Your prostate is a gland that sits just below your bladder and in front of your rectum. It’s an important part of the male reproductive system and helps make your semen.
For reasons that experts still don’t understand, prostate cells can sometimes become cancerous. These cancer cells can:
- Start to grow out of control
- End up crowding out your normal prostate cells
- Live longer than healthy cells
- Travel to other parts of your body and cause damage
Prostate cancer is one of the most common types of cancer. Cases of advanced prostate cancer are rising in men of every age group.
Hormone therapy for advanced prostate cancer
Hormone therapy (HT) is often the first treatment choice for advanced prostate cancer. It’s not a cure, but it can slow down how fast the cancer cells spread in your body.
Your specific type of hormone therapy and how long it works can depend on your cancer stage (how far it’s already spread) and the chance that your cancer will keep growing quickly.
What Is Advanced Prostate Cancer?
Advanced prostate cancer means your cancer cells have spread outside the prostate gland. Your doctor may refer to your advanced prostate cancer as:
Stage 3 prostate cancer. Also called locally advanced prostate cancer or non-metastatic prostate cancer, your cancer cells are growing outside your prostate. The cancer cells may be in nearby tissues like your lymph nodes or seminal vesicles (where the fluid in your semen is made).
Stage 4 prostate cancer. Also called metastatic prostate cancer, your cancer cells have broken free from your prostate and spread (metastasized) to more distant parts of your body. Your cancer cells may be in your bones, liver, or lungs.
Hormone Therapy Based on Your Risk Group
Your doctor could also decide to treat you with hormone therapy based on your risk group. They assign this to you based on factors like your physical exam, biopsy (tissue sample) results, and protein-specific antigen (PSA) level.
PSA is a protein made by your prostate. When you have cancer in your prostate, PSA can be measured through a blood test.
Your risk group helps your doctor understand how likely it is that your cancer is aggressive and will spread quickly.
Hormone therapy is often used in prostate cancer that falls into one of these risk groups:
- Intermediate (unfavorable)
- High risk
- Very high risk
What Happens When You Have Hormone Therapy?
Hormone therapy isn’t one medication. Doctors use this term to describe a number of treatments that can block your body from making or using male sex hormones (androgens) that prostate cancer cells use to grow.
You may get hormone therapy as pills, shots, or as surgery. Hormone therapy treats advanced prostate cancer by:
- Shrinking tumors
- Slowing down how fast the cancer cells spread
- Lessening symptoms caused by the cancer
There’s no cure for advanced prostate cancer. Hormone therapy can only try to control it. Because of that, you’ll likely need to have other cancer treatments, too.
Types of Hormone Therapy
Prostate cancer is a complex condition. But there are many hormone therapies that can effectively treat advanced prostate cancer. Here are some common types.
Orchiectomy
This surgery removes part or all of your testicles, where over 90% of your testosterone is made. It’s a permanent procedure, and you can’t reverse it once it’s done.
An orchiectomy can cause many prostate tumors to stop growing or shrink for a while.
Luteinizing hormone-releasing hormone (LHRH) agonists
This treatment acts like LHRH and at first, the medicine floods your pituitary gland to cause a testosterone flare (surge). But after a while, the gland stops responding, which leads to a drop in testosterone.
LHRH antagonists
These medicines block the pituitary gland from releasing LH, which stops your testicles from making testosterone.
Androgen synthesis inhibitors
This kind of hormone therapy targets an enzyme called CYP17. This enzyme helps your body make some types of androgens.
Anti-androgens
These drugs attach to special receptors on prostate cancer cells and prevent them from using testosterone. You usually take an anti-androgen with another type of hormone therapy.
Advanced prostate cancer treatments
If you have advanced prostate cancer, hormone therapy will probably be part of your treatment plan, but your doctor will likely want you to have other treatments, too.
Options include a second hormone therapy, or it could include non-hormone treatments.
How Long Do You Take Hormone Therapy?
