Hormone therapy for metastatic prostate cancer

Some drugs work by stopping male hormones being made in your testicles. These drugs are injected under your skin or into a muscle or given as an oral tablet. Examples include the injections goserelin (Zoladex®), leuprorelin (Prostap®), triptorelin (Decapeptyl®), leuprorelin acetate (Eligard®) and degarelix (Firmagon®) and the tablet relugolix (Orgovyx ®).

Starting hormone therapy injections

When you start this therapy, you may be asked to take anti-androgen tablets for a week or 2 before your first injection. This is because with some hormone therapy drugs, 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 from happening. 

Your doctor may prescribe these tablets for some time before and after starting injection treatment to help prevent this problem.

How often will I have hormone therapy? 

Injections can be given once a month or every 3, 6 or 12 months. The amount of hormone therapy you get is the same however often you have the injections. This is because some of the injections are ‘slow release’ and give you the medication slowly over a longer period. This might save you from having to make more trips to your GP to have injections. 

If you are on tablets, they are usually taken daily.

You may also be given newer drugs that also stop testosterone causing cell growth. These drugs are called androgen receptor pathway inhibitors and are given as tablets that you take at home. These drugs can block testosterone from entering prostate cancer cells. This prevents testosterone from helping the cancer cells to grow. For example, enzalutamide (Xtandi®), darolutamide
(Nubeqa®) and apalutamide (Erleada®). 

Other tablets help to stop the production of testosterone in your body. For example, abiraterone (Zytiga®). You may have to take a steroid tablet with some treatments. Your doctor will advise you on this.

These affect more than half the men who get hormone therapy. You may find them difficult to cope with. Hot flushes can be anything from a mild warming sensation to an unpleasant all-over hotness which causes heavy sweating. A hot flush usually lasts 4-5 minutes but can last for just a few seconds or up to 10 minutes.

The following tips may help to ease the effects of hot flushes:

• Wear cotton or special wicking-fabric clothing. Cotton absorbs moisture and wicking fabrics take moisture away from the body to keep you dry and comfortable.
• Have layers of clothing and bedding so that you can remove or add layers as your body temperature changes.
• It may help to avoid certain foods and drinks such as spicy foods, caffeine, alcohol and hot drinks – try and keep a note of any food or drink that makes your flushes worse so that you can avoid them.
• Have cool drinks, avoid warm areas, use an electric fan.
• Use sprays or moist wipes, to help lower your skin temperature.
• Avoid hot baths or showers, as they may trigger a hot flush.

You may get tenderness or swelling in your breast if you are having
hormone therapy. This swelling is also known as gynaecomastia. It can vary from mild tenderness, with or without mild swelling, to a more obvious amount of tissue growth around the breast area.

Medications like tamoxifen can help. If this side-effect concerns you,
tell your doctor or nurse.

Hormone therapy affects how your bones are formed and can lead to osteoporosis. This means that bones can become brittle, making them more likely to break (fracture). 

Taking regular exercise, such as walking, and eating foods rich in vitamin D and calcium will help to keep your bones strong. Avoiding smoking and excessive alcohol can also help. Your doctor may advise bone strengthening medications. Read more about bone health or get in touch with the Irish Osteoporosis Society 

Hormone therapy may affect your weight, particularly around your
waist. You might also lose some of your muscle tone and strength.

Taking some exercise and eating well may help you to avoid putting
on too much weight. Your doctor can advise you on suitable exercise
and diet and can refer you to a dietitian, if necessary.

Hormone therapy can cause fatigue or ongoing tiredness. If you are
troubled by fatigue, talk to your doctor so that they can rule out
other causes of fatigue and adjust your medication, if necessary.

There is evidence that taking regular exercise improves tiredness in
men on hormone therapy for prostate cancer. You might find that
taking regular exercise gives you more energy and helps you to
cope. Read more about fatigue and ways to manage.

Less testosterone in your body might cause mood changes, poor
concentration or memory problems, anxiety and sometimes depression. Some therapies, like relaxation therapy, meditation or yoga, might help you to cope with these frustrating symptoms. Exercise may also be beneficial. 

You can also discuss your concerns with your doctor or nurse. They can refer you to a professional counsellor or doctor if indicated. Read more about Irish Cancer Society-funded counselling. 

Research suggests that longer term use of hormone therapy may increase the risk of heart problems. 

Managing other risk factors for your heart health is important while on treatment for prostate cancer. This includes looking after your general health such as having your blood pressure and cholesterol checked. Being physically active and trying to keep a healthy weight may help to protect your heart health. 

Ask your doctor about this and about any checks you should have.