Hormone therapy for prostate cancer

Overview

Hormone therapy for prostate cancer is treatment to stop the male hormone testosterone from reaching prostate cancer cells in your body. Hormone therapy for prostate cancer is also known as androgen deprivation therapy.

Most prostate cancer cells rely on testosterone to help them grow. Hormone therapy cuts off the supply of testosterone or stops testosterone from reaching the cancer cells, causing cancer cells to die or to grow more slowly.

Hormone therapy for prostate cancer may involve medications or possibly surgery to remove the testicles.

Why it's done

Hormone therapy for prostate cancer is used to stop your body from producing the male hormone testosterone, which fuels the growth of prostate cancer cells.

Your doctor may recommend hormone therapy for prostate cancer as an option at different times and for different reasons during your cancer treatment.

Hormone therapy can be used:

• In advanced (metastatic) prostate cancer, to shrink the cancer and slow the growth of tumors — which might relieve signs and symptoms
• In prostate cancer that recurs after treatment
• In locally advanced prostate cancer, to make external beam radiation therapy more effective
• In those with a high risk of recurrence after initial treatment, to reduce that risk

Risks

Side effects of hormone therapy for prostate cancer can include:

• Loss of muscle mass
• Increased body fat
• Loss of sex drive
• Erectile dysfunction
• Bone thinning, which can lead to broken bones
• Hot flashes
• Decreased body hair, smaller genitalia and growth of breast tissue
• Fatigue
• Changes in behavior
• Problems with metabolism

Intermittent dosing

To minimize the side effects of hormone therapy medications, your doctor may recommend you take them only until prostate cancer responds to the treatment. You might need to resume these medications if the disease recurs or progresses.

Early research shows this intermittent dosing of hormone therapy medications may reduce the risk of side effects. However, additional studies are needed to determine the long-term survival benefits of intermittent therapy.

Your doctor might suggest intermittent dosing if:

• You have an elevated level of prostate-specific antigen (PSA) in your blood, but no other evidence of spreading cancer
• There is evidence of spreading cancer, but survival is a secondary factor for you compared with quality of life

How you prepare

As you consider hormone therapy for prostate cancer, discuss your options with your doctor. Approaches to hormone therapy for prostate cancer include:

• Medications that stop your body from producing testosterone. Certain medications — known as luteinizing hormone-releasing hormone (LHRH) or gonadotropin-releasing hormone (GnRH) agonists and antagonists — prevent your body's cells from receiving messages to make testosterone. As a result, your testicles stop producing testosterone.
• Medications that block testosterone from reaching cancer cells. These medications, known as anti-androgens, usually are given in conjunction with LHRH agonists. That's because LHRH agonists can cause a temporary increase in testosterone before testosterone levels decrease.
• Surgery to remove the testicles (orchiectomy). Removing your testicles reduces testosterone levels in your body quickly and significantly. But unlike medication options, surgery to remove the testicles is permanent and irreversible.

What you can expect

LHRH agonists and antagonists

LHRH agonist and antagonist medications stop your body from producing testosterone.

These medications are injected under your skin or into a muscle monthly, every three months or every six months. Or they can be placed as an implant under your skin that slowly releases medication over a longer period of time.

These medications include:

• Leuprolide (Lupron, Eligard)
• Goserelin (Zoladex)
• Triptorelin (Trelstar)
• Degarelix (Firmagon)

Testosterone levels may increase briefly (flare) for a few weeks after you receive an LHRH agonist. Degarelix is an exception that doesn't cause a testosterone flare.

Decreasing the risk of a flare is particularly important if you are experiencing pain or other symptoms due to cancer because an increase in testosterone can worsen those symptoms. To decrease the risk of a flare, your doctor might recommend you take an anti-androgen either before or along with an LHRH agonist.

Anti-androgens

Anti-androgens block testosterone from reaching cancer cells. These oral medications are usually prescribed along with an LHRH agonist or before taking an LHRH agonist.

Anti-androgens include:

• Bicalutamide (Casodex)
• Nilutamide (Nilandron)
• Flutamide

Orchiectomy

You'll be given anesthetics to numb your groin area. The surgeon makes an incision in your groin and extracts the entire testicle through the opening, then repeats the procedure for your other testicle. Prosthetic testicles can be inserted if you choose.

All surgical procedures carry a risk of pain, bleeding and infection. Orchiectomy is usually performed as an outpatient procedure and doesn't require hospitalization. Typically, no additional hormone therapy is required after orchiectomy.

Other medications

When prostate cancer persists or recurs despite hormone therapy, other medications can be used to block testosterone in the body. Each medication targets testosterone in the body in a different way.

These other medications include:

• Abiraterone (Zytiga)
• Corticosteroids, such as prednisone
• Enzalutamide (Xtandi)
• Ketoconazole

These other medications are generally reserved for men with advanced prostate cancer that no longer responds to other hormone therapy treatments.

Results

Hormone therapy for prostate cancer doesn't cure the disease.

Almost all prostate cancers that require hormone therapy eventually recur or progress despite hormone therapy. But hormone therapy may manage prostate cancer by slowing its growth for months or years.