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Hormone therapy for prostate cancer

Androgen deprivation therapy; ADT; Androgen suppression therapy; Combined androgen blockade; Orchiectomy - prostate cancer; Castration - prostate cancer

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.

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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:

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:

It may also be used:

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 (LH-RH) analogs (injections) and anti-androgens (oral tablets). 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:

LH-RH analogs are given as a shot anywhere from once a month to every 6 months. These drugs include:

LH-RH antagonists are another class of treatments, including degarelix (Firmagon) and relugolix (Orgovyx). They reduce androgen levels more quickly and have fewer side effects. LH-RH antagonists are 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:

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:

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:

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

References

American Cancer Society website. Hormone therapy for prostate cancer. www.cancer.org/cancer/prostate-cancer/treating/hormone-therapy.html. Updated September 23, 2021. Accessed December 7 2021.

Eggener S. Hormonal therapy for prostate cancer. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 161.

National Cancer Institute website. Hormone therapy for prostate cancer. www.cancer.gov/types/prostate/prostate-hormone-therapy-fact-sheet. Updated February 22, 2021. Accessed December 7, 2021.

National Cancer Institute website. Prostate cancer treatment (PDQ) - health professional version. www.cancer.gov/types/prostate/hp/prostate-treatment-pdq. Updated September 3, 2021. Accessed December 7, 2021.

National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology (NCCN guidelines): prostate cancer. Version 2.2022. www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Updated November 30, 2021. Accessed December 7, 2021.

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Review Date: 10/3/2021  

Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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