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Introduction
This page has been written for patients who have been recommended hormone therapy for prostate cancer. It explains what the treatment involves, describes side-effects you may experience, and how best to cope with them.
We understand this is a worrying time for patients and their families, and we hope this page can help to answer any questions you have. If you have any questions about the treatment or information on this page, please speak to the team looking after you.
We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law, we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to having the procedure and understand what it involves.
Staff will explain all of the risks, benefits and possible alternatives before they ask you to sign a consent form. If you are unsure about any aspect of your proposed treatment, please do not hesitate to speak to the team looking after you.
During your time with us we aim to provide the highest standards of care and support you in your decisions regarding your treatment. We will respect your dignity, individuality, and personal preferences.
Your care will be managed and given by therapeutic radiographers, doctors, and nurses. You will meet both male and female healthcare professionals during your treatment. If you have any concerns about this, please talk to the radiographers about it. We try to be sensitive to your needs, so please do not hesitate to discuss things with the team caring for you.
Hormones are substances that occur naturally in your body. They act as chemical messengers and help control the growth and activity of cells and organs.
Testosterone is a hormone which controls the growth and development of the prostate gland, but also other characteristics such as muscle strength, erections and the size and function of the penis and testicles. Testosterone is made mainly in the testicles, but a small amount also comes from the adrenal glands, which sit on top of your kidneys.
Prostate cancer cells usually need testosterone to grow. If the level of testosterone is reduced, it is possible to slow the growth of the cancer and even cause it to shrink.
Hormone therapy is the use of injections and/or tablets to stop your body from making testosterone. Hormone therapy on its own won’t cure your prostate cancer. If you have hormone therapy on its own, the treatment will aim to control your cancer and delay or manage any symptoms. Hormone therapy can also be used with other treatments, such as radiotherapy, to make the treatment more effective.
Hormone therapy is an option for many people with prostate cancer but can be used in different ways depending on whether your cancer has spread. How you will be given the hormone therapy and for how long depends on the grade and stage of your tumour, your age and general health. It is often given for several months or several years but can also be given life-long. Your doctor and specialist nurse will discuss the best choice of hormone therapy for you.
Localised (early) prostate cancer- used temporarily alongside surgery, external beam radiotherapy or brachytherapy.
Localised (advanced) prostate cancer- used long-term because of the patient’s choice, or because surgery or radiotherapy are not suitable for them.
Recurrent prostate cancer- because neither radical prostatectomy (the removal of the prostate gland) nor radical radiotherapy (to the prostate) can be repeated.
Metastatic prostate cancer- given life-long treatment.
There are two main types of drugs used in hormone therapy for prostate cancer. These are called gonadotropin-releasing hormone (GnRH) agonists and anti- androgens.
Gonadotropin-releasing hormone (GnRH) agonists
GnRH stimulates the pituitary gland to release luteinizing hormone which affects how much testosterone the body makes. Testosterone is mainly produced by the testicles. GnRH agonists block the production of leutenising hormone from the pituitary gland. The testicles do not receive the message and so the production of testosterone is “switched off”.
The GnRH agonists used at UCH are Triptorelin and Leuprorelin. Both can be given as an injection into the buttocks or just under the skin of your tummy or arm.
Triptorelin can be given monthly, 3 monthly or 6 monthly. Leuprorelin can be given monthly or 3 monthly. The injections can be given by your GP or practice nurse at the GP surgery, or a district nurse if you are unable to visit the GP. Some people find the injection a little uncomfortable, and you may notice some slight bruising around the injection site afterwards. If you request it, a tiny amount of anaesthetic cream can be used on the skin to numb the area before the injection.
Anti-androgens
These drugs block the effects of the testosterone from your testicles and adrenals. They do not reduce the amount of testosterone. On the surface of the prostate cancer cells there are proteins called receptors. These receptors act as a lock, when testosterone meets them, they unlock or activate the cancer cells to grow.
