Hormonal therapies for prostate cancer

Hormonal therapy may be given to treat early (localised) prostate cancer. It may be used to treat men who aren’t well enough to have surgery or radiotherapy, or men who have been monitored with watchful waiting and the cancer progresses. It can also be used with radiotherapy.

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 hormonal therapy. These include; erection problems, bone thinning, hot flushes, weight gain and breast swelling.

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

Hormonal therapy

Hormonal therapy may be given to treat men with early (localised) prostate cancer:

  • if they aren’t well or fit enough for surgery or radiotherapy
  • if their cancer starts to progress while they are being monitored using watchful waiting
  • if they are having radiotherapy.

It may be given before radiotherapy to help shrink the tumour. This is known as neo-adjuvant treatment. It may also be given during or after radiotherapy to reduce the chance of the cancer coming back. This is known as adjuvant treatment.

If you are having hormonal therapy, your specialist will tell you when you will have it and how long for.

Hormonal therapies can be given as injections or tablets.


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 and include:

Goserelin is given as 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. The 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:

  • flutamide (Chimax®, Drogenil®) – this is taken three times a day
  • bicalutamide (Casodex®) – this is taken once daily.

Anti-androgen tablets can be given alone. They may be 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.

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 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.


  • 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.