Hormone therapy

Prostate cells, including cancerousMalignant, a tumour that may invade surrounding tissues or spread to distant parts of the body. ones, need the male sex hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. testosterone to grow. The aim of hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. therapy is to reduce the amount of testosterone in the body, so that cellThe basic unit of all living organisms. growth in the prostate slows down. This can slow or shrink cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. growth. This treatment also reduces the chances of the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. returning in the treatment of localised or locally-advanced prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., and is used to treat metastatic prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body..

Recommended:

  • If you have localised prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., where it is given in addition to surgery or radiotherapy
  • In locally-advanced prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., where it is given before or after radiotherapy or surgery
  • In metastatic prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., where hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. therapy is the main treatment option and usually starts as soon as the condition is diagnosed.

Hormone therapy can be in the form of:

  • Medical hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. therapy: tablets or injections
  • Surgical hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. therapy: removal of the testicles (orchidectomy).

Research is under way to find out when it is best to give hormonal therapy in the treatment of localised prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body., and for how long.

Advantages of hormone therapy

  • Good for relieving symptoms such as bone pain and problems passing urine.

Disadvantages

  • Will not cure cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. but can keep it at bay for years
  • The effectiveness of a drug can become reduced and a change or discontinuation of medication may then be needed.

Hormone-refactory prostate cancer

Over time, the effectiveness of hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. therapy can wear off. When this happens, the cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. is said to be hormone-refractoryUnresponsive to hormone therapy., sometimes called HR prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body..

Hormone-refractory prostate cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. is quite common. Usually, patients go on to be treated with medications called bisphosphonatesA family of drugs that prevent the break down of bone by cells called osteoclasts., radiotherapy The treatment of disease using radiation.(for pain relief) or chemotherapyThe use of chemical substances to treat disease, particularly cancer..

Medical hormone therapy

Two main types of medication are used in medical hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. therapy. They can be used on their own or in combination:

  • Pituitary down-regulators, also called gonadotropin-releasing hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. (GnRH) analogues or luteinising-hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. releasing hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. (LHRH) analogues, are given by injection and prevent the pituitary glandAn organ with the ability to make and secrete certain fluids. in the brain from triggering testosterone production by the testicles
  • Anti-androgens, taken as tablets, block the action of testosterone on cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. cells.

See the practical help page Hormone treatment - making a decision.

Pituitary down-regulators

These medications include:

  • Goserelin acetate, usually given as a pellet injected under the skin of the abdomenThe part of the body that contains the stomach, intestines, liver, gallbladder and other organs.
  • Leuprorelin and triptorelin given as a liquid injected under the skin or into a muscleTissue made up of cells that can contract to bring about movement..

Injections are either given once a month or every three months.

Anti-androgens

Commonly used anti-androgens are:

  • Flutamide
  • Bicalutamide
  • Cyproterone acetate.

These medications are taken daily.

Advantages of medical hormone therapy

  • Good for relieving symptoms such as bone pain and problems passing urine.

Disadvantages of medical hormone therapy

  • Will not cure cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. but can keep it at bay for years
  • At first, the injections of pituitary down-regulators may make your symptoms worse, an effect sometimes called a tumour flare. Anti-androgenA type of steroid hormone that stimulates male development. Testosterone is an androgen. tablets can be given to help with this
  • Possible side effects of medical hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. therapy include: problems getting an erectionThe enlarged, rigid state of the penis during sexual arousal., loss of sexual desire, hot flushes, sweating, fatigue and weight gain.

Surgical hormone therapy

Surgical hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. treatment consists of the complete removal of the testicles from the scrotum, called orchidectomy, or removal of the part of the testicles that produces testosterone, called subcapsular orchidectomy.

Recovery from the operation tends to be quick and no further hormoneA substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. therapy is needed.

The operation can be done using a general or local anaestheticA medication that reduces sensation in a part of the body. and will not normally need a stay in hospital. It is possible to replace the testicles with silicone implants that look and feel the same. This operation can be upsetting for men, but sharing your feelings with others can help.

Advantages of surgical hormone therapy

  • A single treatment that can remove the need to take tablets or have injections.

Disadvantages of surgical hormone therapy

  • Will not cure cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. but can keep it at bay for years
  • Causes swelling and bruising of the scrotum following surgery
  • Irreversible
  • Possible side-effects, which may be permanent, include: problems getting an erectionThe enlarged, rigid state of the penis during sexual arousal., loss of sexual desire, hot flushes and sweating.