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Hormone therapy for prostate cancer

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on June 23, 2022.

After a patient is diagnosed with prostate cancer, his doctor may recommend hormone therapy as part of the treatment plan. Hormone therapy for prostate cancer reduces levels of androgens (male hormones) to stop them from helping cancer cells grow.

The two most prevalent types of androgens are testosterone and dihydrotestosterone (DHT), both made by the testicles, adrenal glands and prostate cancer cells. Prostate cancer depends on androgens to grow, so by lowering androgen levels, hormone therapy is designed to rob cancer of its fuel.

Hormone therapy for prostate cancer, also known as androgen deprivation therapy (ADT) or hormone suppression therapy, is designed to shrink and/or slow the growth of cancer tumors.

Use of hormone therapy in treating prostate cancer

Hormone therapy is used in several ways, and androgen deprivation in prostate cancer may be given using either medication or surgery. This prostate cancer treatment may be used to:

  • Cause the testicles to produce less androgen
  • Block androgens from doing their job throughout the body
  • Block the body from producing androgens

Hormone therapy is often used for different stages of prostate cancer, including in men with low, intermediate and high risk of cancer growth and spread. This treatment is generally used:

  • In cancers that have spread too extensively to be treated with radiation therapy or surgery 
  • In patients with pre-existing health conditions that prevent them from undergoing surgery or radiation therapy
  • In cancers that recur after initial treatment or that weren’t completely removed by surgery or radiation therapy
  • To help reduce a tumor’s size to make it easier to remove surgically
  • For patients with a high risk of cancer recurrence (in which case, hormone therapy and radiation therapy may be used in combination as part of the initial treatment)

Types of hormone therapy for prostate cancer

There are several types of hormone therapy, and their use depends on the specific type of prostate cancer. Some lower androgen levels in the testicles, others in the adrenal glands.

Lowering testicular androgen levels

One type of hormone therapy works to lower androgen levels in the testicles. This androgen deprivation therapy may be performed surgically or delivered via medication (injected or implanted into the skin).

Orchiectomy

An orchiectomy, also known as surgical castration, is an outpatient procedure to remove the testicles. According to the National Cancer Institute, this surgery may reduce the body’s testosterone by 90 to 95 percent, causing prostate cancer to stop growing or to shrink.

Orchiectomy is irreversible. Prostate cancer castration is also the simplest form of hormone therapy, but the loss of the testicles may be psychologically challenging, so this type of therapy isn’t used as often as medical hormone therapy.

Luteinizing hormone-releasing hormone (LHRH) agonists

Luteinizing hormone-releasing hormone (LHRH) agonists are medications that lower the amount of testosterone produced in the testicles. They’re considered a type of medical castration, with similar outcomes as an orchiectomy.

LHRH agonists produce a side effect known as a tumor flare, which causes testosterone to spike when the medication is first given, before falling drastically. It’s possible to avoid this flare by combining LHRH agonists with other medications called anti-androgens.

This treatment is administered via injections or implants under the skin, ranging from one treatment a month to once every six months. Commonly used LHRH agonists include:

  • Lupron Depot®, Eligard® (leuprolide)
  • Trelstar® (triptorelin)
  • Camcevi® (leuprolide mesylate)
  • Zoladex® (goserelin)

Luteinizing hormone-releasing hormone (LHRH) antagonists

Luteinizing hormone-releasing hormone (LHRH) antagonists work much like LHRH agonists but don’t cause tumor flares. This often makes LHRH antagonists an appropriate option for advanced prostate cancer, because once cancer has spread, even a brief tumor flare may increase tumor growth and cause uncomfortable side effects like bone pain.

Common LHRH antagonists include:

  • Firmagon® (degarelix), administered each month via an injection
  • Orgovyx® (relugolix), taken by pill each day.

Lowering adrenal gland androgen levels

Because LHRH agonists and antagonists only lower testosterone production levels in the testicles, other treatments may be needed to lower androgens made by the adrenal glands or the prostate cancer itself.

Medications that lower adrenal gland androgen levels include:

  • Zytiga® (abiraterone): Taken orally each day, this treatment is often used when cancer has spread to the bones or if the patient is high-risk or has castrate-resistant prostate cancer, meaning it’s still growing despite low testosterone levels.
  • Nizoral® (ketoconazole): This treatment is also taken orally and works similarly to abiraterone. It’s also used in men with advanced prostate cancer whose cancer has spread.

Anti-androgens for prostate cancer

Another class of hormone therapy uses anti-androgen drugs, which work by stopping androgens from attaching to androgen receptors, slowing prostate cancer growth.

This type of treatment is taken daily as a pill and is usually combined with another type of hormone therapy, either to prevent tumor flares or if an orchiectomy or LHRH agonist or antagonist drugs have stopped yielding results.

Anti-androgen drugs for prostate cancer include:

  • Eulexin® (flutamide)
  • Nilandron® (nilutamide)
  • Casodex® (bicalutamide)

Side effects of hormone therapy for prostate cancer

As with all prostate cancer treatments, hormone therapy may produce side effects. Though these side effects vary depending on the type of therapy used, general side effects associated with hormone therapy include:

  • Weight gain
  • Hot flashes
  • Lower libido
  • Fatigue
  • Erectile dysfunction
  • Loss of strength and muscle
  • Reduced bone density, which may lead to fractures
  • Resistance to insulin
  • Liver damage

Additional medications, exercise plans and emotional support may be used to help manage these and other side effects..

Hormone therapy in hormone-sensitive prostate cancer

Hormone-sensitive cancer depends on hormones to grow. For those with early-stage prostate cancer that’s at increased risk of spreading, hormone therapy may be given before, during or after radiation therapy or after surgery. It may also be used in men who have localized cancer and are unable to have other treatments.

For cancers that have recurred after radiation therapy or surgery, hormone therapy is the primary treatment. In patients with advanced prostate cancer, hormone therapy is usually combined with ADT and sometimes chemotherapy.

Treating castration-resistant prostate cancer

Castration-resistant prostate cancer continues to grow, even after androgen levels have been reduced. These patients may undergo a combination of hormone therapies, including ADT, sometimes combined with immunotherapy, chemotherapy and/or radioactive drugs.

Clinical trials are also continuously working toward new treatments that may help men with castration-resistant cancer.

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