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Hormone therapy for prostate cancer

Androgen deprivation therapy; ADT; Androgen suppression therapy; Combined androgen blockade

Hormone therapy for prostate cancer uses surgery or drugs to lower the levels of male sex hormones in a man's body. This helps slow the growth of prostate cancer.

Male Hormones and Prostate Cancer

Androgens are male sex hormones. Testosterone is one main type of androgen. Most testosterone is made by the testicles. The adrenal glands also produce a small amount.

Androgens cause prostate cancer cells to grow. Hormone therapy for prostate cancer lowers the effect level of androgens in the body. It can do this by:

  • Stopping the testicles from making androgens using surgery or medicines
  • Blocking the action of androgens in the body
  • Stopping the body from making androgens

When is Hormone Therapy Used?

Hormone therapy is almost never used for people with Stage I or Stage II prostate cancer.

It is mainly used for:

  • Advanced cancer that has spread beyond the prostate gland
  • Cancer that has failed to respond to surgery or radiation
  • Cancer that has recurred

It may also be used:

  • Before radiation or surgery to help shrink tumors
  • Along with radiation therapy for cancer that is likely to recur

Drugs That Lower Androgen Levels

The most common treatment is to take drugs that lower the amount of androgens made by the testicles. They are called luteinizing hormone-releasing hormone (LHRH) analogs. These drugs lower androgen levels just as well as surgery does. This type of treatment is sometimes called "chemical castration."

Men who receive androgen deprivation therapy should have follow-up exams with the doctor prescribing the drugs:

  • Within 3 to 6 months after starting therapy
  • At least once a year, to monitor blood pressure and perform blood sugar (glucose) and cholesterol tests
  • To get PSA blood tests to monitor how well the therapy is working

LHRH analogs are given as a shot or as a small implant placed under the skin. They are given anywhere from once a month to once a year. These drugs include:

  • Leuprolide (Lupron, Eligard)
  • Goserelin (Zoladex)
  • Triptorelin(Trelstar)
  • Histrelin (Vantas)

Another medicine, degarelix (Firmagon), is an LHRH antagonist. It reduces androgen levels more quickly and has fewer side effects. It is used in men with advanced cancer.

Some doctors recommend stopping and restarting treatment (intermittent therapy). This approach appears to help reduce hormone therapy side effects. However, it is not clear if intermittent therapy works as well as continuous therapy. Some studies indicate that continuous therapy is more effective or that intermittent therapy should only be used for select types of prostate cancer.

Surgery to remove the testicles (castration) stops the production of most androgens in the body. This also shrinks or stops prostate cancer from growing. While effective, most men do not choose this option.

Drugs That Block Androgen

Some drugs that work by blocking the effect of androgen on prostate cancer cells. They are called anti-androgens. These drugs are taken as pills. They are often used when medicines to lower androgen levels are no longer working as well.

Anti-androgens include:

  • Flutamide (Eulexin)
  • Enzalutamide (Xtandi)
  • Bicalutamide (Casodex)
  • Nilutamide (Nilandron)

Drugs That Stop the Body From Making Androgens

Androgens can be produced in other areas of the body, such as the adrenal glands. Some prostate cancer cells can also make androgens. Three drugs help to stop the body from making androgens from tissue other than the testicles.

Two medicines, ketoconazole (Nizoral) and aminoglutethimide (Cytradren), treat other diseases but are sometimes used to treat prostate cancer. The third, abiraterone (Zytiga) treats advanced prostate cancer that has spread to other places in the body.

When Hormone Therapy Stops Working

Over time, prostate cancer becomes resistant to hormone therapy. This means that cancer only needs low levels of androgen to grow. When this occurs, additional drugs or other treatments may be added.

Side Effects

Androgens have effects all over the body. So treatments that lower these hormones can cause many different side effects. The longer you take these medicines, the more likely you are to have side effects.

They include:

  • Trouble getting an erection and not being interested in sex
  • Shrinking testicles and penis
  • Hot flashes
  • Weakened or broken bones
  • Smaller, weaker muscles
  • Changes in blood fats, such as cholesterol
  • Changes in blood sugar
  • Weight gain
  • Mood swings
  • Fatigue
  • Growth of breast tissue, breast tenderness

Androgen deprivation therapy can increase the risks for diabetes and heart disease.

Weighing the Options

Deciding on hormonal therapy for prostate cancer can be a complex and even difficult decision. The type of treatment may depend on:

  • Your risk for cancer coming back
  • How advanced your cancer is
  • Whether other treatments have stopped working
  • Whether cancer has spread

Talking with your provider about your options and the benefits and risks of each treatment can help you make the best decision for you.

References

Hormone Therapy for Prostate Cancer. National Cancer Institute. Update 6/23/2014. www.cancer.gov/types/prostate/prostate-hormone-therapy-fact-sheet. Accessed August 31, 2015.

Hormone (Androgen Deprivation) Therapy for Prostate Cancer. American Cancer Society. Updated 3/12/2015. www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-treating-hormone-therapy. Accessed August 31, 2015.

Mohler JL, Kantoff PW, Armstrong AJ, et al. Prostate cancer, version 2.2014. J Natl Compr Canc Netw. 2014. May;12(5):686-718. PMID: 24812137 www.ncbi.nlm.nih.gov/pubmed/24812137.

Nelson WG, Carter B, DeWeese TL, Antonarakis ES, Eisenberger MA. Prostate Cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2014:chap 84.

Review Date: 9/13/2015

Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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