A number of treatment choices can help you if you have advanced prostate cancer. Since this type of cancer needs male sex hormones – called androgens – to grow, hormone therapy can be a good way to slow it down. Also known as androgen deprivation therapy, or ADT, hormone therapy is designed to either stop your body from making the main androgen, testosterone, or to keep it from acting on prostate cancer cells.
In advanced prostate cancer that hasn't spread beyond nearby tissues, hormone treatment can help make external beam radiation – another type of treatment for prostate cancer – work better at lowering the chances that the cancer will come back. You'll find that hormone therapy is normally paired with other treatments like this, because alone, it doesn’t cure prostate cancer. If used on its own, it will mainly control your cancer and delay or manage any symptoms of it. You can get hormone therapy intermittently – on for a period, time then off for some time – or constantly.
If you're considering hormone therapy for advanced prostate cancer, you should know what to expect if you have this treatment.
How Do You Get Hormone Therapy for Advanced Prostate Cancer?
Not everyone who has prostate cancer needs hormone therapy. This kind of treatment makes the most sense for people with different risk levels and if you have specific reactions to other types of treatment you’ve had. You’re most likely to get hormone therapy when:
- You have advanced prostate cancer that has spread past the prostate.
- Your cancer may still be in or around your prostate after surgery.
- Your prostate cancer comes back, also called recurrence.
- You are going through radiation therapy for cancer that is likely to come back.
- You are trying to shrink tumors before radiation or surgery.
- You can't have surgery, radiation, or other direct prostate treatment because of your age, other health conditions you have, or possible side effects of targeted treatments.
Where You Get Hormone Therapy
You'll usually get hormone therapy at your regular doctor's office, in a chemotherapy day clinic, or you may take it at home. Your care team will let you know where you will have your treatment.
Hormone therapy comes in many forms: pills, surgery, or as a shot or infusion. Which kind you get depends on the type of hormone therapy.
LHRH agonists and antagonist medicines
Luteinizing hormone-releasing hormone (LHRH) agonists and antagonists are hormone therapies that stop the testicles from making testosterone.
Shots. You'll usually get this kind of hormone therapy as a shot under your skin or into your muscle every month, three months, or six months. You may get it in your arm, your stomach area, your thigh, or your bottom.
Implants. LHRH agonists also come as small under-skin implants – often in your abdomen, or belly area – to release the medication to you slowly over time. These implants can last between one and 12 months, depending on the type you get.
Pills. One type of LHRH antagonist, relugolix (Orgovyx), is a pill rather than a shot, and you take it daily.
Antiandrogens
You may also take pills that block androgens from attaching to prostate cancer cells, which spurs their growth. Antiandrogens, also called androgen receptor antagonists, attach to the cancer cells to stop the androgens from doing so instead. You take these by mouth daily or up to three times each day.
These drugs are sometimes used with other hormone therapies to lower testosterone levels. For instance, antiandrogens are often combined with LHRH agonists to manage initial flare-ups in testosterone levels that LHRH medication causes. You might also take these before you get shots or implants or after surgery that removes the testicles.
Androgen-blocking medications
Cells in other parts of your body, such as the adrenal glands, can also make androgens. So you may take other androgen-blocking drugs to keep those cells from making male hormones that cause prostate cancer cells to grow while your current hormone therapy is keeping the testicles from doing so.
Taken as a pill, these medications – including abiraterone (Yonsa, Zytiga) and ketoconazole – are often called CYP17 inhibitors because they help stop other cells from pumping out testosterone by blocking the CYP17 enzyme.
If your prostate cancer doesn't go away or it returns, you might get androgen-blocking medications plus corticosteroids like prednisone, which help lower inflammation in the body. These types of hormone therapy medicines can also treat advanced prostate cancer that's high risk or not reacting to other hormone therapy treatments.
Orchiectomy
This less common but very effective type of hormone therapy involves removing the testicles since they're the main creators of androgens. Your surgeon will numb the groin area and cut into it to remove each testicle. You're usually able to go home after this type of surgery instead of staying in the hospital.
