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What is hormone therapy?

Testosterone causes prostate cancer to grow, so the most common way of controlling how much testosterone there is in your body is to have hormone therapy. This is also known as androgen deprivation therapy or ADT. Your doctor may recommend hormone therapy to reduce the amount of testosterone in your body. It is usually available as injections, implants, tablets, or a nasal spray.

Some men may have hormone therapy before, during, or after radiotherapy or chemotherapy. Other men may only have hormone therapy. Hormone therapy is used for all prostate cancer stages, but it is the main treatment for men with advanced prostate cancer.

Your doctor will discuss your treatment options with you.

Testosterone: A hormone, or chemical, made by the testicles which controls how the prostate works.

Advanced prostate cancer: Cancer that has spread from the prostate to other parts of the body through the bloodstream.

LHRH agonists
LHRH agonists are usually given as injections or implants. They work by blocking messages from the brain that tell your testicles to make testosterone. Treatment with these drugs is sometimes called “chemical” or “medical castration.” This is because the effect on the body is the same as having your testicles removed.

Common LHRH agonists are shown below. All drugs have a generic name and a name given by the pharmaceutical company that produces them. This is called a trade name.

LHRH: Luteinising hormone-releasing hormone.

Generic name Trade name(s)
Buserelin Suprefact®
Goserelin Zoladex®, Reseligo®
Leuprorelin or Leuprolide Eligard®, Staladex®, Enanton®, Prostap®, Lucrin®, Lutrate®
Triptorelin Decapeptyl SR®, Salvacyl®, Diphereline®, Gonapeptyl®

Your doctor will discuss which LHRH agonists treatment is recommended for you.

It is common for the body to produce a testosterone surge when you first start LHRH agonist treatment. This is called a “flare”. Flares can make your symptoms worse to begin with, and they may cause the tumour to grow quickly for a short time. Because of this, you will also be given tablets to take, known as anti-androgens. These tablets stop testosterone from reaching the cancer cells, so they cannot grow.

LHRH antagonists
LHRH antagonists work in a slightly different way to LHRH agonists. They prevent the testicles from making testosterone but do not cause flares as LHRH agonists do, so you will not need to take anti-androgen tablets.

Degarelix (Firmagon®) is the LHRH antagonist treatment available in Europe. It is given as a monthly injection under the skin.

Some men may be offered an operation to remove their testicles. This is called an orchidectomy, or surgical castration. An orchidectomy is a straightforward operation. It is usually done using a local anaesthetic, but it can be done under a ‘general’ anaesthetic. With both types of anaesthesia, you will not feel anything during the surgery. If you have a ‘local’ you will be awake the whole time and if you have a ‘general’ you will be asleep during the procedure. Once done, an orchidectomy cannot be reversed, so you need to be sure this is the right treatment option for you.

Anti-androgens are a group of drugs that stop testosterone from entering the cancer cells, preventing the cells from growing. They are usually given alongside other hormone treatments or radiotherapy. But you may be offered anti-androgen treatment on its own to see if it will shrink your tumour.

If you are prescribed anti-androgen tablets, you will also need to have regular blood tests. This is to check your levels of blood cells and how well your liver and kidneys are working.

Your doctor will discuss which anti-androgen drug best manages your stage of prostate cancer. You may want to know the names of the different anti-androgen drugs that may be available to you. Please be aware that some of the drugs listed may not be available across the whole of Europe.

Generic name Trade name(s)
Bicalutamide Casodex®, Bicalutamid®
Flutamide Flutasin®, Flutamid®
Nilutamide Anandron®
Cyproterone Cyprostat®
Apalutamide Erleada®, Erlyand®
Darolutamide Nubeqa®
Enzalutamide Xtandi®

Abiraterone (Zytiga®, Yonsa®) is a different type of hormone therapy. It is usually offered to men with advanced prostate cancer whose cancer does not respond to other treatments. It is taken as tablets rather than injections.

Like other hormone treatments, it works by stopping the body from producing testosterone, but differently from other treatments. Abiraterone treatment is not a cure, but it can help keep the cancer under control and help with some of your symptoms.

If you choose to take abiraterone, you will also have to take steroid tablets. Taking steroids in combination with abiraterone will lower your chances of having side effects ofthe treatment.