If you have advanced prostate cancer, your doctor will probably want you to have hormone therapy. This treatment tries to stop cancer cells by blocking the hormones they use to grow and spread.
Hormone therapy can be up to 95% effective at treating prostate cancer. But it’s important to know that it can’t cure your condition. It can only slow down how fast the cancer spreads.
Your doctor will figure out whether hormone therapy is right for you based on the stage or risk group of your prostate cancer.
What Is Hormone Therapy?
Hormone therapy can be a successful treatment for prostate cancer, but the term “hormone therapy” can be confusing. Some experts prefer to call it androgen deprivation therapy (ADT) or androgen suppression therapy. Those names make clear that it’s different from the “hormone therapy” that people get when they’re:
- Going through menopause and getting estrogen
- Getting extra testosterone if they’re older and don’t have prostate cancer but need it to stay healthy
You could also hear hormone therapy referred to as “anti-testosterone therapy.”
How hormones link to prostate cancer
Androgens, such as testosterone, are male sex hormones. About 95% of your body’s testosterone is made in the testicles. Your prostate, the walnut-sized gland that makes your semen, relies on androgens to function.
Androgens also connect to and activate a special protein on your prostate cells called an androgen receptor. This helps all prostate cells — both normal ones and cancerous ones — to grow.
Experts still aren’t sure what causes your prostate cells to become cancerous and spread out of control. Instead of dying like normal cells, these cancer cells clump together to form a tumor. By blocking your body from making or using natural androgens, hormone therapy deprives prostate cancer cells of the androgens that they need to keep growing.
Prostate Cancer Treatment Plan: By the Numbers
Your treatment plan will likely include hormone therapy if you have advanced (stage 3 or stage 4) prostate cancer.
To make that diagnosis, your doctor will factor in the results from different tests like:
- Imaging scans
- Biopsy (tissue sample)
- Genetic testing
- Blood tests
Your doctor will pay close attention to your:
Gleason score
This is a number, usually between 6 through 10, that doctors give to cancer cells after looking at them under a microscope.
The number tells you how fast and quickly the cancer is likely to spread in your body. A higher number means the more aggressive the type of cancer is thought to be.
Prostate-specific antigen (PSA) level
PSA is a normal protein made by your prostate. Prostate cancer can cause higher levels than usual.
A rising PSA level after you’ve already had treatment can also make you a good candidate for hormone therapy.
Types of Advanced Cancer That Can Benefit From Hormone Therapy
Generally speaking, hormone therapy can help many types of prostate cancer. Your doctor will look at the stage and other factors to decide on the best treatment.
Risk Groups and Hormone Therapy
Even if your prostate cancer is in stage I, II, or III, your doctor may decide to treat you with hormone therapy.
Many doctors use specific details about your type of cancer to assign you into one of six risk groups.
Your risk group is based on factors like:
- How far the prostate tumor has grown
- PSA level
- Prostate biopsy results
- Grade group
Your grade group is like the Gleason score but assigns you a number from 1 to 5:
- A low number means your cancer is likely to grow slowly.
- A high number means your cancer is likely to grow quickly.
Some risk levels can see good results when treated with hormone therapy.
Your doctor could also suggest hormone therapy early on in your treatment plan if you have other serious health issues. It can also be an option if you can’t have surgery or radiation to treat your prostate cancer.
Different Types of Hormone Therapy
Hormone therapy isn’t one specific treatment. It’s a general term that describes many different therapies. They all stop androgens from being made or used inside your body.
Orchiectomy
Your testicles can be removed in an outpatient surgery in your doctor’s office. Since your testicles make 95% of the testosterone in your body, an orchiectomy can be a useful way to treat advanced prostate cancer. But not everyone wants to have this permanent procedure.
Luteinizing hormone-releasing hormone (LHRH) agonists
This is the most common hormone therapy for prostate cancer. These lab-made proteins prevent your pituitary gland from releasing LHRH, a hormone that signals when it’s time to make more androgens.
Luteinizing hormone-releasing hormone (LHRH) antagonists
These medications block your pituitary gland from making luteinizing hormone (LH), which lowers your body’s androgen levels.
