About hormone therapy for prostate cancer

Man walking outside

Hormone therapy, also known as androgen deprivation therapy (ADT), can slow down prostate cancer in one of two ways:

  • Preventing your body from making testosterone.

  • Blocking testosterone from reaching the prostate cancer cells.

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.

Why is testosterone so important to prostate cancer?

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.

What kinds of hormone therapies are used to lower testosterone?

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.

Medications to reduce testosterone production in the testicles

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.

    Depending on the type, they can be given:

  • Once a month.

  • Once every 3, 4, or 6 months.

  • Once a year.

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

LHRH stands for luteinizing hormone-releasing hormone. These medications prevent your testicles receiving the message from your brain (with LHRH being the messenger) to produce testosterone.

    Examples of LHRH agonists include:

  • Leuprolide (Lupron, Eligard)

  • Triptorelin (Trelstar)

  • Buserelin (Suprefact)

Histrelin (Vantas) and goserelin (Zoladex) work in a similar way but are implants.

GnRH stands for gonadotropin-releasing hormone. Similar to LHRH agonists, these medications also prevent the testicles from making testosterone.

    Example of a GnRH antagonist:

  • Degarelix (Firmagon)

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 (testosterone blockers)

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.

    Older anti-androgens include:

  • Nilutamide (Anandron or Nilandron)

  • Cyproterone acetate (Androcur or Cyprostat)

  • Flutamide (Drogenil or Eulexin)

  • Bicalutamide (Cosudex or Casodex)

    Newer anti-androgens include:

  • Enzalutamide (Xtandi)

  • Apalutamide (Erleada or Erlyand)

  • Darolutamide (Nubeqa)

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

  • Abiraterone acetate (Zytiga).

Orchiectomy (surgery to remove the testicles)

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.

Intermittent hormone therapy

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.

When is hormone therapy used to treat prostate cancer?

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:

  • Radiation therapy (often)

  • Chemotherapy (usually)

  • Surgery (rarely)

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.

How do you know if hormone therapy for prostate cancer is working?

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.

Are there any side effects of hormone therapy for prostate cancer?

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.

    Possible side effects of hormone therapy can include:

  • Fatigue (feeling more tired).

  • Loss of muscle mass and possibly strength.

  • Increase in body fat.

  • Thinning of the bones.

  • Decrease in body hair.

  • Larger or tender breasts.

  • Changes in your metabolism.

  • Changes in your mood.

Changes to your sex life

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.

Body and mood changes while on hormone therapy for prostate cancer

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.

You can also contact Beyond Blue for caring and confidential support, 24 hours a day.

Talk to your care team about managing the side effects of hormone therapy for prostate cancer

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.

Who's on your care team?

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.

What should I talk to my team about?

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.

    Here are some questions to ask your care team:

  • What type of hormone therapy are you recommending for me and why?

  • How do I know if my hormone therapy has worked or if it needs to be continued?

  • How long will the side effects of hormone therapy for prostate cancer last?

  • What will happen if I stop my treatment?

  • Are there any clinical trials I can take part in?

  • Are there other treatments I’ll need to stop my cancer from growing or if hormone therapy alone becomes ineffective?

  • What happens if my cancer comes back?

  • Who will be my key contact if I need assistance during this time?

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.