Hormone therapy works by decreasing the hormones in your body that encourage prostate cancer to multiply. Nonhormone therapies focus on killing existing cancer cells.

If prostate cancer reaches an advanced stage and cancer cells have spread to other parts of the body, you will need treatment. Watchful waiting, which may have been your doctor’s first course of action, is no longer an option.

People with advanced prostate cancer now have more available treatment options than ever before. These include both hormone therapies and nonhormone treatment options.

The exact treatment you’ll receive depends on your stage of prostate cancer and any underlying conditions you have. Remember that your treatment experience can be quite different from someone else’s.

To decide on a treatment, you’ll need to consider the overall goal of the treatment, its side effects, and whether you’re a good candidate. Being informed about the available treatments can help you and your doctor decide which treatment, or combination of treatments, is best for you.

Hormone therapy is also known as androgen deprivation therapy (ADT). It’s often considered a key treatment for metastatic prostate cancer.

How hormone therapy works

Hormone therapy works by decreasing the levels of hormones (androgens) in the body. Androgens include testosterone and dihydrotestosterone (DHT). These hormones encourage prostate cancer to multiply. Without androgens, tumor growth is slowed and the cancer may even go into remission.

Approved hormone treatments

Several approved hormone treatments exist for prostate cancer. These include:

  • GnRH agonists, such as leuprolide (Eligard, Lupron) and goserelin (Zoladex), work by lowering the amount of testosterone made by the testicles.
  • Anti-androgens, such as nilutamide (Nilandron) and enzalutamide (Xtandi), are usually added to GnRH agonists to help prevent testosterone from attaching to tumor cells.
  • Another type of GnRH agonist called degarelix (Firmagon) blocks signals from the brain to the testes so that the production of androgens is stopped.
  • Surgery to remove the testicles (orchiectomy) will stop the production of male hormones.
  • Abiraterone (Zytiga) is an LHRH antagonist that works by blocking an enzyme called CYP17 to halt the production of androgens by cells in the body.

Treatment goals

The goal of hormone therapy is remission. Remission means that all of the signs and symptoms of prostate cancer go away. People who’ve achieved remission aren’t “cured,” but they can go many years without showing signs of cancer.

Hormone therapy may also be used to reduce the risk of recurrence after preliminary treatment in men who are at a high risk of recurrence.

How treatments are given

Hormone treatments differ in how you receive them.

  • GnRH agonists are typically given as either an injection or placed under your skin (as an implant).
  • Anti-androgens are taken as a pill once per day.
  • Degarelix is given as an injection.
  • Zytiga is taken by mouth once per day in combination with a steroid called prednisone.

A chemotherapy drug called docetaxel (Taxotere) is sometimes used in combination with hormone therapies.

Surgery to remove the testicles can be done as an outpatient procedure. You should be able to go home a few hours after an orchiectomy.

Candidates for hormone therapies

Most people with advanced prostate cancer are candidates for hormone therapy. It’s usually considered when prostate cancer has spread beyond the prostate, and surgery to remove the tumor is no longer possible.

Prior to starting treatment, you’ll need to have a liver function test along with a blood test to make sure your liver can break down the medications properly.

Currently, enzalutamide (Xtandi) is only approved for use in people with prostate cancer that has already spread to other parts of the body, and when the body no longer responds to medical or surgical treatments to lower testosterone levels.

In some cases, prostate cancer cells can resist hormone treatments and multiply even in the absence of male hormones. This is called hormone-resistant (or castration-resistant) prostate cancer.

People with hormone-resistant prostate cancer can no longer remain on monotherapy (one hormone therapy alone) because it will allow their testosterone to return to typical levels and fuel cancer growth. In these instances, doctors will usually also prescribe a pill that blocks the androgen or its receptor in order to get a positive response from treatment.

Common side effects

The most common side effects of hormone therapies include:

What is life like after hormone therapy for prostate cancer?

According to the National Cancer Institute, most of the emotional and sexual side effects caused by a reduction in testosterone levels will go away after a person stops taking hormone therapy.

People who lose bone mass can be given drugs (bisphosphonates) to slow or reverse this loss. Exercise may also help reduce side effects such as fatigue, weight gain, and insulin resistance.

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If hormone treatment isn’t working or your cancer is growing and spreading too quickly, treatment with other nonhormone options may be recommended.

Approved nonhormone treatments

Nonhormone treatments for advanced prostate cancer include:

Treatment goals

The goal of chemotherapy, radiation, and other nonhormone treatments is to slow down the growth of the cancer and extend a person’s life.

Chemotherapy and other nonhormone treatments probably won’t be able to cure the cancer, but they can significantly prolong the lives of people with metastatic prostate cancer.

Candidates for nonhormone therapy

You may be a candidate for nonhormone treatments such as chemotherapy or radiation if:

  • Your PSA levels are rising too quickly for hormone treatments to manage it.
  • Your cancer is spreading rapidly.
  • Your symptoms are getting worse.
  • Hormone treatments fail to work.
  • The cancer has spread to your bones.

How treatments are given

Chemotherapy is generally given in cycles. Each cycle typically lasts a few weeks. You might need multiple rounds of treatment, but there’s usually a period of rest in between. If one type of chemotherapy stops working, your doctor may recommend other chemotherapy options.

Sipuleucel-T (Provenge) is given as three infusions into a vein, with about 2 weeks between each infusion.

Radium Ra 223 is also given as an injection.

Common side effects of chemotherapy

Common side effects of chemotherapy include:

  • hair loss
  • nausea and vomiting
  • diarrhea
  • fatigue
  • loss of appetite
  • neutropenia (low white blood cells) and higher risk of infection
  • changes in memory
  • numbness or tingling in the hands and feet
  • easy bruising
  • mouth sores

Common side effects of radiation therapy

Radiation treatments can reduce your red blood cell count and cause anemia. Anemia causes fatigue, dizziness, headache, and other symptoms. Radiation treatment can also lead to incontinence (loss of bladder control) and erectile dysfunction.

If left untreated, most cases of prostate cancer will spread beyond the prostate to local tissues and organs. However, not all cancers are the same.

Some people with low or intermediate risk of cancer progression can take an active surveillance or “wait and see” approach. In some of these cases, the cancer may never spread or cause symptoms.

However, treatment should be considered if the cancer begins growing outside the localized area within the prostate or starts to cause symptoms.

How long can a man live with prostate cancer without treatment?

A 2023 study found that 97% of people diagnosed with localized prostate cancer lived 15 years after diagnosis, regardless of whether they received surgery, radiation therapy, or active monitoring.

Can you treat prostate cancer without hormone therapy?

Yes. A doctor may decide to treat prostate cancer with nonhormone therapy such as surgery, radiation therapy, and chemotherapy. Nonhormone therapy is typically used when a cancer is growing and spreading too quickly or if the cancer has become resistant to hormone therapy.

What is the best hormone therapy for advanced prostate cancer?

Most people with advanced prostate cancer have hormone therapy. Doctors may prescribe a combination of different hormone therapy drugs or hormone therapy with chemotherapy.

Nonhormone therapies are a good option for people with advanced prostate cancers that no longer respond to hormone treatments alone.

What stage of prostate cancer requires hormone treatment?

Prostate cancers need male sex hormones called androgens to grow. Hormone therapies that decrease androgen levels or block their growth are often used for early stage prostate cancers.

If the cancer starts spreading or has spread beyond the prostate (later stage cancers), doctors may recommend nonhormonal treatments, such as surgery, chemotherapy, or radiation treatment, with or without hormone therapy.

Hormone therapies and surgeries are typically recommended first to treat advanced prostate cancer.

Generally, prostate cancer is controlled the longest while on anti-androgen (hormone) therapies. However, when resistance to hormone manipulation sets in, a doctor might recommend chemotherapy, immunotherapy, and radiotherapies (either Radium 223 or Lutetium-177 vipivotide tetraxetan PSMA therapy) to try and manage the cancer temporarily.

Even with treatment, most cases of advanced prostate cancer cannot be cured. But treatments can slow the growth of the cancer, reduce symptoms, and improve survival. Many people live for years with advanced prostate cancer.

Making decisions about treatments can be confusing and challenging because there’s a lot to consider. Remember that you don’t need to make the decision alone. With guidance from your oncologist and medical care team, you can make an informed decision on the best treatment plan for you.