Prostate Cancer Health Center

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Alternatives to conventional hormone therapy

• Intermittent androgen deprivation (IAD). This involves cycles of hormone therapy medicines. Taking breaks during hormone therapy gives men the chance to recover their ability to function sexually. It also gives relief from the other side effects of hormone therapy, including hot flashes and the effects on energy as well as bone and muscle mass. The long-term survival outcome of IAD compared to conventional ADT is not yet known.
• Antiandrogen monotherapy. Antiandrogens are medicines that block the action of androgens in the body. When used alone, antiandrogens usually don't work as well as other hormone therapy. And they may increase the chance of death if taken by men who have localized cancer and who are using active surveillance.⁴
• Oral sequential hormone therapy. In this treatment, medicines that block the action of androgens in the body are taken with medicines that stop other changes that happen with androgens. Most studies have used finasteride (Proscar) or dutasteride (Avodart). This therapy usually causes a steady, painful increase in the size of breast tissue. This side effect may be prevented by radiation to the breasts before starting this hormone therapy. Or surgery may be needed to remove the extra breast tissue. Early studies have shown good results. But it is not yet known whether oral sequential hormone therapy helps men who have prostate cancer live longer.

Side effects of hormone therapy

The side effects of hormone therapy increase with the length of time that a man uses this therapy. Some of the side effects from hormone therapy will go away when a man who is taking medicine finishes his hormone therapy. For a man who has an orchiectomy, the side effects of sterility and loss of sexual interest are immediate and permanent.

Side effects of hormone therapy may include:

• Thin or brittle bones (osteoporosis).
• Increased body mass (BMI) and higher levels of fats in the blood.
• Reduced muscle mass.
• Low red blood cell count (anemia) and fatigue.
• Increased risk for diabetes and heart disease.

Other side effects may include hot flashes, erection problems and reduced sex drive, breast enlargement, and cognitive impairment. Some men may experience depression.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems).

Long-term side effects of hormone therapy

The long-term side effects of hormone therapy, even for men taking medicine, are not known. But hormone therapy has been linked to a higher risk for diabetes and cardiovascular disease.¹

One large study found that hormone therapy appears to be linked to a higher risk of death from heart problems in men who had surgery for localized prostate cancer.³

Hormone therapy and quality of life

The side effects of hormone therapy for prostate cancer often affect a man's quality of life. But there are treatments that can help with some of the side effects listed above. For example, exercise can help counteract the loss of muscle mass and will help with fatigue. There are medicines that can help with hot flashes, nausea, diarrhea, and bone loss. Treatments are available for erection problems and a reduced sex drive. Radiation before hormone therapy may help prevent breast enlargement. For men with depression, counseling and medicine may help. For more information, see the topic Depression.

Above all, talk with your doctor about any of the symptoms you have while you are taking hormone therapy. Your doctor may know about a local support group for men who have prostate cancer.