Unlike LHRH agonists, they don’t cause a flare of testosterone after you first start taking them. That means the medicine doesn’t raise your risk for prostate cancer growth.
You could be prescribed a pill or get a monthly shot.
Androgen synthesis inhibitors
You take this type of medication to keep other cells in your body, including prostate cancer cells, from making more androgens. Androgen synthesis inhibitors work by blocking a specific enzyme known as CYP17 enzyme.
Your doctor may also prescribe them if you have an orchiectomy but your cancer keeps spreading.
Anti-androgens
Instead of stopping your body from making androgens, this type of daily medication prevents androgens from working normally. Your doctor may want you to take anti-androgen pills if other kinds of hormone therapy aren’t helping enough by themselves.
Estrogens
Female sex hormones can also prevent your testicles from making testosterone. But they’re rarely used to treat advanced prostate cancer today because of the side effects that they can cause.
Other Advanced Prostate Cancer Treatments You Could Have
Because hormone therapy alone can’t cure prostate cancer, your doctor will likely suggest another treatment at some point. Besides radiation and chemotherapy, that could include:
- Immunotherapy, medicines that boost your immune system to kill cancer cells
- Targeted therapy, medications that target and attack cancer cells
- Cryotherapy, which freezes cancer cells with a very cold substance
High-intensity ultrasound therapy is also used to destroy cancerous prostate tissue.
Side Effects of Hormone Therapy
Everyone is different, so you may not have all the side effects. Here are the side effects of hormone therapy for advanced prostate cancer.
You don’t need to go through physical or emotional side effects alone. If you have symptoms while you’re taking hormone therapy, let your doctor know.
While you may feel uncomfortable talking about any changes you’ve noticed, your doctor may be able to prescribe medications to help manage them.
They could also suggest other things you can do to keep any side effects from interfering with your daily life. For instance, studies show exercise can help with some side effects of hormone therapy.
What If Hormone Therapy Doesn’t Work?
If you take hormone therapy for more than a few months, you’ll get regular blood tests to check your PSA levels. A rising number could mean that the prostate cancer cells are starting to resist the current hormone therapy and are spreading again.
The cancer cells in your prostate may start to change so they no longer rely on androgens like testosterone to grow. Experts call this hormone-resistant, or castration-resistant, disease. You could also hear it referred to as hormone-resistant prostate cancer (HRPC).
Hormone therapy can still be an option. Your doctor can add other medications to your treatment plan.
It’s common to have a lot of questions about advanced prostate cancer treatment. Write them down so you can ask your doctor at your next visit. They’re the best person to ask about how hormone therapy can benefit you and what you can expect as you start it.
Show Sources
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SOURCES:
Mayo Clinic: “Hormone therapy for prostate cancer,” “Hormone therapy medicines and advanced prostate cancer — What you need to know,” “Metastatic (Stage 4) Prostate Cancer.”
Cleveland Clinic: “Prostate Cancer,” “Prostate.”
National Cancer Institute: “Hormone Therapy for Prostate Cancer,” “Prostate Cancer Treatment,” “Prostate Cancer Treatment (PDQ) — Patient Version,” “Many Men With Metastatic Prostate Cancer Are Not Getting the Recommended Treatments, Study Finds.”
Johns Hopkins Medicine: “Hormone Therapy for Prostate Cancer.”
UCSF Department of Urology: “Hormone Therapy.”
Dana-Farber Cancer Institute: “Five Things You Should Know About Aggressive Prostate Cancer.”
Harvard Health: “Treating Advanced Prostate Cancer.”
Prostate Cancer Foundation: “Hormone Therapy,” “Treatment of Hormone-Resistant Prostate Cancer,” “Treatment of Metastatic Hormone-Sensitive Prostate Cancer.”
Fred Hutch Cancer Center: “Hormone Therapy for Prostate Cancer.”
American Cancer Society: “Initial Treatment of Prostate Cancer, by Stage and Risk Group,” “Tests to Diagnose and Stage Prostate Cancer,” “Risk Groups and Lab Tests To Help Determine Risk From Localized Prostate Cancer,” “Initial Treatment of Prostate Cancer, by Stage and Risk Group.”
