Hormone therapy for locally advanced prostate cancer
Hormone therapy is the main treatment for prostate cancer that has spread outside your prostate gland. Prostate cancer depends on the male hormone testosterone to grow. By reducing the amount of testosterone in your body the growth of cancer cells can be slowed or stopped.
Hormone therapy aims to shrink the cancer and improve symptoms like poor urine flow. Hormone therapy can work well for years. While you are having hormone therapy you will have regular check-ups and your doctor will watch your response to treatment. He or she will check any symptoms and examine you as well. Your PSA level will be measured too. This test is used as a guide to the success of the treatment. Hormone therapy is frequently used alongside radiotherapy for locally advanced prostate cancer.
How does hormone therapy work?
Hormones are made naturally in your body and control how normal cells grow and work. Testosterone is a male hormone, or androgen, that controls the growth and development of male sexual organs and also your sex drive (libido).
Most testosterone is made in your testicles and a small amount is made by your adrenal glands near your kidneys. The growth of prostate cancer cells can be driven by testosterone. By reducing the amount of testosterone in your body, or by blocking it from getting to the prostate cancer cells, prostate cancer can be slowed down or stopped.
Hormone therapy used in the treatment of locally advanced prostate cancer can shrink prostate cancer cells both in your prostate gland and anywhere else in the surrounding area. Another name for hormone treatment is androgen deprivation therapy. Androgens are male hormones, so androgen deprivation means stopping or blocking the action of male hormones in your body.
What are the types of hormone therapy?
There are three main types of hormone therapy that can either stop your body making testosterone or block the effects of it on prostate cancer cells:
Injections or implants to stop your body making testosterone
Tablets called anti-androgens to stop the effect of testosterone
Surgery to remove the testicles
Injections or implants
Some drugs ‘turn off’ the making of male hormones in your testicles. The drugs commonly used include goserelin (Zoladex®), leuprorelin (Prostap®) triptorelin (Decapeptyl®), leuprorelin acetate (Eligard®) and degarelix (Firmagon®).
These drugs are injected as a pellet or liquid under your skin or into a muscle. Injections can be given once a month or every 3 or 6 months. Histrelin (Vantas®) is an implant that can be placed under the skin in your arm. The implant needs to be changed once a year.
The amount of hormone therapy you get is the same whether you have the injection every 1, 3 or 6 months or once a year, as some of the injections are ‘slow release’ and give you the medication slowly over a longer period of time. For some men this saves trips to the GP to have the injection.
You might find that your testicles become smaller in size once you have been on hormone therapy injections for a while.
Starting injection hormone therapy
When you start taking hormone therapy you will be asked to take anti-androgen tablets for a week or two before your first injection. This is because your body’s first response to the injection is to try to make more testosterone. This could make your cancer grow more quickly and is known as ‘tumour flare’. The tablets block the effect of the testosterone and stop this happening. Your doctor will prescribe these tablets for some time before and after starting injection treatment to help prevent this problem.
Other hormone drugs can block testosterone from entering your prostate cancer cells. This prevents the cancer cells from growing. These drugs are called anti-androgens. Common ones are flutamide (Drogenil®), bicalutamide (Casodex®) and cyproterone acetate (Androcur®).
Combination therapy or maximal androgen blockade
Hormone injections or tablets can be given on their own. Sometimes a combination of the injections and tablets may be used. This is known as combination therapy or complete androgen blockade (CAB) or maximum androgen blockade (MAB). Combination therapy prevents testosterone from being made in your testicles and also blocks small amounts made by your adrenal glands from working on prostate cancer cells.
Call our Cancer Nurseline on 1800 200 700 to speak with a cancer nurse or visit our section Hormone therapy and prostate cancer. Help, information and literature are also available at our Daffodil Centres, which are information points located in certain hospitals around the country.
Surgical hormone therapy
Most testosterone is made in your testicles, so removing the testicles will block the release of testosterone straight away. Surgery to remove your testicles is known as an orchidectomy. It is done through a small cut in your scrotum. The scrotum is the sac that holds your testicles. Very occasionally men choose this option, but this type of surgery is not used very often any more as many men find the idea of this operation very distressing. Your doctor and nurse will give you more advice, if you opt for this treatment.
What are the side-effects of hormone therapy?
