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 along with radiation treatment when there is a
high risk of the cancer returning. Or hormone therapy may be used after surgery
or radiation if any cancer remains.
Hormone therapy may also help men who have
cancer that has spread and who cannot have surgery or radiation. It may be used when prostate cancer has spread outside the prostate (metastatic disease). In these cases, hormone therapy reduces pain and helps men live a little longer.1
Hormone therapy may be used to suppress prostate cancer cells, which is reflected in lower levels of prostate-specific antigen (PSA).
Hormone therapy may also be used as the main treatment for prostate cancer instead of surgery or radiation. But hormone therapy doesn't seem to help men ages 66 and older who have localized prostate cancer. These men live just as long with active surveillance.2
Taking medicines is one way
to reduce androgens. Another way, used much less often, is surgery to remove
the testicles, also known as an orchiectomy.
Sometimes androgen deprivation (orchiectomy or an LH-RH
agonist) and an antiandrogen are used together for treatment. This targets the testosterone made by the testicles and the adrenal glands. It is called a
combined androgen blockade (CAB). According to research studies, men who had CAB that included flutamide or nilutamide lived longer than the men who had only androgen deprivation therapy.3
Other hormone therapies may include the use of
medicines such as megestrol, estrogen, aminoglutethimide
combined with hydrocortisone, and corticosteroids (prednisone, dexamethasone,
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.3 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.
The side effects of hormone therapy increase with the length of time that a man uses this therapy. Some of the side effects from hormone therapy will go away when a man who
is taking medicine finishes his hormone therapy. For a man who has an
orchiectomy, the side effects of sterility and loss of sexual interest are
immediate and permanent.
Side effects of hormone therapy may
Other side effects may include hot flashes, erection problems and reduced sex drive, breast enlargement, and cognitive impairment. Some men may experience depression.
See Drug Reference for a full list of side effects. (Drug
Reference is not available in all systems).
long-term side effects of hormone therapy, even for men taking medicine, are
not known. But hormone therapy has been linked to a higher risk for diabetes, cardiovascular disease, and a shorter life span.3
One large study found that
hormone therapy appears to be linked to a higher risk of death from heart
problems in men who had surgery for localized prostate cancer.4
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 before hormone therapy may help prevent 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.
Saylor PJ, Smith MR (2010). Adverse effects of androgen deprivation therapy: Defining the problem and promoting health among men with prostate cancer. Journal of the National Comprehensive Cancer Network, 8(2): 211–223.
Lu-Yao GL, et al. (2008). Survival following primary androgen deprivation therapy among men with localized prostate cancer. JAMA, 300(2): 173–181.
Nelson 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.
Tsai HK, et al. (2007). Androgen deprivation therapy for localized prostate cancer and the risk of cardiovascular mortality. Journal of the National Cancer Institute, 99(20): 1516–1524.
September 12, 2012
E. Gregory Thompson, MD - Internal Medicine
& Christopher G. Wood, MD, FACS - Urology, Oncology
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