Hormonal Therapy for Prostate Cancer

A man with prostate cancer may have hormone therapy before, during, or after radiation therapy. Hormone therapy is also used alone for prostate cancer that has returned after treatment.

Male hormones (androgens) can cause prostate cancer to grow. Hormone therapy keeps prostate cancer cells from getting the male hormones they need to grow. The testicles are the body's main source of the male hormone testosterone. The adrenal gland makes other male hormones and a small amount of testosterone.

Hormone Therapy Uses Drugs or Surgery

Drugs. Your doctor may suggest a drug that can block natural hormones

Luteinizing hormone-releasing hormone (LH-RH) agonists .These drugs can prevent the testicles from making testosterone. Examples are leuprolide, goserelin, and triptorelin. The testosterone level falls slowly. Without testosterone, the tumor shrinks, or its growth slows. These drugs are also called gonadotropin-releasing hormone (GnRH) agonists.

Antiandrogens. These drugs can block the action of male hormones. Examples are flutamide, bicalutamide, and nilutamide.

Other drugs. Some drugs can prevent the adrenal gland from making testosterone. Examples are ketoconazole and aminoglutethimide.

Surgery. Surgery to remove the testicles is called orchiectomy.

After orchiectomy or treatment with an LH-RH agonist, your body no longer gets testosterone from the testicles, the major source of male hormones. Because the adrenal gland makes small amounts of male hormones, you may receive an antiandrogen to block the action of the male hormones that remain. This combination of treatments is known as total androgen blockade (also called combined androgen blockade). However, studies have shown that total androgen blockade is no more effective than surgery or an LH-RH agonist alone.

Hormone therapy causes side effects such as impotence, hot flashes, and loss of sexual desire. Also, any treatment that lowers hormone levels can weaken your bones. Your doctor can suggest medicines that may reduce your risk of bone fractures.

An LH-RH agonist may make your symptoms worse for a short time at first. This temporary problem is called "flare." To prevent flare, your doctor may give you an antiandrogen for a few weeks along with the LH-RH agonist.

An LH-RH agonist such as leuprolide can increase body fat, especially around the waist. The levels of sugar and cholesterol in your blood may increase too. Because these changes increase the risk of diabetes and heart disease, your health care team will monitor you for these side effects.

Antiandrogens (such as nilutamide) can cause nausea, diarrhea, or breast growth or tenderness. Rarely, they may cause liver problems (pain in the abdomen, yellow eyes, or dark urine). Some men who use nilutamide may have shortness of breath or develop heart failure. Some may have trouble adjusting to sudden changes in light.

If you receive total androgen blockade, you may have more side effects than if you have just one type of hormone treatment.

If used for a long time, ketoconazole may cause liver problems, and aminoglutethimide can cause skin rashes.