Hormone therapy (androgen deprivation therapy) is widely used in prostate cancer treatment — to shrink tumours before radiotherapy, improve outcomes for aggressive cancers, and manage advanced disease. Patient advocate Andrew Gabriel explains what men are rarely told before starting treatment, including how to protect sexual function, monitor cardiovascular health, and access peer support through patient groups.
Why it’s used — Hormone therapy switches off testosterone to pause or slow prostate cancer growth, often alongside radiotherapy or as a bridge during treatment delays
Side effects matter — Men are frequently not counselled about the full range of side effects, including impacts on sexual function, bone density, cardiovascular health, and mental wellbeing
Protect sexual function — PDE5 inhibitors and vacuum pumps during treatment can prevent permanent erectile damage that occurs when sexual organs are inactive for 2-3 years
Support groups help — Peer support reduces anxiety and improves decision-making, yet many men are never referred to a support group by their hospital
Know your options — Focal therapies such as HIFU (NICE IPG424) may be an alternative for men with localised prostate cancer, potentially avoiding hormone therapy altogether
In this episode of OnFocus, patient advocate and educator Andrew Gabriel draws on his own prostate cancer experience and years of advocacy work to discuss what every man should know about hormone therapy. Gabriel is a well-known leader of patient support groups and a recognised authority on androgen deprivation therapy (ADT). His talk, ‘Surviving Hormone Therapy,’ has been attended by hundreds of patients and clinicians across the UK.
Andrew is part of Prostate Cancer UK’s Patients as Educators Programme, which supports clinicians in their patient engagement.
Links to Andrew’s videos:
Please find below a written transcript of the interview. To discuss your prostate cancer treatment options, including focal therapy alternatives that may help you avoid hormone therapy, call The Focal Therapy Clinic: 020 7036 8870.
An Interview with Patient Advocate Andrew Gabriel
Joining this episode of OnFocus is patient advocate and educator, Andrew Gabriel. Through his own experience with prostate cancer and his advocacy work, Gabriel has become a well-known leader of patient support groups and a recognised source of knowledge on hormone therapy. His hugely popular talk, ‘Surviving Hormone Therapy,’ has been attended by hundreds of patients and clinicians who value its honesty and candour.
Andrew is part of Prostate Cancer UK’s Patients as Educators Programme, which supports clinicians in their patient engagement.
Links to Andrew’s videos:https://www.youtube.com/watch?v=soAzPAmhG50https://www.youtube.com/watch?v=zAtYQZ_lT3s
What Is Hormone Therapy and Why Is It Used for Prostate Cancer?
Hormone therapy — also called androgen deprivation therapy (ADT) — works by suppressing testosterone, the hormone that fuels most prostate cancers. It is used to shrink tumours before radiotherapy, improve outcomes for aggressive cancers, extend life in advanced disease, and as a bridging treatment when other therapies are delayed. Hormone therapy is not a cure but can pause cancer growth effectively, sometimes for many years.
Use of Hormone Therapy
Purpose
Typical Duration
Neo-adjuvant (before radiotherapy)
Shrink the prostate to improve radiotherapy targeting
3-6 months
Adjuvant (with radiotherapy)
Improve cancer control for aggressive disease
6 months to 3 years
Advanced/metastatic disease
Slow cancer progression and extend survival
Ongoing (intermittent or continuous)
Bridging treatment
Pause cancer during diagnostic or treatment delays
Weeks to months
Source: NICE Guideline NG131 — Prostate cancer: diagnosis and management
“The prostate is activated by testosterone, which causes it to grow. Most cases of prostate cancer are also driven by testosterone. So you can kind of switch off prostate cancer, at least temporarily, by switching off testosterone. And that’s what hormone therapy does.”
For men with localised prostate cancer, focal therapy options such as HIFU (NICE IPG424) or NanoKnife IRE (NICE IPG768) may treat the cancer directly — potentially avoiding hormone therapy and its side effects entirely. In The Focal Therapy Clinic’s audit of 265 patients, 90% remained cancer-free at one year with 90%+ sexual function preservation.
