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Hormone therapy for prostate cancer is also known as androgen deprivation therapy (ADT). Prostate cancer cannot grow or survive without androgens, which include testosterone and other male hormones. Hormone therapy decreases the amount of androgens in a man's body. Reducing androgens can slow the growth of the cancer and even shrink the tumor.
Hormone therapy may be used:
When hormone therapy slows the growth of prostate cancer, a man's prostate-specific antigen (PSA) levels will go down. PSA tests will show if the treatment is working.
Medicines for hormone therapy
Taking medicine, such as luteinizing hormone-releasing hormone (LHRH) medicine, is one way to reduce androgens.
Other hormone therapies may include the use of medicines such as aminoglutethimide combined with hydrocortisone, corticosteroids (dexamethasone, hydrocortisone, and prednisone), estrogen, and megestrol.
Surgery as hormone therapy
Another way, used much less often, is surgery to remove the testicles, also known as an orchiectomy. This surgery is considered to be hormone therapy. This is because removing the testicles, where more than 90% of the body's androgens are made, decreases testosterone levels. Removing the testicles may be the simplest way to reduce androgen levels, but it is permanent.
Research does not clearly show whether starting hormone therapy before symptoms appear allows men to live longer than if they waited until after symptoms appear to start taking medicine.footnote 1 Men who start hormone therapy almost always stay on it for the rest of their lives. So waiting until symptoms appear may allow men to delay the serious side effects of hormone therapy.
Hormone therapy usually works well at first to stop cancer growth. But in most cases, the cancer begins to grow again within a few years. At this point, the cancer is described as hormone-resistant, meaning it is not responding to standard hormone therapy. When this happens, other kinds of hormone treatments may be tried.
When hormone treatments no longer keep the cancer from growing, the cancer is called castrate-resistant prostate cancer (CRPC). Treatments that may be used to help men live longer include chemotherapy, immunotherapy, and medicines like enzalutamide.
In men who take medicine for hormone therapy, the side effects get worse over time. Some of the side effects will go away after the man stops taking the medicine. Side effects may include:
Other side effects may include hot flashes, erection problems and reduced sex drive, breast enlargement, and cognitive impairment. Some men may experience depression.
In men who have surgery for hormone therapy, two side effects happen right away and are permanent—the man becomes sterile and loses interest in sex. Other than those two side effects, surgery tends to have fewer side effects than medicine.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems).
The side effects of hormone therapy for prostate cancer often affect a man's quality of life. But there are treatments that can help with some of the side effects listed above. For example, exercise can help counteract the loss of muscle mass and will help with fatigue. There are medicines that can help with hot flashes, nausea, diarrhea, and bone loss. Low-dose radiation or taking tamoxifen may help prevent or reduce breast enlargement. For men with depression, counseling and medicine may help. For more information, see the topic Depression.
Above all, talk with your doctor about any of the symptoms you have while you are taking hormone therapy. Your doctor may know about a local support group for men who have prostate cancer.
CitationsNelson JB (2012). Hormone therapy for prostate cancer. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 2934–2953. Philadelphia: Saunders.Other Works ConsultedSun M, et al. (2015). Comparison of gonadotropin-releasing hormone agonists and orchiectomy: Effects of androgen-deprivation therapy. JAMA Oncology, published online December 23, 2015. DOI: 10.1001/jamaoncol.2015.4917. Accessed January 25, 2016.
ByHealthwise StaffPrimary Medical ReviewerE. Gregory Thompson, MD - Internal MedicineKathleen Romito, MD - Family MedicineSpecialist Medical ReviewerChristopher G. Wood, MD, FACS - Urology
Current as ofMarch 28, 2018
Current as of: March 28, 2018
Author: Healthwise Staff
Medical Review: E. Gregory Thompson, MD - Internal Medicine & Kathleen Romito, MD - Family Medicine & Christopher G. Wood, MD, FACS - Urology
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