Prostate Cancer: Hormone Therapy
Prostate cancer may be treated with hormone therapy. It’s also called androgen deprivation therapy (ADT). Androgens are male hormones. They boost the growth of prostate cancer cells. Hormone therapy is done to lower the amount of male hormones made by the body. Or it can stop the hormones from getting to the cancer cells. This therapy may be done with medicines. Or surgery may be done to remove the testicles (orchiectomy). This lowers the amount of male hormones in the body.
Is hormone therapy right for you?
Your healthcare provider may advise hormone therapy for you if:
Your healthcare provider wants to reduce the size of the cancer before radiation therapy
You can’t have surgery or radiation therapy
You have cancer that is locally advanced (it has grown outside the prostate and into nearby areas)
You have advanced cancer that won’t be helped by surgery or radiation therapy
The cancer remains or has come back after surgery or radiation therapy
Hormone therapy with medicine
Hormone therapy can be done with different types of medicine. More than 1 type may be used for treatment. They include:
LHRH (luteinizing hormone-releasing hormone) agonists. These lower the amount of male hormones made by the testicles. They are given by an injection. Or they may be implanted under the skin.
LHRH antagonists. These also lower the amount of male hormones made by the testicles. They do it more quickly than LHRH analogs. They are given as an injection under the skin.
CYP17 inhibitors. These slow the amount of hormones made in prostate cancer cells and other body cells. They are often used with orchiectomy, LHRH analogs, or LHRH antagonists. They are given as pills.
Anti-androgens. These stop male hormones from working. They are often used with orchiectomy, LHRH analogs, or LHRH antagonists. They are given as pills.
The length of time for hormone therapy varies. It also may be started and stopped. This is called intermittent hormone therapy. Your healthcare provider will talk with you about the treatment schedule that is best for you.
Hormone therapy with surgery (orchiectomy)
An orchiectomy is surgery to remove the testicles. This is done to stop most of the male hormones in the body from being made, which can often slow or stop the growth of the prostate cancer. The surgery is done by a urologist. This is a doctor who is a specialist in urinary and genital health.
During the procedure:
The doctor makes 1 or 2 incisions on each side of the scrotum. The testicles are partly or completely removed. Prosthetic testicle implants can be put in if desired.
The incisions are stitched and the scrotum is left intact.
Side effects of hormone therapy
Side effects are similar for all types of hormone therapy (although there are some differences with different types of medicines). Many of these are caused by the decrease in male hormones. The side effects can include:
Trouble having or keeping an erection
Less desire for sex
Decrease in the size of the penis and testicles
Thinning of the bones (osteoporosis)
Changes in facial hair
Anemia or low red blood cell count
Trouble with memory and concentration
Increased risk of cardiovascular disease and diabetes
Other side effects might also be possible with certain medicines.
Coping with side effects
Talk with your healthcare provider about what to expect from your specific treatment. Some of the side effects can be prevented or treated. For example:
Weight-bearing exercise and medicine can help decrease bone loss.
Regular exercise can help prevent weight gain and muscle loss. It can also help prevent depression and feeling tired.
Medicine and therapy (counseling) can help treat depression.
Talk with your healthcare team about any side effects you have.
May 21, 2017
Alteri, Rick, MD,Gersten, Todd, MD