Hormone therapy for metastatic prostate cancer

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Hormone therapy is the main treatment for metastatic prostate cancer. It can control the cancer for many years. Most men with metastatic prostate cancer will stay on hormone therapy. 

How does hormone therapy work? 

The male hormone testosterone can help prostate cancer cells to grow and spread. Hormone therapy can slow down the growth of prostate cancer by reducing the amount of the male hormone testosterone in your body by: 

  • Interfering with the production of testosterone 
  • Stopping the testosterone from getting to the prostate cancer cells 

How is hormone therapy given?

Injections
These stop your body making testosterone. The drugs are injected under your skin or into a muscle. Injections can be given once a month or every 3, 6 or 12 months.  Examples include goserelin (Zoladex®), leuprorelin (Prostap®), triptorelin (Decapeptyl®), leuprorelin acetate (Eligard®) and degarelix (Firmagon®). You might find that your testicles become smaller in size once you have been on hormone therapy injections for a while. Read more about hormone therapy side-effects.

Tablets
Hormone therapy tablets can stop testosterone being produced. For example, abiraterone (Zytiga®). Others block the effect of testosterone so it doesn’t help the prostate cancer cells to grow. For example, enzalutamide (Xtandi®) and bicalutamide (Casodex®).

Injections and tablets together
Using injections and tablets together is known as combination therapy or complete androgen blockade (CAB) or maximum androgen blockade (MAB). It can prevent testosterone being made in your testicles. It also stops the small amount of testosterone made by your adrenal glands from working on prostate cancer cells.

Tumour flare

Your body can respond to some hormone therapies by trying to make more testosterone. This is called ‘tumour flare’. Tablets called anti-androgens taken before and during treatment can stop this happening. 

Tablets

Hormone therapy tablets can stop testosterone being produced. For example, abiraterone (Zytiga®). Others block the effect of testosterone so it doesn’t help the prostate cancer cells to grow. For example, enzalutamide (Xtandi®) and bicalutamide (Casodex®).

Injections and tablets together

Using injections and tablets together is known as combination therapy or complete androgen blockade (CAB) or maximum androgen blockade (MAB). It can prevent testosterone being made in your testicles. It also stops the small amount of testosterone made by your adrenal glands from working on prostate cancer cells.

Will I get side-effects?

Not everyone gets side-effects. The most common side-effects are:

  • Change in sexual function
  • Hot flushes
  • Weight gain
  • Fatigue
  • Mood changes
  • Breast swelling and tenderness
  • Osteoporosis or bone thinning

Ask your doctor about any likely side-effects of your treatment and ways to prevent them. For example, exercise can help with many of the side-effects, such as weight gain, bone thinning, mood changes and fatigue. Read more about hormone therapy side-effects and ways to cope. 

How will I know if it’s working? 

You will have regular check-ups to see how well the treatment is working. You doctor will also do tests:

PSA level
Your PSA level usually falls when you start hormone therapy. If your PSA level goes up on a few occasions, it may be a sign that your hormone therapy is not keeping the cancer under control as well as it had been.

Testosterone level
Your doctor may test the level of testosterone in your body, to check the hormone therapy is adequately blocking its production.

Other treatment options

If your treatment isn’t controlling the cancer as well as before, your doctor may give you extra treatments with your hormone therapy or you may have a different treatment such as chemotherapy, radiotherapy, steroids and / or bone strengthening drugs. 

For more information

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