Prostate cancer cells need male hormones called androgens to grow. Testosterone and DHT (dihydrotestosterone) are androgens. Most androgens are made in the testicles. Hormone therapy keeps prostate cancer cells from using androgens. This can shrink the tumors and/or slow their growth.
When It's Used
Hormone therapy is a common treatment for all stages of prostate cancer. You might get it along with other treatments like radiation and chemotherapy.
Doctors often use it when:
- Your cancer has spread too far outside your prostate to be cured with surgery or radiation.
- Your tumor is big. Hormone therapy can shrink it before you get radiation. This helps the radiation work better.
- The cancer comes back after surgery or radiation.
- There’s a high risk that your cancer will come back after radiation. In this case, your doctor might use hormone therapy along with radiation.
When you have advanced prostate cancer, the cancer has spread to another part of your body. It may be in your lymph nodes, or in another organ like your bones or lungs. Hormone therapy can help control it and ease the symptoms it causes.
How It Works
Hormone therapy stops your body from making androgens or keeps the prostate cancer cells from using these hormones to grow.
Hormone therapy doesn't cure prostate cancer by itself. But it can help you feel better and live longer.
Types of Hormone Therapy for Prostate Cancer
There are many kinds of hormone therapy. Sometimes two or more types are used together. These are the most common ones:
Androgen deprivation therapy (ADT) keeps your testicles from making androgens. It’s often the first kind of hormone therapy you get for prostate cancer. Doctors can do it any of these ways:
- Orchiectomy is surgery to remove your testicles. It’s also called surgical castration.
- LHRH (luteinizing hormone-releasing hormone) agonists are drugs that stop your testicles from making androgens. You get them in shots or as implants put under your skin.
- LHRH antagonists are another group of drugs that keep your testicles from making androgens. They can be taken as pills or given as shots.
Using drugs to stop your testicles from making androgens is called medical castration. Both methods work equally well, but surgical castration is permanent.
Androgen receptor blockers, or anti-androgen drugs, keep androgens from working. They block the proteins on cells where these hormones attach. So even though there are androgens in your body, the cancer cells can’t use them as fuel to grow. You take these drugs as pills. They’re usually added to ADT if it stops working.
Androgen synthesis inhibitors are drugs that keep all parts of your body from making androgens. This includes your adrenal glands and even prostate cancer cells, both of which can make small amounts of androgens. (Even these amounts may be enough to fuel the growth of cancer cells.) You take these drugs as pills.
Deciding Which Option Is Best for You
Your treatment team will talk with you about:
- Your hormone therapy options
- The goal of hormone treatment
- When to start it
- What treatment will be like
- How long it will last
- Possible side effects
There’s no one best way to use hormone therapy. Your doctor will consider your cancer stage (how big your tumor it is) and grade (how fast it’s growing), as well as your age, preferences, and overall health.
Side Effects of Hormone Treatment
The loss of testosterone that hormone therapy causes leads to side effects in nearly all men. These can include:
- Trouble getting an erection (erectile dysfunction, or ED)
- Less interest in sex (loss of libido)
- Shrinkage of your testicles and penis
- Breast growth (gynecomastia) and tenderness
- Hot flashes
- Muscle loss
- Thinking changes and memory loss
- Weight gain
- Heart problems
- High cholesterol levels
- Thinning of bones (osteoporosis)
- Depression and mood swings
Other side effects depend on the type of hormone therapy you get. For instance, anti-androgens tend to have less effect on your sex life. But they can cause diarrhea, tiredness, and liver problems.
Most side effects go away over time after treatment ends. That's not the case with testicle-removal surgery, though. Its side effects are permanent.
Your doctor can treat many of the side effects. And there are things you can do to help prevent some of them. You might take statins to help control your blood cholesterol, or calcium supplements to help with bone problems.
Talk to your treatment team so you know what to expect when you're on hormone therapy. Tell them about any changes you notice. Treating side effects right away can keep them from getting worse.
What to Expect
You might get hormone therapy in your doctor’s office, in an outpatient treatment center, or as pills you take at home.
Your treatment team will watch you closely while you're having the treatment. They'll do blood tests to check your PSA levels. That's important because, over time, hormone therapy tends to stop working.
If your PSA level starts to steadily go up over time, the cancer cells may have become able to grow without androgens. This is called castration-resistant prostate cancer (CRPC). Your doctor might change or stop your hormone therapy, or suggest a different kind of treatment.
Your doctor will also do blood tests to check your testosterone levels, organ function, and overall health. You might get other tests to watch for certain treatment side effects. For instance, bone density scans can be used to watch for osteoporosis.
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American Society of Clinical Oncology: “Prostate Cancer: Types of Treatment,” “Prostate Cancer: Coping with Treatment.”
American Cancer Society: “Hormone Therapy for Prostate Cancer.”
Cancer Research UK: “What is advanced prostate cancer?” “Hormone therapy for advanced prostate cancer,” “Making decisions about treatment for advanced cancer.”
Prostate Cancer Foundation: “Hormone Therapy for Prostate Cancer.”
National Cancer Institute: “Hormone Therapy for Prostate Cancer.”
National Comprehensive Cancer Network: “Prostate Cancer Version 2.2022—November 30, 2021.”
UCLA Health: “Hormone Therapy and Prostate Cancer.”