Hormone Therapy for Prostate Cancer
Understanding when hormone therapy is recommended, how it works, and what to expect during treatment.
Hormone therapy is commonly used to treat higher-risk and advanced prostate cancer. Learn when it may be recommended, how it works, the different treatment options available, possible side effects, and how treatment is monitored.
Overview
Hormone therapy is an important treatment option for many men with prostate cancer. It is commonly used alongside radiotherapy for higher-risk disease, as treatment for cancer that has spread beyond the prostate, or when prostate cancer returns after previous treatment.
What Is Hormone Therapy for Prostate Cancer?
Most prostate cancer cells rely on male hormones called androgens, particularly testosterone, to grow and multiply.
Hormone therapy, also known as androgen deprivation therapy (ADT), reduces testosterone levels in the body or blocks its effects on prostate cancer cells.
Lowering testosterone can slow or shrink prostate cancer, relieve symptoms, and improve the effectiveness of other treatments such as radiotherapy.
Hormone therapy does not involve surgery to remove the prostate. It is usually given as injections, tablets, or a combination of both.
When Is Hormone Therapy Recommended?
Hormone therapy may be recommended in several situations.
Localised High-Risk Prostate Cancer
For men with higher-risk localised prostate cancer, hormone therapy is often combined with radiotherapy.
Starting hormone therapy before radiotherapy and continuing it afterwards can improve cancer control and reduce the risk of recurrence.
Locally Advanced Prostate Cancer
If cancer has grown beyond the prostate but has not spread to distant organs, hormone therapy may be used together with radiotherapy as part of a multimodal treatment approach.
Metastatic Prostate Cancer
When prostate cancer has spread to lymph nodes, bones, or other organs, hormone therapy is often a key part of treatment.
In many cases, additional medications may be combined with hormone therapy to improve outcomes.
Biochemical Recurrence
Some men develop a rising PSA level after surgery or radiotherapy despite no visible cancer on imaging.
Hormone therapy may be recommended depending on PSA trends, imaging findings, previous treatments, and overall health.
Advanced Cancer Symptom Relief
Hormone therapy may also help relieve symptoms caused by advanced prostate cancer, including bone pain or urinary obstruction.
What Types of Hormone Therapy Are Available?
Hormone therapy can be given in different ways depending on the stage of prostate cancer and previous treatments. Some medications reduce testosterone production, while others block testosterone from stimulating prostate cancer cells. Many men receive a combination of treatments.
LHRH Agonists
These medications reduce testosterone production by the testes.
Examples include:
- Leuprorelin
- Goserelin
- Triptorelin
They are usually given as injections every one, three, or six months.
Some men experience a temporary increase in testosterone levels shortly after starting treatment, known as a “tumour flare”. Additional medication may be prescribed temporarily to reduce this effect.
LHRH Antagonists
These medications reduce testosterone levels more rapidly and do not cause tumour flare.
Examples include:
- Degarelix
- Relugolix
Depending on the clinical situation, they may be given as injections or tablets.
Anti-Androgen Medications
These medications block testosterone from acting on prostate cancer cells.
Examples include:
- Bicalutamide
- Enzalutamide
- Apalutamide
- Darolutamide
Androgen Synthesis Inhibitors
These medications reduce hormone production from multiple sources within the body.
Examples include:
- Abiraterone acetate
They are often used together with other treatments for advanced prostate cancer.
Your treatment plan will depend on the stage of cancer, previous treatments, PSA levels, imaging findings, general health, and treatment goals.
How Long Does Hormone Therapy Last?
The duration of hormone therapy varies depending on the type and stage of prostate cancer.
- Around 4–6 months for some men receiving radiotherapy
- 18–36 months for selected higher-risk prostate cancer
- Long-term treatment for metastatic prostate cancer
Your doctor will discuss the expected duration of treatment based on your individual situation.
What Side Effects Can Occur?
Because hormone therapy lowers testosterone levels, it can affect several aspects of physical and emotional health.
