Advanced Prostate Cancer Treatments

In many patients, endocrine therapy provides temporary relief of symptoms of advanced prostate cancer. Endocrine therapy may reduce tumor size and levels of prostate specific antigen (PSA) in most men.

Patients will be started on hormone/ADT treatments if:

• The prostate cancer has spread too far to be cured by surgery or radiation, or if the patient is not a candidate to receive these treatments for various medical reasons
• The cancer remains or comes back after initial treatment with surgery or radiation therapy

Examples of medications used to stop or slow down hormones

• Luteinizing hormone releasing hormone agonists (LHRH agonists) can stop the testicles from making testosterone, including leuprolide (Lupron), leuprolide acetate (Eligard) ), triptorelin (Trelstar), and goserelin (Zoladex)
• Luteinizing hormone releasing hormone antagonists, such as Firmagon (degarelix)
• Anti-androgens can block the action of androgens (hormones that promote male sex characteristics), such as testosterone. An example is Casodex (bicalutamide).
• Some drugs can prevent the adrenal glands from making androgens, such as ketoconazole.
• Secondary blockers include Xtandi (enzalutamide) ZYTIGA® (abiraterone acetate)

Hormone-related drugs approved to treat advanced prostate cancer

• luteinizing hormone-releasing hormone (LHRH) analogs
• luteinizing hormone-releasing hormone (LHRH) antagonists
• anti-androgens

An orchiectomy is a surgical procedure to remove both testicles, the main source of male hormones, such as testosterone, to decrease the amount of hormone being made. This is mostly used after surgical removal of the prostate has failed.


LHRH agonists are administered as regular shots ranging from once a month to once every six months. The most common- ly used LHRH analogs in the U.S. are leuprolide (Eligard, Lupron), histrelin (Vantas), triptorelin (Trelstar), and goserelin (Zoladex). This drug may be used in combination with radiation. They cause side effects similar to those from the surgical orchiectomy. These drugs carry a risk of triggering diabetes, heart disease, osteoporosis, breast pain or enlargement, erec- tile dysfunction, decrease in libido, diarrhea and/or constipation, increase in belly fat. Before starting one of these drugs, patients should tell their doctor if they have a history of diabetes, heart disease, stroke, heart attack, high blood pressure, high cholesterol, or cigarette smoking.

This class of drug can block LHRH from stimulating testosterone production without causing a surge of testosterone, eliminating the tumor flare. The drug in this class is called Degarelix (Firmagon). This drug may also be used as combination treatment during radiation. But is also used to treat advanced prostate cancer. It has been shown to decrease the progression of disease, but further trials are needed to look at long-term outcomes. This medicine is given as an injection every 28 days. It is fairly well tolerated with common side effects being local injection site problems, including a lump at the injection site, tenderness, itching, and redness, dysfunction, hot flashes, and bone loss.

Even with hormone injections, cancer may progress to the point where the adrenal glands or prostate cancer cells themselves may produce androgens that fuel the cancer’s growth. Stronger treatments need to be added to a regimen of the injected hormone therapies. Hormonal medications that inhibit the synthesis of androgen, include abiraterone acetate (Zytiga), and enzalutamide (Xtandi), both taken orally.

About ten percent of testosterone in the body is created by the adrenal glands and few therapies focus on shutting down this production until it becomes absolutely necessary to rid the body of all testosterone. Zytiga is used with steroids to shut down the adrenal glands while avoiding the adverse effects of chemother- apy. Use of Zytiga is contraindicated with men that have severe liver impairment. Blood pressure and electrolytes (monitored in the blood) need to be controlled before starting on Zytiga. No food two hours before taking Zytiga and one hour after taking this medication.

Xtandi is able to block androgen receptors to slow the production of testosterone without the use of a steroid. Xtandi cannot be used in men with a seizure disorder or with severe renal failure. This medication can be taken with or without food. Blood pressure will be monitored regularly, along with some blood tests, including liver function, kidney, function, and electrolytes. The PSA lab test is the primary way to determine how well the medications are managing the prostate cancer, along with scans.

Side effects of these therapies include: breast pain or enlargement, cholesterol level changes, dysfunction and lower libido, diarrhea and / or constipation, increase in belly fat, joint pain, swelling, increased risk of osteoporosis, and cardiovascular events.

Xofigo can be absorbed by other organs, primarily the bone marrow and digestive system, which may result in side effects in those healthy tissues.

Learn more about Xofigo