Hormonal therapy for early prostate cancer

You may be given hormonal therapy along with radiotherapy or brachytherapy. It makes your treatment work better. You may have it for:

  • a few months before radiotherapy to shrink the cancer
  • a few months or longer after radiotherapy to reduce the risk of the cancer coming back.

Men with high risk prostate cancer may be given hormonal therapy for up to 3 years.

If you are having watchful waiting and the cancer starts to grow, you may have hormonal therapy on its own. Some men may decide to have hormonal therapy on its own. This is instead of having surgery or radiotherapy. It may be because they are not well enough for these treatments or do not want to have them.

There are different types of hormonal therapy that may be used. Your doctor or nurse will explain the drug that is most suitable for your situation. You may be given hormonal injections or hormonal tablets. Sometimes you have both for a short time.

Hormonal therapy

Prostate cancer needs the hormone testosterone to grow. Testosterone is mainly made by the testicles. Hormonal therapies lower your testosterone levels or stop it reaching the prostate cancer cells.

Testosterone is important for:

  • sex drive (libido)
  • getting an erection
  • facial and body hair
  • muscle development and bone strength.


Hormonal therapy with radiotherapy

Doctors often advise having hormonal therapy along with radiotherapy (including brachytherapy), to make treatment more effective. This is usually if you have intermediate-risk or high-risk early prostate cancer. You may also have hormonal therapy before treatment with HIFU.

You may have hormonal therapy during radiotherapy and either:

  • a few months before radiotherapy, to shrink the cancer and make treatment more effective (called neo-adjuvant treatment)
  • after radiotherapy, to reduce the chance of the cancer coming back (called adjuvant treatment).

Your doctor will advise when and how long you should have the hormonal therapy for. If you have intermediate-risk prostate cancer, you may have hormonal therapy for up to a few months after treatment finishes. Men with high-risk prostate cancer may be advised to have hormonal therapy for 2 to 3 years after radiotherapy finishes.


Hormonal therapy on its own

If your doctors are using the watchful waiting approach and the cancer starts to grow, you may have hormonal therapy on its own.

Some men decide to have hormonal therapy on its own instead of with surgery or radiotherapy. Unlike these treatments, hormonal therapy on its own will not get rid of all the cancer cells. Doctors do not usually advise this. But it may be suitable if you:

  • are not well enough to have surgery or radiotherapy
  • do not want these treatments.

Hormonal therapy can slow down or stop the cancer cells growing for many years. Not having surgery or radiotherapy means you avoid the side effects of these treatments. Hormonal therapy can also cause side effects. It is important to talk to your doctor or nurse about it before you decide.


Types of hormonal therapy

There are different types of hormonal therapy that may be used. Your doctor or nurse will explain the drug that is most suitable for your situation.

LHRH agonists

The pituitary gland in the brain makes a hormone called luteinising hormone (LH). This hormone tells the testicles to make testosterone. LHRH agonists interfere with this action and stop the testicles making testosterone. You have them as an implant injection or an injection under the skin.

The commonly used LHRH agonists are:

A nurse or doctor at your GP practice or hospital can give you these drugs.

Goserelin is given as an injection of a small pellet (implant) under the skin of the tummy (abdomen). The drug is released slowly as the pellet dissolves. You have it every 4 weeks. You can also have it as a longer-acting injection every 12 weeks.

Leuprorelin and triptorelin are given as an injection under the skin or into a muscle. You have these monthly, or every 3 to 6 months.

The first time you have one of these drugs, it can cause a temporary increase in testosterone. This can make any symptoms worse for a short time. This is sometimes called tumour flare. To prevent this, your doctor usually asks you to take an anti-androgen drug. You take it for a short time before and after starting the LHRH agonist.

Anti-androgen drugs

These drugs stop testosterone from reaching the cancer cells. You take them as tablets.

Some men may have anti-androgen drugs with radiotherapy instead of having an LHRH agonist with radiotherapy. Or you may have an anti-androgen before and after the first injection of a LHRH agonist, to prevent any symptoms getting temporarily worse (tumour flare).

Anti-androgen drugs include:

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