Hormonal Therapy

What is Hormonal Therapy or Androgen Deprivation Therapy (ADT)?

Prostate cancer cells use the hormone testosterone to grow, similar to our need for food. Hormonal therapy is also known as androgen deprivation therapy (ADT). It uses drugs to block or lower testosterone and other male sex hormones that fuel cancer. ADT essentially starves prostate cancer cells of testosterone. ADT is used to slow cancer growth in cancers that are advanced or have come back after initial local aggressive therapy. It is also used for a short time during and after radiation therapy.

Hormone therapy is done surgically or with medication:

Surgery: Removes the testicles and glands that produce testosterone with a procedure called an orchiectomy.

Medication: There are a variety of medications used for ADT. There are two types that are used at first. One is the injection of luteinizing hormone releasing hormone (LH-RHs) inhibitors. These are also called either agonists or antagonists. They suppress the body's natural ability to turn on testosterone production. A second type (which is often given with the first type) are called non-steroidal anti-androgens. These pills block testosterone from working.

These therapies have been used for many years and are often offered as the first option for men who can't have or don't want other treatments. Hormone therapy usually works for a while (maybe for years) until the cancer "learns" how to bypass this treatment.

There are new medications available in recent years that may be used after other hormone therapy fails. This condition is called "castration-resistant prostate cancer" (CRPC). For more information on this, review our Advanced Prostate Cancer website article.

To block the production of androgens in CRPC patients, there are a few options. The drug Abiraterone (Zytiga), given with prednisone, is one option that blocks an enzyme called CYP17, to stop these cells from making androgens. Another option is a drug, enzalutamide (Xtandi ®) that blocks the testosterone from working in a different way. This medication blocks signals in cells that tell it to grow and divide. Like other hormone therapies, these options also only work for a while. When they stop working, chemotherapy may be an option. 

What Are The Benefits, Risks and Side Effects of Hormone Therapy?

Hormone therapy has been linked to heart disease, diabetes and the loss of bone. You should discuss these risks with your doctor before you begin this treatment for prostate cancer.

Hot flashes and fatigue are also short-term side effects of hormone treatment. The same is true for the loss of sexual drive. 

Updated August 2018