one GnRH blocker available and it is called degarelix (Firmagon®). This is given as a liquid injected under the skin (subcutaneously) of the tummy usually every month.

Anti-androgens

Some hormonal therapy drugs work by attaching themselves to proteins (receptors) in the cancer cells. This blocks the testosterone from acting on the cancer cells. These drugs are called anti-androgens and are given as tablets.

Commonly used anti-androgens are:

Anti-androgen tablets are occasionally used on their own as hormonal treatment for prostate cancer. They are also given for one or two weeks before and after the first injection of an LH blocker. This helps to prevent tumour flare.

Back to Hormonal therapies explained

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.