Prostate cancer - androgen deprivation therapy

What is prostate cancer?#

The prostate is a small gland that surrounds the urethra and is part of the male reproductive system. It produces some of the fluid that makes up semen, which enriches and protects sperm.

Prostate cancer occurs when abnormal cells develop in the prostate. These cells can continue to multiply and may spread beyond the prostate.

• Cancers that stay within the prostate are called localized prostate cancer.
• If the cancer extends into the surrounding tissues or the pelvic lymph nodes, it is called locally advanced prostate cancer.
• If it spreads to other parts of the body, including other organs, lymph nodes outside the pelvis and bones, it is called advanced or metastatic prostate cancer.

What is hormone therapy?#

Hormone therapy, or androgen deprivation therapy (ADT), uses medicines to reduce testosterone levels and treat prostate cancer. Testosterone is one of several male hormones known as androgens that are important for a healthy prostate. Unfortunately, testosterone can also help prostate cancer cells to grow and spread, so lowering testosterone can slow the growth of the cancer.

Hormone therapy is the standard first-line treatment for advanced prostate cancer. It is also used in combination with radiation therapy to treat localized and locally advanced prostate cancer, and it may be combined with other treatments such as newer anti-androgens and chemotherapy.

Hormone therapy can keep prostate cancer under control for several years by shrinking it, delaying its growth and reducing symptoms. How well it controls the cancer differs from one man to another. There are many different types of hormone therapy medicines, so if one is not effective for you, your doctor may prescribe a different one.

Depending on the type of cancer and what other treatments you have had or are having, you could be on hormone therapy for a few months, for several years, or indefinitely. It can be given in many forms, including oral tablets, injections, an injectable implant, or a combination of these. Hormone therapy treats prostate cancer cells wherever they are in the body.

Who can have hormone therapy?#

You may be offered hormone therapy:

• if you have prostate cancer that has spread outside the prostate gland or to other parts of the body (advanced or metastatic prostate cancer)
• before, during and/or after prostate radiation therapy, to reduce the chance of the cancer spreading and improve the likelihood of a cure.

What are the benefits?#

Hormone therapy can produce a rapid and often long-term reduction in the growth of prostate cancer, which can be seen as a fall in your PSA level.

What does hormone therapy involve?#

Hormone therapy can be given as medications (injections, implants or tablets) that block the production of testosterone or block the effects of testosterone on cells. These methods are reversible, and in most cases, once treatment stops, your testosterone level and its effects on the body return to normal after a period of time.

Testosterone production can also be permanently stopped by a surgical procedure to remove the testicles (called an orchidectomy), which stops about 95% of the body’s testosterone production. However, this is rarely done these days, as injections or implants are commonly used instead. When it is performed, it is usually done as a day procedure, and it is unlikely you will need to stay in hospital overnight.

Many men have trouble accepting the removal of their testicles, and some are concerned about how they will look afterwards. It is possible to have implants inserted; these are small and soft, and they look and feel like normal testicles. Ask your doctor, nurse or a member of your healthcare team for advice.

Possible side effects of hormone therapy#

All prostate cancer treatments, including hormone therapy, can have side effects. How likely you are to have them depends on the type of hormone therapy and how long you are on it. If you are having other treatments as well, you may also experience side effects from those.

Hormone therapy affects people differently. Some men have minimal or no side effects, while others are very troubled by them. After stopping treatment, some side effects diminish with time, but sometimes they do not go away. Recovery depends on your age, the type of hormone therapy, whether you had a short course over a few months or a longer course over several years, and whether the treatment was continuous or intermittent.

Possible side effects include:

• loss of libido or sex drive
• erection problems
• hot flushes and night sweats
• fatigue (tiredness)
• weight gain from increased body fat
• declining bone density (osteoporosis)
• loss of muscle mass and muscle weakness
• depression or mood swings
• poor memory, concentration and physical unsteadiness
• breast swelling and tenderness
• increased risk of cardiovascular disease and diabetes
• other effects such as headaches, itching, dry skin, rashes, gastrointestinal issues, nausea and vomiting.

Ask your doctor how long you will be on hormone therapy and what to expect when you stop. It helps to find out as much as you can about your treatment and its side effects before you start, so you can be better prepared. If you are troubled by side effects, contact your doctor.

Looking after yourself#

Hormone therapy can affect all areas of your life, so it is important to look after yourself. If you have prostate cancer, it is normal to have a wide range of feelings, such as shock, sadness, anger, fear and frustration. You may also notice physical effects of stress, such as nausea, stomach upsets, feeling irritable or on edge, and trouble sleeping. Some days will be worse than others.

It can help to talk through your problems with a partner or good friend, gather information and advice from trusted sources, and focus on keeping well. If you are distressed and having trouble coping, talk to your doctor or a member of your healthcare team.

Physical activity and exercise#

Physical activity is very important for maintaining and improving your physical and psychological health. Aim to do some physical activity most days, if not every day. Targeted exercise can help slow the progression of prostate cancer, reduce treatment side effects and support your recovery. It can also improve your quality of life and help with anxiety and depression.

Some of the most effective forms of exercise are:

• resistance training, such as lifting weights, stair climbing and higher-intensity resistance workouts
• cardiorespiratory exercise, such as fast walking, jogging, cycling and swimming.

For the best results, consider getting advice from an accredited exercise physiologist.

Diet and nutrition#

A healthy, balanced diet can improve your strength, vitality and wellbeing, help you manage your cancer experience, and improve your outcomes from treatment. For the best diet:

• eat plenty of fruit and vegetables, wholegrain foods, and lean meat, fish, poultry and low-fat dairy
• avoid animal fats, processed meals, biscuits, cakes and pies, salt and added sugars
• drink plenty of water
• limit alcohol
• stop smoking.

Key points#

• Testosterone is one of several male hormones known as androgens that are important for a healthy prostate, but it can also help prostate cancer grow.
• Hormone therapy lowers testosterone to slow the cancer, and it can be given as tablets, injections or implants; surgery to remove the testicles is rarely recommended now.
• All prostate cancer treatments, including hormone therapy, can have side effects, and these affect people differently.
• If you are having other treatments as well, you may also experience side effects from those.
• Hormone therapy can affect all areas of your life, so it is important to look after yourself with support, exercise and a healthy diet.

Where to get help#