Hormonal Therapy

Hormonal therapy is usually the first treatment used to control prostate cancer which has spread to other areas of the body and in some cases can cause it to go into remission for several years. It can help to reduce symptoms like pain or problems passing urine.

Hormonal therapy reduces the body’s natural production of testosterone, the male hormone that ‘feeds’ prostate cancer. 

How Treatment Works

There are several types of hormonal therapy for non-localised prostate cancer. They are usually given as injections : Gosrelin (Zoladex®), Leuporelin (Prostap®) and Triptorelin (Decapeptyl® and Gonapeptyl Depot®). 

This treatment is given either once a month or every three months, usually by a GP. It is injected into the skin of the lower abdomen although some like Prostap may be injected into an arm or leg. 

Before men start hormonal injections, they will usually be given a course of tablets called anti-androgens such as Flutamide, Cyproterone Acetate or Biclutamide. They will usually need to start taking these tablets two weeks before an injection is given and for a short while afterward.

Once started, hormonal therapy will cause a drop in testosterone, leading to a lower PSA level. This happens because the hormonal therapy is ‘starving’ the cancer.  

What if Hormonal Therapy Stops Working?

Unfortunately, after some time, hormonal therapy may no longer work. Then a different treatment will be needed.  

A large clinical trial looking at different medications to control more advanced prostate cancer has recently finished. This trial called the STAMPEDE trail has had a huge impact on the understanding of which different types of treatment, including different types of hormone therapy can be used at different stages of advanced prostate cancer treatment.

Side Effects of Hormonal Therapy

Hormonal therapy is very effective at controlling and regressing prostate cancer but men may experience certain side effects.

Here is a list of common side effects and some strategies which can help: 

Hormonal Therapy Side Effects Symptom Management
Tiredness Schedule rest periods in your day. Plan ahead so that you don’t have to rush. Cut out any unnecessary activities and use labour-saving options.
Weight gain Stay active.
Hot flushes Avoid spicy food. Avoid smoking, caffeine and too much alcohol. Wear natural fabrics like cotton. Use natural fabrics for your bedding. Use a fan in your bedroom and carry a handheld fan. Always keep an insulated water bottle full of iced water with you, especially at night. NICE has recommended medication known as medroxyprogesterone and the anti-androgen Cyproterone Acetate to help treat persistent and difficult hot flushes in men on hormonal therapy.
Breast swelling (gynaecomastia) The drug tamoxifen may help reduce breast swelling and tenderness. It may be possible to have a limited dose of radiotherapy to the breast area.
Loss of sex drive (libido) You can read about this in detail here.
Holistic hormonal therapy relief Meditation, breathing exercises and acupuncture may all help. Up to date information on alternative health treatments from the NHS choices website can be found here.

Watch here to learn about Malcolm’s journey from diagnosis and treatment to the emotional and physical challenges of living with advanced prostate cancer.

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