Hormone Therapy for Prostate Cancer Also known as androgen-deprivation therapy or ADT, hormone therapy is used to stop testosterone from being released or to prevent it from acting on prostate cells. Find out if this is a treatment option for you. Prostate cancer is fueled by hormones called androgens. The primary male androgen is testosterone. Hormone therapy, also called androgen deprivation therapy (ADT), stops or slows the body’s ability to make testosterone. The goal is to stop tumor growth and/or shrink the tumor.In many cases, prostate cancer tumors respond to the removal of testosterone. However, some cancer cells grow independently of testosterone and remain unaffected by this treatment. These hormone-independent cells continue to progress and hormone therapy will have less of an impact on the tumor over time.For this reason, hormone therapy can't stop cancer. However, it is an important part of the treatment regimen in most cases during recurrent or advanced prostate cancer.Is hormone therapy right for you?Hormone therapy has long been an important treatment for men with advanced prostate cancer. It is increasing in use before, during and/or after other treatments. Hormone therapy may be used:before radiation to try to shrink the tumorif your prostate cancer returns after surgery or radiationif your prostate cancer has spread (metastasized)Hormone therapy is usually used during a time of rising PSA. But be sure to form a team of doctors and get opinions on when it might be best for your individual case. Types of hormone therapy & side effects The most commonly used types of hormone therapy include anti-androgens, luteinizing hormone treatment, and inhibitors. Since hormone therapy is a common treatment, we have an understanding of their side effects which can include cardiovascular (heart) problems, erectile dysfunction, hot flashes, weight gain, and changes in bone density. Learn more about the different types and side effects below. Expand All Orchiectomy An orchiectomy is the surgical removal of the testicles (which make more than 90% of the testosterone in the body). Men who prefer a one-time, low-cost procedure may go with this option. However, the procedure is permanent and irreversible. That’s why most men opt for drug therapy instead. LHRH agonists Luteinizing hormone-releasing hormone (LHRH) is a hormone released into the body prior to producing testosterone. Blocking the release of LHRH with the use of LHRH therapies is the most common hormone therapy used on prostate cancer patients. Drugs in this class include:Eligard (leuprolide)Lupron (leuprolide)Viadur (leuprolide)Trelstar (triptorelin)Zoladex (goserelin)They are administered as regular shots ranging from once per month to once per year. LHRH agonists cause what is known as a “flare” reaction - a rise in testosterone over the first several weeks following a shot (which can cause a temporary additional rise in PSA) before the drug starts to take action. LHRH antagonists Antagonist medications are a newer class of drugs that can block LHRH from stimulating testosterone production without causing an initial surge of testosterone, or flare. This class includes:Firmagon (degarelix)Orgovyx (relugolix)Firmagon is given as a monthly shot. Orgovyx is the first oral (pill) LHRH antagonist for men with advanced prostate cancer.Multiple studies have shown that LHRH antagonists may result in fewer cardiovascular side effects compared with LHRH agonists. Anti-androgens The “flare” or rise in testosterone associated with LHRH agonists (leuprolide, etc.) can be prevented with anti-androgens. They can help block the action of testosterone in prostate cancer cells. Anti-androgens include:Casodex (bicalutamide)Eulexin (flutamide)Nilandron (nilutamide)These hormone therapies are not typically used by themselves to treat prostate cancer but are instead used along with LHRH agonists. Inhibitors and blockers A newer class of hormone treatments that inhibit and block testosterone are referred to as androgen directed therapies. Androgen directed therapies are all oral medications, meaning they are pills you take by mouth. The FDA has approved several of these drugs for various classifications of advanced disease:Metastatic castration-resistant prostate cancer (mCRPC)Metastatic hormone-sensitive prostate cancer (mHSPC)Non-metastatic castration-resistant prostate cancer (nmCRPC)For more information about these types of advanced disease, visit our advanced prostate cancer section.The goal of abiraterone (Zytiga, Yonsa) is to block the production of testosterone and other androgens. Abiraterone is used with steroids (prednisone) to minimize its effects.Yonsa is approved for the treatment of mCRPCZytiga is also approved for mCRPC, and to treat mHSPC in conjunction with ADTXtandi (enzalutamide), Erleada (apalutamide), and Nubeqa (darolutamide) block androgen receptors to slow the production of testosterone without the use of a steroid.Xtandi is FDA-approved for nmCRPC in combination with ADT, to treat mCRPC, and to treat mHSPC in combination with ADTErleada is FDA-approved to treat mHSPC and for nmCRPC, in combination with ADTDarolutamide is FDA-approved for nmCRPC in combination with ADT Side effects Some side effects of using hormone therapies include:Breast pain or enlargementCardiovascular events, such as heart attacksCholesterol level changesConcentration, learning, and memory problemsDiarrhea and/or constipationErectile dysfunction and lower libido (loss of sexual desire)FatigueHot flashesMood changesIncreased risk of diabetesIncreased risk of osteoporosis (loss of bone density) and bone fractures (breaks)Increased risk of strokesWeight gain and increase in belly fatIn addition, research has shown a weak link between prolonged ADT and an increased risk of dementia.Some ADTs include a warning about an increased risk of diabetes, heart disease, and stroke. Regular follow-up appointments with your primary care doctor and a cardiologist will help you manage risks while on hormone therapy. Play Video Close Webinar What you need to know about ADT Dr. Alicia Morgans, Associate Professor at Harvard Medical School, Medical Oncologist at Dana-Farber and Chair of ZERO’s Medical Advisory Board, addresses how ADT is used to treat prostate cancer. Dr. Morgans also discusses who can benefit from ADT, how to manage side effects, and what questions to ask your doctor. Watch more educational videos here. ZERO's Educational Materials Library
Prostate cancer is fueled by hormones called androgens. The primary male androgen is testosterone. Hormone therapy, also called androgen deprivation therapy (ADT), stops or slows the body’s ability to make testosterone. The goal is to stop tumor growth and/or shrink the tumor.In many cases, prostate cancer tumors respond to the removal of testosterone. However, some cancer cells grow independently of testosterone and remain unaffected by this treatment. These hormone-independent cells continue to progress and hormone therapy will have less of an impact on the tumor over time.For this reason, hormone therapy can't stop cancer. However, it is an important part of the treatment regimen in most cases during recurrent or advanced prostate cancer.Is hormone therapy right for you?Hormone therapy has long been an important treatment for men with advanced prostate cancer. It is increasing in use before, during and/or after other treatments. Hormone therapy may be used:before radiation to try to shrink the tumorif your prostate cancer returns after surgery or radiationif your prostate cancer has spread (metastasized)Hormone therapy is usually used during a time of rising PSA. But be sure to form a team of doctors and get opinions on when it might be best for your individual case.