The anti- androgens “attach” themselves to the receptors thereby blocking the testosterone, so the cancer cell cannot grow. One example of such a drug is Bicalutamide. Bicalutamide is usually taken daily in tablet form before and at the beginning of the Triptorelin or Leuprorelin injections.
Talk to your doctor or specialist nurse about your own situation, as what may be important to one person might be less important to someone else.
Advantages
- It’s an effective way to control prostate cancer, even if it has spread to other parts of your body.
- It can be used alongside other treatments to make them more effective.
- It can help to reduce some of the symptoms of advanced prostate cancer, such as urinary symptoms and bone pain.
Disadvantages
- It can cause side effects that might have a big impact on your daily life.
- It can’t cure your cancer when it’s used by itself, but it can help to keep the cancer under control, sometimes for many years.
There are some side effects common to all hormone therapies used for prostate cancer, and some that vary from drug to drug. You may experience only a few side effects, while others experience more. These side effects are temporary and generally reversible once the hormone therapy is stopped. Possible side effects may include:
Hot flushes
Hot flushes are a common side effect of hormone therapy and are like the hot flush’s women get when they’re going through the menopause. They can start as a feeling of warmth in your neck or face. This often spreads to other parts of your body. You may experience symptoms such as reddening of the skin, sweating, feelings of your heart beating in your chest (palpitations) or feelings of panic or irritability. They may get better as you get used to treatment. However, in some men the flushes continue for as long as you are on hormone therapy.
Talk to your doctor or specialist nurse if your hot flushes are hard to cope with. They will be able to provide you with practical advice on living with hot flushes or prescribe you medication.
Tumour flare
After the first Triptorelin or Leuprorelin injection there may be a temporary increase in the production of testosterone. Because of this, you may find that you experience an increase in symptoms such as bone pain or urinary obstruction. You will be prescribed Bicalutamide to take for a few weeks before the first injection to prevent this from occurring.
Changes to your sex life
This is a major side effect of hormone therapy. Hormone therapy can cause the following changes to your sex life:
- Low sex drive (low libido).
- Problems getting or maintaining an erection.
- Less intense orgasms.
- Reduced semen production.
- Changes to the size of your penis and testicles.
These changes may last while you are taking drugs such as Triptorelin or Leuprorelin. This is because you are not producing any testosterone. You may regain your sex drive and ability to get an erection when the treatment stops. This can take several months, (12 – 18months) after stopping, and will depend on how well your body recovers after the hormone treatment. Some men keep their sex drive and ability to maintain an erection when taking Bicalutamide alone, but there is a risk of becoming impotent with long-term treatment. About one in five men keep their ability to get an erection, even with long-term treatment. Your doctor and specialist nurse will discuss this more fully with you and discuss treatments available for erectile dysfunction. At UCH you can be referred to health professionals who specialise in erection problems.
Tiredness and fatigue
Hormone therapy can make you feel very tired. Fatigue can affect your everyday life, energy levels, motivation, and emotions. This may improve over time and there are things you can do to help manage fatigue. These include being physically active and planning your day to make the most of when you have more energy. Long-term hormone therapy can cause you to have a low level of iron in your blood. This can make you tired and breathless. You may have blood tests from time to time to check the iron levels in your blood.
Weight gain
Some people put on weight while they’re on hormone therapy, particularly around the waist. Eating a healthy diet and being more physically active may help you to maintain your normal weight. You can be referred to the oncology dietitian for further advice.
Strength and muscle loss
Testosterone is important for muscle strength. Hormone therapy can cause you to lose some muscle tissue. This can change the way your body looks and how physically strong you feel. Regular gentle resistance exercise may help reduce muscle loss ad keep your muscles strong. Talk to your doctor or specialist nurse before you start if you aren’t normally very physically active. They can help you work out what is best for you. Some men may also get aching muscles or joint pain due to muscle loss. Talk to your doctor or specialist nurse if you have any pain in your muscles or joints. They can talk to you about ways to manage it.
