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Hormone Therapy, also known as Androgen Deprivation Therapy (ADT) is generally used in the treatment of advanced prostate cancer, (cancer which has spread beyond the prostate) but can also be used in association with external beam radiotherapy and in patients undergoing low dose rate brachytherapy, to help shrink the size of the prostate.

Testosterone, the male hormone released from the testicles, fuels prostate cell growth in both healthy cells and prostate cancer cells. It is for this reason that testosterone is targeted for intervention with hormone therapy. The cancer cells die if testosterone is not present though unfortunately, not all cancer cells are affected by ADT and some cells can still grow even if testosterone is not present. These cells are known as androgen independent cells. When a patient is on ADT their PSA readings drop significantly and are often undetectable.

The options for Prostate Cancer Hormone Therapy

There are two ways in which male hormones can be reduced. They can be reduced by surgical removal of the testicles known as orchidectomy or by hormone therapy medications. These medications are known as either LHRH agonists or Antiandrogens. Previously, these 2 types of medications were frequently taken together although the effectiveness of the combination of these is now questioned.

Orchiectomy:

This is a surgical procedure to remove the testicles. It is a day surgical procedure and is performed through a small cut in the scrotum. Once it is performed its effects are not reversible.

LHRH agonists:

(Luteinizing hormone releasing hormone) This common hormone therapy reduces the amount of testosterone produced by the testis by blocking the release of luteinizing hormone (LH). LH is a hormone produced by the brain that switches on testosterone production in the testis. These are given by injection into the subcutaneous tissues or muscle and are given once a month, once every 3 months, once every 4 months or once a year.

Antiandrogens:

These stop testosterone and other male hormones from entering cells and from being recognised by the androgen receptors which detect testosterone. Testosterone levels do not reduce but testosterone cannot get into the cells to act. Antiandrogens are often used in combination with LHRH for the initial 4 weeks of treatment, to reduce sometimes painful symptoms of LHRH which can cause testosterone to flair and temporarily increase a patient’s symptoms. There are several types of antiandrogens available on the market but the common ones are Androcur (cyproterone acetate), Anandron (nilutamide) and Casodex (bicalutamide). These medications are in tablet form and are generally considered not to be the optimal choice for men with metastatic prostate cancer, as they are not as effective as LHRH agonists or orchiectomy.

What you can do to help with your Hormone Treatment

Diet

Diet is very important for patients undergoing hormone therapy for prostate cancer. There are several things that are thought to be beneficial however the most important thing, is to ensure you have a well balanced diet.

You do not have to stop eating meat but should limit red meat to 3 or 4 times a week and limit the amount of saturated fat intake in your diet. Tomatoes and broccoli are thought to be beneficial but not absolutely necessary. Antioxidants are considered helpful in patients with prostate cancer. Antioxidants can be found in artichokes, blueberries, beans, prunes, raspberries, strawberries and cranberries. For further information on diet and dietary supplements in prostate cancer please click here to download our document.

Patients who are talking hormone therapy, are at risk of osteoporosis and to help prevent this, supplementation with calcium and vitamin D in the form of one tablet twice a day of Caltrate Plus, is recommended.

Exercise

Aerobic exercise such as brisk walking, swimming and cycling is very important and resistance training such as weights, prevents bone loss, improves mood, improves energy, builds muscle and reduces fat. It would be of great benefit to consider supervised training with a personal trainer or physiotherapist.

Do not stop or start ADT by yourself. It is essential that ADT is supervised medically. Stopping or starting ADT or other therapies inappropriately may trigger the cancer to grow or cause unnecessary side effects.