Common side effects include:
- Hot flushes and sweating
- Reduced sexual desire
- Erectile dysfunction
- Fatigue
- Weight gain
- Loss of muscle mass
- Mood changes
- Difficulty concentrating
- Reduced bone density
- Increased body fat
- Breast tenderness or enlargement
Not everyone experiences all of these side effects, and the severity varies between individuals.
Many side effects can be managed with lifestyle measures, medications, or supportive therapies.
Can Lifestyle Changes Help During Hormone Therapy?
Regular exercise and healthy lifestyle habits can help reduce treatment-related side effects and improve overall wellbeing.
Strategies that may help include:
- Regular resistance or strength training
- Moderate cardiovascular exercise
- Maintaining a healthy weight
- Eating a balanced diet with adequate protein
- Avoiding smoking
- Limiting alcohol intake
- Ensuring adequate calcium and vitamin D intake where appropriate
Some men may require bone density assessments or medications to protect bone health during long-term treatment.
Discuss any supplements with your healthcare team before starting them.
How Is Hormone Therapy Monitored?
Regular follow-up helps assess treatment response and monitor for side effects.
Monitoring may include:
- PSA blood tests
- Testosterone levels
- Assessment of symptoms and quality of life
- Blood pressure and weight checks
- Bone health assessments
- Imaging scans when required
Changes in PSA levels are interpreted alongside symptoms, examination findings, and imaging results.
What Happens If Hormone Therapy Stops Working?
Some prostate cancers eventually become less responsive despite low testosterone levels. This stage is known as castration-resistant prostate cancer (CRPC).
A rising PSA level does not always mean hormone therapy has stopped working completely.
Depending on the individual situation, further treatment options may include:
- Newer hormone-blocking medications
- Chemotherapy
- Radioligand therapy
- Targeted therapies
- Clinical trials
Advances in treatment have expanded the options available for men with advanced prostate cancer.
Questions to Ask Your Specialist
You may wish to discuss the following questions during your consultation:
- Why is hormone therapy recommended for me?
- What are the goals of treatment?
- How long is treatment expected to continue?
- What side effects should I expect?
- How will treatment affect my sexual function?
- What can I do to maintain my strength and bone health?
- How often will I need follow-up appointments?
Frequently Asked Questions
Is hormone therapy the same as chemotherapy?
No. Hormone therapy works by reducing or blocking testosterone, while chemotherapy uses medications that directly target rapidly dividing cancer cells.
Can hormone therapy cure prostate cancer?
Hormone therapy alone does not usually cure prostate cancer.
However, when combined with treatments such as radiotherapy, it can improve long-term cancer control for selected patients.
Will hormone therapy affect sexual function?
Reduced libido and erectile dysfunction are common side effects because testosterone levels decrease during treatment.
The degree of change varies between individuals.
Can I exercise during hormone therapy?
Yes. Regular exercise, particularly resistance training and aerobic activity, can help reduce fatigue, maintain muscle mass, support bone health, and improve quality of life.
Will I lose all my testosterone permanently?
In many cases, testosterone levels gradually recover after hormone therapy stops.
Recovery time varies depending on age, treatment duration, and the specific medication used.
What happens if my PSA rises during hormone therapy?
A rising PSA level may require further evaluation with repeat blood tests, imaging, or additional treatment.
Your healthcare team will interpret PSA changes in the context of your overall clinical situation.
Can I continue working while receiving hormone therapy?
Most men are able to continue their usual daily activities, although some experience fatigue or reduced stamina. The impact varies between individuals, and adjustments may be needed depending on your symptoms and the type of work you do.
Can hormone therapy be stopped?
Some men receive hormone therapy for a fixed period, while others continue treatment for several years or indefinitely. This depends on the stage of prostate cancer and how well treatment is working.
Will I need regular PSA tests?
Yes. PSA testing is one of the main ways your doctor monitors how well hormone therapy is controlling prostate cancer. Results are interpreted together with symptoms, examination findings and imaging when necessary.
Discuss Whether Hormone Therapy Is Right for You
Hormone therapy is not appropriate for every man with prostate cancer. Treatment depends on the stage of the disease, previous treatments, PSA trends, imaging findings, your overall health, and your treatment goals. If hormone therapy has been recommended, or if you would like to better understand your options, a consultation can help you make an informed decision.