About hormone therapy for prostate cancer

The type of hormone therapy you may be offered depends on your type of prostate cancer, if you’ve had any other treatments, and personal preferences.

Testosterone is a normal hormone your body produces, mostly in the testicles. It plays a role in appearance, sexual development, sperm production, and sex drive. Testosterone impacts your erections and can affect prostate growth. It’s a critical hormone that your body uses for many other functions, including building your muscle and bone mass.

But there is also an important link between testosterone and prostate cancer. Prostate cancer cells use testosterone to grow and spread; think of it as ‘fertilizer’ for the cancer. Lowering testosterone in the body (either with surgery or medications) can help kill or slow down some prostate cancer cells.

The type of hormone therapy you may be offered depends on your type of prostate cancer, personal preferences, and if you’ve had any other treatments. In some countries, the type of health plan you have can also have an influence.

These hormone therapies lower the amount of testosterone made by your testicles. They are usually given as injections or put under the skin as an implant which releases the medicine slowly over time.

Speak to your doctor about what your exact treatment plan might be.

Both LHRH agonists and GnRH antagonists are commonly used to treat prostate cancer that has spread to other parts of the body like bones and lymph nodes (advanced prostate cancer). They can also be used along with radiation therapy in less advanced prostate cancer.

Anti-androgens work by preventing testosterone from getting to and acting on the prostate cancer cells. They are usually not used on their own to treat prostate cancer but combined with other hormone therapies or treatments. Both older and newer types of anti-androgens may be available, depending on where you live.

Some anti-androgens also work by preventing cells (including prostate cancer cells) from making testosterone. This includes:

During an orchiectomy, both testicles are removed with surgery so there are no testicles to produce testosterone.

An orchiectomy may be offered to men who need long-term hormone therapy.

The surgery is irreversible, meaning you can’t undo it later. So, if you’re considering an orchiectomy, your doctor may suggest trying other forms of hormone therapy first to see how your body responds to low levels of testosterone.

With intermittent hormone therapy, hormone treatment will be paused once your prostate specific antigen (PSA) levels drop and stay stable. Some doctors call this the “off” phase. If PSA levels and testosterone begin to rise, therapy will be started again. One major benefit of this type of treatment is that your side effects might be relieved during the off times.

Hormone therapy may be used at many points during the management of prostate cancer. It may also be used alongside other treatments for prostate cancer. On its own, it doesn’t cure cancer. For men with advanced prostate cancer, hormone therapy is used to try and keep the cancer from growing, which hopefully improves your quality of life and how long you may live.

If you have localized prostate cancer (early-stage cancer that has not spread outside the prostate gland), hormone therapy can be used to increase the effectiveness of your treatment. It may be used with the following treatments:

With locally advanced prostate cancer (when cancer has spread outside the prostate to the immediate surrounding area in the pelvis), hormone therapy is offered before, after, and during radiation therapy to increase its effectiveness.

With advanced prostate cancer (when cancer has spread to organs, bones, and lymph nodes outside the pelvis), hormone therapy is likely to be a life-long treatment. While advanced prostate cancer cannot be cured, the disease may be controlled using hormone therapy. Prostate cancer treated with hormone therapy may become resistant to this treatment over years and you may need other treatments.

During treatment, you’ll have regular checks of your prostate specific antigen (PSA) levels to see how well it’s working. You may also have your testosterone levels checked regularly, to make sure the hormone therapy is lowering your testosterone. If your PSA level goes down, it can mean your treatment is working as planned. The speed at which it falls and how much it falls will be different from one individual to another.

However, if your PSA levels keep rising, your doctor will talk to you about other treatment options. Consistently rising PSA levels can mean the hormone therapy is not working well.

Because hormone therapy lowers your testosterone levels, it’s normal to experience some symptoms or changes to your body during treatment. These changes are normal to go through and you should expect them, but just how much some of them affect you may still come as a surprise. If you’re having hormone therapy and another treatment, it’s important to know the side effects of the other treatment, too.

You might also experience changes to your body, relationships, and libido (overall sexual desire) that could affect your sex life. Learn more about sex life changes after hormone therapy.

Hormone therapy can leave you feeling like you don’t even recognize yourself anymore and questioning your masculinity.

You might experience emotions differently than before, like having mood swings and feeling more teary-eyed than usual. All of this is normal. And sometimes, just knowing that what you’re experiencing is a side effect of your hormone therapy can help. Your body will also go through changes like low energy, growth in your breasts, extra weight, less muscle, and decreased stamina.

All these changes to your body and mind can leave you worn down and feeling stressed. Some men also experience depression and anxiety, and even have trouble concentrating or remembering things. If you have a history of depression and anxiety, it's important to let your care team know. They can help choose the best treatment options to support you and your mental wellbeing.

You’re not alone, and this is a critical moment to reach out for any help you need. There are people (like friends, family, support groups or your care team) that could provide support and help you to manage the impact of those side effects on your life.

Speak to your healthcare team or a counselor if you're feeling overwhelmed and they can find ways to help.

When considering hormone therapy and how you'll manage side effects, it’s important to have open conversations with your care team. There are ways to manage side effects and improve your quality of life. Learning more about what to expect, maintaining a healthy lifestyle, and talking to your care team will play a big part in how you feel before, during, and after hormone therapy.

In addition to your doctors, nurses, and other specialists, consider including a dietitian and exercise physiologist. These diet and exercise healthcare professionals will help you to manage side effects proactively. Good exercise and nutrition can help reduce side effects of prostate cancer treatment and help you feel better during treatment.

Before visiting your care team, it's useful to make a list of all your questions. You can write them down, take notes on your phone, whatever works best for you. Discussing these questions with your care team and your oncologist (cancer doctor) will help you select the treatment that’s right for you.

For more information on how to navigate the side effects of prostate cancer treatment you could participate in workshops or info sessions at your local cancer center.