Listen to the full conversation
Clare Delmar
Hello and welcome to OnFocus, brought to you by The Focal Therapy Clinic, where we connect you with issues facing men diagnosed with prostate cancer that are little known, less understood, often avoided or even ignored. Prostate cancer is now the most commonly diagnosed cancer among men in the UK. With this sombre fact comes a multitude of challenges and opportunities. I’m Clare Delmar.
Andrew Gabriel
It’s a very interesting question. I perhaps ought to sort of explain for listeners who are not familiar with what hormone therapy does, you know, why it’s used. So, the prostate gland in men is required for fathering children, and it produces some components of semen. The prostate is activated by testosterone, which causes it to produce the semen contributions that it normally generates and causes it to grow. And most cases of prostate cancer are also driven by testosterone. So you can kind of switch off prostate cancer, at least temporarily, by switching off testosterone. And that’s what hormone therapy does.
Is PSA Testing for Prostate Cancer a Postcode Lottery?
PSA testing in the UK is not part of a national screening programme — it is entirely patient-driven, which creates significant inequalities in early detection. Men with private healthcare or who proactively request testing are diagnosed early when treatment is most effective and side effects are lowest. Men from lower socioeconomic backgrounds or ethnic minority communities are disproportionately affected, often presenting only when symptoms appear — by which point curative options may be limited.
How PSA testing access varies:
Private annual check-ups — PSA routinely included; cancer detected early via trend monitoring
Proactive GP requests — Depends on GP attitude; some talk patients out of testing
Lower socioeconomic groups — Less awareness of prostate cancer risk; tend not to request testing until symptoms appear
Black men — 1 in 4 lifetime risk (vs 1 in 8 for all men), yet often diagnosed later with more aggressive disease
“You actually want to pick prostate cancer up before you have symptoms because you have a much better chance of a cure with fewer side effects.”
Early detection through PSA testing followed by mpMRI and targeted biopsy gives men the widest range of treatment options — including focal therapy, which preserves quality of life while treating localised cancer.
Are Men Given Informed Consent Before Starting Hormone Therapy?
Many men report being started on hormone therapy without adequate counselling about its side effects or the steps needed to protect their health during treatment. While radiotherapy requires a detailed consent form listing all potential complications, hormone therapy is often prescribed as casually as antibiotics — despite having a more significant long-term impact on quality of life for many patients.
Health Monitoring Checklist During Hormone Therapy
Men on ADT should ensure these are monitored regularly:
Blood pressure — ADT can increase cardiovascular risk
Cholesterol levels — Testosterone suppression can raise lipids
Blood glucose — Increased risk of type 2 diabetes on ADT
Bone density (DEXA scan) — ADT accelerates osteoporosis risk
Sexual function — PDE5 inhibitors and vacuum pumps can prevent permanent erectile damage during treatment
Mental health — Mood changes, fatigue, and cognitive effects are common
“When the urologist said to me, ‘you’re starting hormone treatment,’ he didn’t say anything about it. I said, ‘what are the side effects?’ You know what he said? ‘Your penis will get shorter. Goodbye.’ That was it.”
Andrew notes that men who undergo radiotherapy with adjuvant hormone therapy frequently report that the radiotherapy was manageable, while the hormone therapy had a far greater impact on their daily lives — yet it was the hormone therapy that came without any formal consent process or side-effect counselling.
For men with localised prostate cancer, focal therapy may treat the tumour directly without the need for hormone therapy, preserving both sexual function (90%+ preservation, FTC audit, n=265) and urinary continence (97%, FTC audit, n=265).
Get Expert Advice & The Latest Research
Subscribe to our newsletter to receive the latest updates, expert insights, and breakthrough research on prostate cancer-delivered straight to your inbox.
How Can Men Protect Sexual Function During Hormone Therapy?
