NCCN Guidelines for Patients
Prostate Cancer, Version 1.2016
Overview of cancer treatments 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
• 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
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