Hormone Therapy for Prostate Cancer
Hormone therapy, also called androgen-deprivation therapy (ADT), reduces the effect of male hormones such as testosterone, which can stimulate the growth of prostate cancer.
ADT may be combined with radiation for some intermediate- and high-risk localized cancers, and it is a major treatment for prostate cancer that has spread beyond the prostate.
Hormone therapy can be very effective, but it can also have significant side effects, particularly when used for long periods. An important question is therefore not only whether to use ADT, but which treatment to use and for how long.
How Hormone Therapy Works
Prostate cancer cells usually depend on androgens, particularly testosterone, to grow. ADT works by reducing testosterone levels or blocking the ability of cancer cells to use it.
ADT can shrink the cancer, slow its growth, and make treatments such as radiation more effective. For advanced prostate cancer, newer medications that more completely interfere with androgen production or signaling are often combined with traditional ADT.
When Is Hormone Therapy Used?
For some men with intermediate- or high-risk localized prostate cancer, ADT is given for a period of time along with radiation.
For cancer that has spread beyond the prostate, hormone therapy is one of the main treatments. It may also be used when prostate cancer returns after surgery or radiation.
The appropriate treatment and duration depend on the cancer's risk level, stage, and other individual factors.
Side Effects and Metabolic Health
Common effects of ADT include hot flashes, fatigue, sexual side effects, loss of muscle and bone, and increased body fat.
Hormone therapy can also affect metabolic health, including insulin sensitivity, blood sugar, cholesterol, and cardiovascular risk factors.
Resistance training and aerobic exercise can help preserve muscle, strength, bone health, and physical function. Attention to nutrition, weight, and cardiovascular health is also important.
Men receiving long-term ADT should discuss bone health, metabolic health, exercise, and cardiovascular risk with their medical team.
Bone Health
Longer-term ADT can reduce bone density, and doctors may recommend bone-density testing (DEXA) to monitor for osteoporosis.
Adequate calcium and vitamin D are important, although supplements may not be necessary if dietary intake and vitamin D levels are adequate.
Resistance and weight-bearing exercise are also important for preserving muscle and bone.
How Long Is Hormone Therapy Needed?
The appropriate duration depends on the risk level of the cancer and the treatment being used with it.
When ADT is combined with radiation, some men may need it for only several months, while men with higher-risk disease may benefit from a longer course.
Because side effects generally become more important with longer treatment, it is reasonable to ask:
What benefit is expected from this length of hormone therapy, and could a shorter duration be appropriate for my cancer?
Recovering After Hormone Therapy
After ADT is stopped, testosterone may gradually recover, but the timing varies.
Recovery depends on age, testosterone level before treatment, the type of ADT, and how long it was used. Recovery may occur within months after shorter treatment, while after prolonged ADT it can take considerably longer. In some men, testosterone does not fully return to its previous level.
As testosterone returns, energy, muscle strength, sexual function, and body composition may improve.
Men finishing ADT can ask whether their testosterone and PSA should be monitored together during recovery.
Videos
A useful discussion of how long hormone therapy may be necessary when used with radiation.
PCRI explains how hormone therapy is used for high-risk prostate cancer and discusses common side effects and how they may be managed.
Practical ways to manage common side effects, including fatigue, hot flashes, loss of muscle and bone strength, weight gain, and metabolic changes.
PCRI explains what men can expect as testosterone recovers and the factors that may influence how quickly and completely it returns.