Sexual function typically stops during hormone therapy because testosterone — which drives erections — is suppressed. However, the critical risk that men are rarely warned about is permanent damage: if the erectile tissue goes unused for two to three years, it can atrophy irreversibly. Proactive steps taken from the start of treatment can preserve function for recovery afterwards.
Steps to Protect Erectile Function on ADT
PDE5 inhibitors — Ask your GP or urologist for a prescription (e.g., sildenafil, tadalafil) to maintain blood flow to erectile tissue
Vacuum erection device (pump) — Regular use prevents tissue atrophy even without spontaneous function
Start early — These measures work best when started at the same time as hormone therapy, not after function is lost
Ask proactively — These are rarely offered automatically; you may need to request them
“You can’t go for two or three years without an erection and expect the erections will still work because they won’t. It’s a totally avoidable but major issue with prostate cancer, and it just needs some education.”
For men with localised prostate cancer seeking to preserve sexual function, focal therapy treats only the cancerous tissue while sparing surrounding structures. In The Focal Therapy Clinic’s audit of 265 patients, 90%+ of men maintained erectile function following treatment — compared with the near-total suppression experienced during hormone therapy.
Is Access to Prostate Cancer Treatment Equal Across the NHS?
Treatment options for prostate cancer depend heavily on which hospital you are referred to and what expertise sits on your multidisciplinary team (MDT). If your local hospital does not offer focal therapy or lack specialists in advanced diagnostics like PSMA PET scanning, you may never be told about treatments that could suit your cancer — even if you are an ideal candidate. In England, patients have the right to request referral to any hospital, but most men are not aware of this.
How hospital access affects your options:
MDT composition matters — If no focal therapy specialist sits on your MDT, you will not be offered HIFU (NICE IPG424) or NanoKnife IRE (NICE IPG768), even if you are a suitable candidate
Diagnostic access varies — Hospitals with PSMA PET scanners can detect recurrence at PSA 0.2; those without may wait until PSA reaches 8-10, by which point curative options may be lost
Patient-driven referrals — Men who research focal therapy often drive their own referral to a specialist centre — but most patients lack the knowledge to do this
Right to choose — In England, you can request referral to any NHS hospital or seek a private second opinion at any time
“If you would have been an ideal candidate for a focal therapy, but there’s nobody in the MDT that’s involved in focal therapy treatment because your hospital doesn’t do it, you’re not going to get offered that treatment.”
The Focal Therapy Clinic offers focal therapy across seven UK locations and welcomes NHS and private referrals. To discuss whether you may be suitable, call 020 7036 8870 or request a consultation.
How Do Support Groups Help Men Diagnosed with Prostate Cancer?
A prostate cancer diagnosis is almost always unexpected, and the immediate anxiety of “am I going to die?” can overwhelm rational decision-making. Patient support groups provide education, peer experience, and emotional support that significantly reduces anxiety — yet many men are never referred to one by their hospital, sometimes discovering support groups years into treatment.
What support groups offer:
Understanding your diagnosis — Education about your specific cancer stage, grade, and prognosis reduces fear of the unknown
Treatment experiences — Hearing from men who have had every type of treatment helps inform your decisions
Anxiety reduction — Knowledge and community bring a sense of control during an uncontrollable time
Practical advice — From side-effect management to navigating the NHS referral system
“As you start to understand things, you gradually feel that you’re more in control. You understand where your direction is set. It may not be where you wanted it to be set, but it may not be as bad as you imagined from your naive position at the outset.”
Andrew also counsels against decision regret: “You made the best choice you could at that time. Don’t go there. You start from where you are now.” For men currently weighing treatment options, focal therapy represents an additional choice that many hospital MDTs do not offer — speak to The Focal Therapy Clinic to find out if it may be suitable for you.
If you’ve got any questions about your prostate cancer diagnosis or want to know more about HIFU treatment or NanoKnife treatment, don’t hesitate to get in touch with our friendly, knowledgeable team.