There’s no set timetable for how long you’ll stay on hormone therapy. Your doctor will take into account things like:
- How far the cancer has spread
- Your overall health
- Other cancer treatments you’re taking or have taken in the past
- Your other prescription medications
- Quality-of-life issues
You could take hormone therapy for just a few months. Or your doctor may want you to stay on it for several years or for the rest of your life.
Different Prostate Treatment Approaches
Doctors often combine different treatments and procedures to help your prostate cancer. This helps you choose the medicines that work best for your health.
If you have locally advanced prostate cancer, your cancer may have spread outside the prostate gland and into nearby tissues.
Your doctor may start hormone therapy after surgery or radiation. They may want you to stay on it for six months to up to two years.
If you’re diagnosed with high-risk prostate cancer and also treated with high-dose radiation, your doctor may suggest taking hormone therapy anywhere between four months to two years.
One study found that long-term treatments might be more effective than short-term HT when you have high-risk prostate cancer. Men who stayed on HT longer were less likely to see their cancer come back than those who only had hormone therapy for four months.
When Does Hormone Therapy Stop Working?
Your doctor may rely on regular PSA tests to make sure your hormone therapy is able to control your prostate cancer. A rising PSA number can signal that cancer cells have started to resist hormone therapy and are growing again.
It's common for this to happen. In fact, for people who take hormone therapy:
- About half get treatment-resistant prostate cancer within two to three years.
- Others get treatment-resistant prostate cancer after more than two to three years.
When this happens, doctors call it hormone-refractory or hormone-resistant prostate cancer. Another name is castration-resistant prostate cancer.
When hormone therapy stops working
If your hormone therapy stops working, your doctor may want you to keep taking it so your testosterone stays low.
Then they’ll usually adjust your treatment plan to include:
- Another type of hormone therapy
- Chemotherapy
- Targeted therapy
- Radiation therapy
- Bone medications that can treat cancer cells in your bones
Intermittent Hormone Therapy
A newer approach to keep cancer cells from resisting hormone therapy is called intermittent hormone therapy. Also called intermittent androgen deprivation therapy (ADT), you take scheduled breaks from your hormone therapy.
Doing this could also help relieve some common side effects of HT and improve your quality of life.
How intermittent hormone therapy works
It can be different for everyone, but here's a general outline of what intermittent hormone therapy may look like. This can give you an idea of what to expect.
Researchers are still studying the benefits of intermittent hormone therapy. It might not be the best strategy for everyone. Your doctor will be able to explain if they think it could be the right choice for you.
Hormone Therapy Side Effects
The longer that you’re on hormone therapy, the more likely it is that you’ll have side effects.
Side effects like these usually begin within four to six weeks after you start hormone therapy. Some side effects can be challenging, but learning about them can help you prepare.
If you’re having symptoms, tell your doctor — they can help you manage them. Your health care team can also discuss any other prostate cancer treatments.
What to Expect From Hormone Therapy
Treating advanced prostate cancer is complex, and doctors have a lot of different hormone therapy options to choose from.
Make sure to bring up questions at your next visit so you understand which type could be the right fit for you.
Doctors often have different treatment approaches. If you have concerns about what your doctor suggests, think about getting a second opinion.
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
UCSF Department of Urology: “Hormone Therapy.”
Johns Hopkins: “Hormone Therapy for Prostate Cancer.”
Harvard Health: “Prostate cancer: How long should hormonal therapy last?” “Treating advanced prostate cancer.”
Lancet Oncology: “High-dose radiotherapy and risk-adapted androgen deprivation in localised prostate cancer (DART 01/05): 10-year results of a phase 3 randomised, controlled trial.”
CDC: “Prostate Cancer Basics,” “Treatment of Prostate Cancer,”
Zero Prostate Cancer: “Understanding advanced prostate cancer.”
National Comprehensive Cancer Network Foundation: “2025 NCCN Guidelines for Patients: Advanced-Stage Prostate Cancer.”
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