Types of hormone therapy & side effects The most commonly used types of hormone therapy include anti-androgens, luteinizing hormone treatment, and inhibitors. Since hormone therapy is a common treatment, we have an understanding of their side effects which can include cardiovascular (heart) problems, erectile dysfunction, hot flashes, weight gain, and changes in bone density. Learn more about the different types and side effects below. Expand All Orchiectomy An orchiectomy is the surgical removal of the testicles (which make more than 90% of the testosterone in the body). Men who prefer a one-time, low-cost procedure may go with this option. However, the procedure is permanent and irreversible. That’s why most men opt for drug therapy instead. LHRH agonists Luteinizing hormone-releasing hormone (LHRH) is a hormone released into the body prior to producing testosterone. Blocking the release of LHRH with the use of LHRH therapies is the most common hormone therapy used on prostate cancer patients. Drugs in this class include:Eligard (leuprolide)Lupron (leuprolide)Viadur (leuprolide)Trelstar (triptorelin)Zoladex (goserelin)They are administered as regular shots ranging from once per month to once per year. LHRH agonists cause what is known as a “flare” reaction - a rise in testosterone over the first several weeks following a shot (which can cause a temporary additional rise in PSA) before the drug starts to take action. LHRH antagonists Antagonist medications are a newer class of drugs that can block LHRH from stimulating testosterone production without causing an initial surge of testosterone, or flare. This class includes:Firmagon (degarelix)Orgovyx (relugolix)Firmagon is given as a monthly shot. Orgovyx is the first oral (pill) LHRH antagonist for men with advanced prostate cancer.Multiple studies have shown that LHRH antagonists may result in fewer cardiovascular side effects compared with LHRH agonists. Anti-androgens The “flare” or rise in testosterone associated with LHRH agonists (leuprolide, etc.) can be prevented with anti-androgens. They can help block the action of testosterone in prostate cancer cells. Anti-androgens include:Casodex (bicalutamide)Eulexin (flutamide)Nilandron (nilutamide)These hormone therapies are not typically used by themselves to treat prostate cancer but are instead used along with LHRH agonists. Inhibitors and blockers A newer class of hormone treatments that inhibit and block testosterone are referred to as androgen directed therapies. Androgen directed therapies are all oral medications, meaning they are pills you take by mouth. The FDA has approved several of these drugs for various classifications of advanced disease:Metastatic castration-resistant prostate cancer (mCRPC)Metastatic hormone-sensitive prostate cancer (mHSPC)Non-metastatic castration-resistant prostate cancer (nmCRPC)For more information about these types of advanced disease, visit our advanced prostate cancer section.The goal of abiraterone (Zytiga, Yonsa) is to block the production of testosterone and other androgens. Abiraterone is used with steroids (prednisone) to minimize its effects.Yonsa is approved for the treatment of mCRPCZytiga is also approved for mCRPC, and to treat mHSPC in conjunction with ADTXtandi (enzalutamide), Erleada (apalutamide), and Nubeqa (darolutamide) block androgen receptors to slow the production of testosterone without the use of a steroid.Xtandi is FDA-approved for nmCRPC in combination with ADT, to treat mCRPC, and to treat mHSPC in combination with ADTErleada is FDA-approved to treat mHSPC and for nmCRPC, in combination with ADTDarolutamide is FDA-approved for nmCRPC in combination with ADT Side effects Some side effects of using hormone therapies include:Breast pain or enlargementCardiovascular events, such as heart attacksCholesterol level changesConcentration, learning, and memory problemsDiarrhea and/or constipationErectile dysfunction and lower libido (loss of sexual desire)FatigueHot flashesMood changesIncreased risk of diabetesIncreased risk of osteoporosis (loss of bone density) and bone fractures (breaks)Increased risk of strokesWeight gain and increase in belly fatIn addition, research has shown a weak link between prolonged ADT and an increased risk of dementia.Some ADTs include a warning about an increased risk of diabetes, heart disease, and stroke. Regular follow-up appointments with your primary care doctor and a cardiologist will help you manage risks while on hormone therapy.
Play Video Close Webinar What you need to know about ADT Dr. Alicia Morgans, Associate Professor at Harvard Medical School, Medical Oncologist at Dana-Farber and Chair of ZERO’s Medical Advisory Board, addresses how ADT is used to treat prostate cancer. Dr. Morgans also discusses who can benefit from ADT, how to manage side effects, and what questions to ask your doctor.
