Expert review by Rupa Dainer
Published: 18. June 2024
After reading this article, you will know
- how hormone therapy works
- when the therapy is used
- what the benefits are
- what side effects can occur
Surgery, radiation therapy, and chemotherapy are not the only treatments for prostate cancer. Hormone therapy is another option. What exactly is it, and how does it work?
How does hormone therapy work?
Prostate cancer grows faster when male sex hormones are present. These hormones cause the cancer cells to multiply. So if the hormones are absent, the cancer cell’s growth rate decreases. Hormone therapy uses drugs that stop these hormones from working.
This is done in two different ways:
- They stop the production of these sex hormones.
- They inhibit the activity of sex hormones.
What can it do for you?
Hormone therapy slows prostate cancer growth. Sometimes it can cause the tumor to shrink in size. This may help to prevent more complications and may ease pain and other symptoms.
But sometimes the effects of the drugs wear off over time. The treatment cannot completely eliminate the cancer like surgery or radiation therapy. Hormone therapy is a type of treatment that makes you feel better. Its main goals are to control the cancer and improve your quality of life. In some cases, it may be used after other treatments to lower the chance of the cancer returning.
Hormone therapy sometimes stops working if the cancer cells need fewer sex hormones and start to grow again. When this happens, prostate cancer becomes ‘castration-resistant’ (not affected by hormone therapy). This can take many months or years, depending on the cancer.
When is hormone therapy used to cure prostate cancer?
Your treatment team will give you hormone therapy if the prostate cancer has spread to other parts of your body. It can help with your symptoms and slow down the cancer.
If your symptoms are severe, you may need chemotherapy. Chemotherapy may have more and different side effects than hormone therapy, but it can work faster. Your treatment team can also use both treatments together.
In some cases, your treatment team may temporarily use (for two to three years) hormone therapy after radiation therapy for localized prostate cancer. This helps lower the risk of cancer coming back in certain situations.
Hormone therapy can also be used instead of surgery or radiation therapy if other treatments are too hard on your body, or you do not want to receive these types of treatments.
What hormone therapies are available?
Hormonal therapy for prostate cancer uses different drugs that are divided into two groups. One type of medicine prevents the production of sex hormones. The other targets the cancer cells and blocks the stimulating effect of the hormones.
Drugs that affect the brain
LHRH is a hormone that makes the brain produce testosterone. Two kinds of medicines stop this process – the LHRH agonists and the LHRH antagonists. They both eventually do the same thing. They stop the sex hormones from being made in the testicles.
Both work very well, but they can also cause severe side effects. The drugs are injected under the skin and last for at least one month, sometimes more, depending on the drug.
Note: LHRH agonists and the LHRH antagonists are also called GnRH agonists and GnRH antagonists.
Drugs that affect cancer cells
Male sex hormones are called androgens. Anti-androgens are drugs that stop sex hormones from working. This is also called androgen deprivation therapy (ADT for prostate cancer). They block the area on the cancer cells where the sex hormones attach. This stops the cancer cells from receiving the signal to grow.
They are not as strong as the LHRH agonists and the LHRH antagonists, but they have fewer side effects. Antiandrogens are taken daily in the form of tablets.
Castration-resistant
This happens when the cancer no longer relies on the hormones for growth. Because of this, the drugs described here have no effect anymore. It means the cancer can grow without stimulation from the sex hormones.
If prostate cancer is castration-resistant, there are two other medical options that can help for a while. You take both of these medicines as pills daily.
- The drug abiraterone also stops hormone production in the adrenal glands and the tumor tissue. Other drugs only affect the testicles.
- The drug enzalutamide stops the growth signals from reaching the cancer cells. This slows down cancer growth.
What side effects can you expect?
Hormone therapy can cause many side effects. The side effects are mostly due to the loss of sex hormone effect. Different drugs have different side effects. Your treatment team will tell you more about them.
The following symptoms can occur:
- hot flashes
- lack of drive and depressed mood
- loss of sex drive and erectile dysfunction
- decrease in bone density and bone loss (osteoporosis)
- loss of muscle mass
- weight gain due to more fat
- breast pain and breast enlargement
In summary
- Hormone therapy can stop the growth of prostate cancer and relieve symptoms.
- There are different medicines that have various side effects.
What you can do
- Clarify any unanswered questions you may have about hormone therapy with your treatment team.
- Eat well, exercise, sleep, and learn ways to cope with stress to stay healthy and happy.
- Join online or local groups to talk to other people who have hormone therapy, such as: