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NCCN Guidelines for Patients


Prostate Cancer, Version 1.2016


Overview of cancer treatments Hormone therapy

Hormone therapy

Prostate cancer cells need hormones called

androgens to grow. The main male androgen is

testosterone. Hormone therapy will stop your body

from making testosterone or will stop the action of

testosterone. It can slow tumor growth or shrink the

tumor for a period of time.

The types of hormone therapy are:

• Bilateral orchiectomy is the surgical removal

of both testicles. They are removed since they

make most of the testosterone in the body.

• LHRH (








ormone) agonists are drugs used to stop

the testicles from making testosterone. They

are either injected into a muscle or implanted

under the skin every 1, 3, 4, 6, or 12 months.

LHRH agonists include goserelin acetate,

histrelin acetate, leuprolide acetate, and

triptorelin palmoate.

• LHRH antagonists are drugs used to stop the

testicles from making testosterone. They are

injected under the skin usually every month.

Degarelix is an LHRH antagonist.

• Antiandrogens are drugs that block receptors

on cancer cells from receiving testosterone.

Antiandrogens include bicalutamide,

flutamide, nilutamide, and enzalutamide.

• Estrogens can stop the adrenal glands and

other tissues from making testosterone.

• Corticosteroids can stop the adrenal glands

and other tissues from making testosterone.

Hydrocortisone is a corticosteroid.

• Androgen synthesis inhibitors are drugs that

block the making of androgen at different

sites. Ketoconazole is an antifungal drug that

stops the adrenal glands and other tissues

from making testosterone. Abiraterone acetate

works similarly but is more potent and less


The term “hormone therapy” can be confusing

because of the many names it is called. Some

people refer to all hormone therapy as androgen

suppression therapy or ADT. However, to be exact,

only orchiectomy and LHRH agonists and antagonists

are ADTs.

Sometimes, antiandrogens are used with LHRH

agonists or following an orchiectomy. This type

of treatment is called CAB (






lockade). However, CAB is no better than castration

alone for metastases. Moreover, it may lead to higher

costs and worse side effects.

Finasteride or dutasteride used with CAB is called

triple androgen blockade. The benefit of triple

androgen blockade is probably small if any benefit

exists. If you will be on long-term ADT, your doctor

may consider intermittent treatment to reduce side

effects. Intermittent treatment is alternating periods

of time on and off treatment. It can provide similar

cancer control to continuous hormone therapy.

Side effects of hormone therapy

Hormone therapy has multiple side effects. It can be

hard to know whether you will get a side effect. Many

factors play a role. Such factors include your age,

your health before treatment, how long or often you

take treatment, and so forth.

Side effects differ between the types of hormone

therapy. In general, ADT may reduce your desire for

sex and cause erectile dysfunction. These sexual side

effects don’t seem to lessen with time. The longer

you take ADT, the more your risk for thinning and

weakening bones (osteoporosis), bone fractures,

weight gain, loss of muscle mass, diabetes, and heart

disease increases. Other side effects of ADT include

hot flashes, mood changes, and fatigue.

A side effect specific to orchiectomy is the loss of

your testicles. Implants that look like testicles can