This procedure, which is the simplest and least expensive type of hormone therapy, helps prostate cancer cells get smaller or stop growing altogether for some time. But it is permanent, so you may prefer to take hormone therapy drugs instead.
How Long Does Hormone Therapy Treatment Last?
At some point, most prostate cancers stop reacting to hormone therapy treatment, though doctors can't say how long it will work for everyone. The time that hormone therapy lasts will vary from person to person. It mainly depends on how aggressive your cancer is and how far it has spread.
If you have high-risk prostate cancer, which includes advanced-stage cancer, your treatment can last between four and 24 months. For this reason, your doctor may try different lengths of hormone therapy treatment depending on your situation.
Locally advanced cancer. If your cancer has spread in a small area just beyond the prostate, your hormone therapy may last up to six months before radiotherapy, which is usually used alongside the treatment. You might also continue hormone therapy during and after your radiotherapy for up to three years.
Advanced or metastatic prostate cancer. If your prostate cancer has spread further to other parts of your body, hormone therapy will likely be a lifelong treatment.
Intermittent vs. continuous hormone therapy
Because prostate cancer can become resistant to hormones, doctors sometimes try hormone therapy for fixed periods of time with breaks in between or until your prostate-specific antigen, or PSA, levels are very low. These are proteins that both your normal cells and cancer cells make. How long you're on and off the treatment depends, though you'll usually spend a similar amount of time off from therapy as you spent on it.
It’s thought that intermittent hormone therapy might help delay hormone resistance and make the therapy work well for longer. More clinical trials are needed to confirm that. At the same time, it gives you a break from treatment side effects and can improve your quality of life. This is a common treatment technique, especially if you see your PSA levels go up after surgery or radiation or if your cancer comes back but hasn't spread.
And while some studies show that continuously targeting androgens can help men live longer, others haven't shown much of a difference. Intermittent therapy may not be the best choice in all situations, so talk to your doctor about what they suggest.
How Do You Know if Hormone Therapy for Prostate Cancer Is Working?
The way your doctor will track if your treatment is working depends on the goal of your hormone therapy.
Stopping your prostate cancer. The main way your doctor will find out whether your hormone therapy is helping you is by testing your blood's PSA levels regularly. They should stay at the same level or go down if your hormone therapy is working. If your PSA levels go up, it could mean that the cancer is growing again or becoming resistant to that particular kind of hormone therapy. Your doctor may also suggest that you get scans during your treatment, such as a CT, MRI, PSMA PET, and bone scans.
Lifelong therapy for advanced prostate cancer. Your doctor will keep track of your PSA levels in this instance, too, but they’ll also check for changes in your other symptoms like pain and weight loss. They may also order scans. If your PSA levels start to go up and your scans show changes in your body, this could be a sign that the treatment isn't working as well anymore.
If your hormone therapy stops working, your doctor might suggest a different type of hormone therapy, a combination of hormone therapies, or an alternative treatment altogether.
Show Sources
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SOURCES:
American Cancer Society: “Hormone Therapy for Prostate Cancer,” “Treating Prostate Cancer That Doesn’t Go Away or Comes Back After Treatment.”
Cancer Research UK: “Hormone therapy for metastatic prostate cancer.”
Harvard Health Publishing: “Prostate cancer: How long should hormonal therapy last?” “Intermittent hormone therapy for prostate cancer.”
JAMA Oncology Patient Page: “PSMA PET Scan.”
Johns Hopkins Medicine: “Hormone Therapy for Prostate Cancer.”
Mayo Clinic: “Hormone therapy for prostate cancer.”
National Cancer Institute: “Hormone Therapy for Prostate Cancer.”
Prostate Cancer Foundation: “Hormone Therapy for Prostate Cancer.”
Prostate Cancer UK: “Hormone therapy.”
UCLA Health: “Hormone Therapy and Prostate Cancer.”
UCSF Medical Center: “Hormone Therapy for Prostate Cancer – A Patient Guide,” “Hormone Therapy for Prostate Cancer.”