The common side-effects of hormone therapy include:
Change in sexual function
Hormone therapy can affect your interest in sex, known as your libido, and also your ability to get an erection (erectile dysfunction). You could discuss your concerns with your partner and get advice from your doctor, nurse or a professional psychosexual counsellor. Medications, injections and vacuum devices that may help with erectile dysfunction are available. Your doctor will advise you about which treatment is best for you.
For further information please see the section Sex, Erectile Dysfunction and Prostate Cancer. You can call our Cancer Nurseline on Freephone 1800 200 700 or visit your local Daffodil Centre to speak to a cancer nurse in confidence. If you prefer to email the nurses, please send your message to email@example.com
You can also read further information about sex and prostate cancer.
Hot flushes and sweating happen because the lack of testosterone affects the part of your brain that regulates heat. Speak to your doctor if they are troubling you, as medication may be prescribed.
See our factsheet Hormone therapy and prostate cancer, which has tips on managing your hot flushes.
Hormone therapy may affect your weight, particularly around your waist. You might also lose some of your muscle tone and strength. Taking regular exercise will help you to stay a healthy weight, help prevent loss of muscle and bone strength and is also good for your heart. A healthy diet can help you to stay a healthy weight. You can get further advice from your doctor or our cancer nurses.
Hormone therapy can cause fatigue or extreme tiredness for some men. As with other side-effects, some men may not feel tiredness at all, while others might feel very tired every day. If you are troubled by tiredness, talk to your doctor so that he or she can rule out other causes of fatigue.
You might find that taking regular exercise helps you to manage your tiredness, gives you more energy and helps you to cope. For further information about fatigue download our Coping with Fatigue booklet or call our Cancer Nurseline on 1800 200 700 if you would like to have a copy posted to you.
Testosterone affects how your mind works. When there is less testosterone in your body you might get mood changes, poor concentration or memory problems, anxiety and sometimes depression.
Some men may feel more aware of their emotional side and may find that they may cry more easily than before they were on the hormone treatment.
Some therapies, like relaxation therapy, meditation or yoga, might help you to cope with these frustrating symptoms. Discuss your concerns with your doctor or nurse who may refer you to a professional counsellor. You could also visit your local community-based cancer support centre where you may have the opportunity to meet others, join groups and/or arrange a one-to-one appointment with a professional counsellor.
Breast swelling and tenderness
Tenderness or swelling in the breast (also known as gynaecomastia) can occur if you are given hormone therapy. It occurs more commonly with anti-androgen therapy. It can vary from mild tenderness, with or without mild swelling, to a more noticeable amount of tissue growth around the breast area. Medications like Tamoxifen can help. If this side-effect concerns you tell your doctor or nurse.
Osteoporosis or bone-thinning
Hormone therapy affects how your bones are formed and can lead to osteoporosis. This means that bones can be less dense and become brittle, making them more prone to breaking (fractures).
Taking exercise, such as walking, and eating foods rich in vitamin D and calcium can help to prevent osteoporosis. You can get calcium from dairy products such as cheese, milk and yoghurt and also from tinned fish such as sardines and salmon. Broccoli and leafy green vegetables are other good sources of calcium. Your body needs vitamin D to work with the calcium so it is important to include this too.
Our section Bone health and cancer has lots of information on keeping your bones healthy and bone-strengthening drugs.
You can also talk to your doctor or nurse for advice on reducing your risk of bone-thinning, visit www.irishosteoporosis.ie or call the Irish Osteoporosis Society on Lo-Call 1890 252 751.
How will I know my hormone therapy is working?
Your doctor will monitor your PSA level while you are on hormone therapy. Because hormone therapy stops the growth of prostate cancer cells, your PSA usually falls when you start hormone therapy. This is how your doctor will measure your response to the treatment.
Hormone therapy usually controls prostate cancer growth for many months or years. It is difficult for doctors to tell you how long it is expected to work for because it depends on a number of things such as how much cancer is present and the grade of your cancer. If your PSA 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.
You can download our booklet Understanding locally advanced and advanced prostate cancer for more information or call our Cancer Nurseline to order a copy. You can also pick up booklets from a Daffodil Centre.
It often helps to talk to another man who might have gone through a similar experience of prostate cancer. To talk one-on-one with a volunteer who has been in a similar situation, call our Cancer Nurseline on 1800 200 700 and we can put you in contact with a volunteer.
You could also join our online message board and post questions or messages anonymously to other male members undergoing or who have finished treatment for prostate cancer. Visit our Online Community.
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