Hormonal therapies for locally-advanced prostate cancer

Hormonal therapy is a common treatment for locally advanced prostate cancer. You may have it before radiotherapy to help reduce the size of the tumour. It may also be given with or after radiotherapy treatment to reduce the risk of the cancer returning. Sometimes it’s used on its own. Your doctor will tell you how long you’ll need the treatment for.

You can have treatment in the following ways:

  • Injections – these drugs switch off the production of male hormones from the testicles by reducing a hormone from the pituitary gland. You’ll have a pellet or liquid injected under your skin.
  • Tablets – drugs called anti-androgens attach themselves to proteins on the surface of cancer cells. This blocks the testosterone from entering the cancer cells. These may be used on their own or before injections.

You may have side effects during or after your hormonal therapy treatment. These include; erection problems, bone thinning, hot flushes, weight gain and breast swelling.

Your doctor will discuss the possible advantages and disadvantages of treatment with you.

Hormonal therapy

Hormonal therapy is usually given with radiotherapy to locally advanced prostate cancer, but it may be given on its own.

It may be given before radiotherapy to help shrink the tumour. This is known as neo-adjuvant treatment.

It may be given during or after radiotherapy to reduce the chance of the cancer coming back. This is known as adjuvant treatment.

Hormonal therapies can be given as injections or tablets.


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

Goserelin is a small pellet which is injected under the skin of the tummy (abdomen). Leuprorelin and triptorelin are given as liquids which are injected under the skin or into a muscle. Injections are given either monthly or every three months.


Other drugs work by attaching themselves to proteins (receptors) on the surface of the cancer cells. This blocks the testosterone from going into the cancer cells. These drugs are called anti-androgens.

Commonly used anti-androgens are:

Anti-androgen tablets are usually given for one or two weeks before and after the first injection of a leutenising hormone blocker. This prevents tumour flare, which is when symptoms from the prostate cancer get worse after the first dose of treatment.

Duration of hormone treatment

Your doctor will advise how long you should have the hormonal therapy for. It may be stopped after the radiotherapy or continued for a period of 2–3 years, depending on the extent of the tumour and the start of the treatment.

Some men may be treated with intermittent hormonal therapy, which means that the treatment is started and stopped depending on their PSA blood test result. Intermittent therapy causes fewer side effects but you will need to have your PSA regularly monitored. It’s only suitable for some men.

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 (goserelin and leuprorelin) 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. 

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.

Advantages of hormonal therapy

  • It can slow or stop the growth of cancer cells for many years. 
  • It doesn’t involve surgery or radiation, so there’s little risk of bowel or bladder problems.

Disadvantages of hormonal therapy 

  • It won’t get rid of all the cancer cells if it’s the only treatment given. 
  • It can cause a range of side effects that include erection problems (erectile dysfunction) and a lowered sex drive, hot flushes and breast swelling.

Back to Hormonal therapies explained

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 locally advanced prostate cancer.