Breast swelling or tenderness
Hormone therapy may cause swelling (gynaecomastia) or tenderness in the breast area. This is a common side effect of Bicalutamide hormone therapy. The breasts can become tender and slightly enlarged. Breast swelling and breast pain can be very distressing and difficult to cope with. Many men feel embarrassed and less confident about themselves when they have it. Talk to your doctor or specialist nurse. They can work out the best treatment and support for you.
Bone health
Bone health is also important when on long term hormone treatment. The lack of testosterone can cause weakness of your bones, also known as osteoporosis.
Your doctor will assess if you are at high risk of bone loss. Getting older and having cancer treatment can increase the risk of bone loss. You may have a bone density scan, also called a DEXA or DXA scan, if you are at high risk.
Mood changes
Some men may experience mood swings, become more emotional than usual and anxious not only due to hormone therapy, but also dealing with a prostate cancer diagnosis and the impact of a cancer diagnosis on their lives. If you feel that you are struggling with your feelings, please don’t be embarrassed to talk to the team looking after you. If you need to discuss your feelings or personal issues in more depth you can be referred to the oncology psychology team. They are trained to listen, and to help you explore and clarify your thoughts and feelings.
Loss of body hair
Some men lose their body hair while they are on hormone therapy. This is because testosterone plays a role in hair growth. When testosterone is reduced, you might lose some of it. This can happen anywhere on your body, including your face, chest, and pubic area. The hair should grow back if you stop hormone therapy.
You’ll have regular blood tests to check the level of a protein called prostate specific antigen (PSA). PSA is a protein made by both normal and cancerous prostate cells. It is in the blood in small amounts in all men, unless they have had their prostate gland completely removed.
While the hormone therapy is working, the level of PSA should stay stable or may go down. But if prostate cancer cells are starting to grow and develop, the level of PSA may go up. Then your doctor may need to change your treatment. They will discuss this with you.
My Keyworker is:
They can be contacted on: 0203 447 7151
Or via email: uclh.uro-oncology.cns@nhs.net
Dr Mitra’s Secretary
t: 020 3447 9287
Dr Davda’s Secretary
t: 020 3447 9287
Dr Fittall’s Secretary
t: 020 3447 9287
Radiotherapy Review Team (via Radiotherapy Reception)
t: 020 3447 3700/3701
Radiotherapy reception
t: 020 3447 3700/ 020 3447 3701
Out of hours oncology advice number (available 24 hours)
t: 07947 959020
If you have any concerns that you would like to discuss in confidence, please contact our PALS (Patient Advice and Liaison Service) for information and advice.
t: 020 3447 3042
Prostate Cancer UK
t: 0800 074 8383
w: www.prostatecanceruk.org
WhatsApp: 020 3310 7100
Tackle Prostate Cancer
t: 0800 035 5302
e: helpline@tackleprostate.org
w: www.tackleprostate.org
Orchid: Fighting Male Cancer
t: 0808 802 0010
e: helpline@orchid-cancer.org.uk
w: www.orchid-cancer.org.uk
Errol McKellar Foundation (Black Afro-Caribbean men with prostate cancer)
w: www.
Metro Walnut (peer support group for LGBTQ people with prostate cancer)
w: www.
Live Though This (LGBTIQ+ Cancer Support)
w: www.livethroughthis.co.uk
Continence Foundation
e: info
w: www.continence-foundation.org.uk
Macmillan Cancer Support
t: 0808 808 0000
e: cancerline
w: www.macmillan.org.uk
Maggies
w: www.maggies.org
Cancer Research UK
t: 0808 800 4040
w: www.
Carers UK
t: 0808 808 7777
e: adviceline
w: www.carersuk.org
Carers Trust
w: www.
NHS Choices
w: www.nhs.uk
UCLH cannot accept responsibility for information provided by other organisations.
Services
Page last updated: 08 August 2024
Review due: 31 July 2025