Hormone therapy
Hormone therapy, also called endocrine therapy, uses medicine to block or lower the levels of hormones in your body. Prostate cancer needs the hormone testosterone to grow, so blocking it can shrink the tumour, making other treatments, particularly radiotherapy treatment, more effective. However, this treatment can come with significant side effects.
If you have concerns about whether hormone therapy is right for you, speak to our expert team of clinical specialists for a second opinion.
Dr Christos Mikropoulos: What is radiotherapy for prostate cancer?
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Playlist
Radiotherapy / Hormone Therapy for Prostate Cancer
SUMMARY
Dr. Christos Mikropoulos (Oncologist, The Focal Therapy Clinic): Radiotherapy is a widely used prostate cancer treatment, utilizing precision-shaped photon beams to target cancer while minimizing harm to surrounding tissues. This advanced approach ensures effective cancer control with reduced side effects. Christos Mikropoulos - https://www.thefocaltherapyclinic.co.uk/about-us/our-consultants/dr-christos-mikropoulos/ Radiotherapy - https://www.thefocaltherapyclinic.co.uk/living-with-prostate-cancer/treatment-options/radiotherapy/
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Read more.
Dr Christos Mikropoulos What is hormone therapy
00:41
Playlist
Radiotherapy / Hormone Therapy for Prostate Cancer
SUMMARY
Dr. Christos Mikropoulos (Oncologist, The Focal Therapy Clinic): Hormone therapy suppresses male hormones to control prostate cancer. It has historically been used alongside radiotherapy to improve effectiveness, though this practice is evolving with newer treatment approaches. Understanding when hormone therapy is beneficial helps optimize patient outcomes.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Read more.
Dr Christos Mikropoulos What are the side effects of hormone therapy
00:41
Playlist
Radiotherapy / Hormone Therapy for Prostate Cancer
SUMMARY
Dr. Christos Mikropoulos (Oncologist, The Focal Therapy Clinic): Hormone therapy lowers male hormone levels, often causing hot flashes, fatigue, mood swings, and libido loss. These effects are usually temporary after short-term treatment, and management strategies can help improve quality of life during therapy.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Read more.
Dr Christos Mikropoulos When is radiotherapy more appropriate than Prostatectomy
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Playlist
Radiotherapy / Hormone Therapy for Prostate Cancer
SUMMARY
Dr. Christos Mikropoulos (Oncologist, The Focal Therapy Clinic): Patients with localized prostate cancer are offered all treatment options, including surgery, radiotherapy, and focal therapy. Both surgery and radiotherapy are effective, and the choice is made through an informed consent process, ensuring patients understand risks, benefits, and long-term outcomes.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Read more.
Dr Christos Mikropoulos What are the downsides of radiotherapy
00:41
Playlist
Radiotherapy / Hormone Therapy for Prostate Cancer
SUMMARY
Dr. Christos Mikropoulos (Oncologist, The Focal Therapy Clinic): Radiotherapy, often combined with hormone therapy, is given with curative intent but can cause bowel, bladder, and erectile side effects. It is a one-time treatment and cannot be repeated in the same area, making the initial choice of treatment crucial.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Read more.
Dr Christos Mikropoulos Has radiotherapy had a lot of advances
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Playlist
Radiotherapy / Hormone Therapy for Prostate Cancer
SUMMARY
Dr. Christos Mikropoulos (Oncologist, The Focal Therapy Clinic): Radiotherapy has advanced significantly, with image-guided techniques improving accuracy and reducing side effects. Stereotactic radiotherapy now allows for prostate cancer treatment in just five sessions instead of twenty, making it a more convenient and effective option for patients.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Read more.
Dr Christos Mikropoulos Should a patient scheduled for radiotherapy consider Focal Therapy
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Playlist
Radiotherapy / Hormone Therapy for Prostate Cancer
SUMMARY
Dr. Christos Mikropoulos (Oncologist, The Focal Therapy Clinic): If an MRI confirms a focal lesion, patients initially offered radiotherapy may be eligible for focal therapy instead, depending on their case. This targeted approach preserves healthy tissue and reduces side effects while effectively treating cancer.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Read more.
Dr Christos Mikropoulos What are the side effects of brachytherapy
00:32
Playlist
Radiotherapy / Hormone Therapy for Prostate Cancer
SUMMARY
Dr. Christos Mikropoulos (Oncologist, The Focal Therapy Clinic): Brachytherapy is an effective local radiotherapy treatment using radioactive implants to target prostate cancer. While highly effective, it may cause urinary issues, and patients must limit contact with young children and pregnant women due to residual radiation exposure.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Read more.
Dr Christos Mikropoulos How common is brachytherapy in the UK
00:11
Playlist
Radiotherapy / Hormone Therapy for Prostate Cancer
SUMMARY
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Read more.
Dr Christos Mikropoulos If I have radiotherapy, how likely is it that I will need hormone therapy
00:39
Playlist
Radiotherapy / Hormone Therapy for Prostate Cancer
SUMMARY
Dr. Christos Mikropoulos (Oncologist, The Focal Therapy Clinic): Most radiotherapy patients need hormone therapy for up to six months. Side effects can be severe, including hot flashes, fatigue, and joint stiffness due to rapid hormone changes. Understanding these effects can help patients prepare and manage symptoms effectively.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Read more.
Hormone therapy for prostate cancer
00:41
Playlist
Radiotherapy / Hormone Therapy for Prostate Cancer
SUMMARY
Dr. Christos Mikropoulos (Oncologist, The Focal Therapy Clinic): Hormone therapy lowers male hormone levels to treat prostate cancer. It can cause hot flushes, fatigue, and libido changes, but these symptoms usually improve after treatment ends. Managing side effects effectively can help patients maintain their quality of life during therapy.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Read more.
Brachytherapy for prostate cancer
00:24
Playlist
Radiotherapy / Hormone Therapy for Prostate Cancer
SUMMARY
Dr. Christos Mikropoulos (Oncologist, The Focal Therapy Clinic): Brachytherapy is internal radiotherapy, using radioactive seeds implanted in the prostate to deliver targeted treatment while minimizing damage to surrounding tissues. This precise approach helps reduce side effects compared to external beam radiotherapy.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Read more.
Radiotherapy for prostate cancer side effects
00:32
Playlist
Radiotherapy / Hormone Therapy for Prostate Cancer
SUMMARY
Dr. Christos Mikropoulos (Oncologist, The Focal Therapy Clinic): Radiotherapy for prostate cancer can cause bowel and bladder inflammation, leading to increased bowel urgency, loose stools, and frequent urination due to the prostates location in the pelvis. Managing these side effects effectively can improve comfort and quality of life during treatment.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Read more.
“…there are a lot of men that have been put on extended hormonal therapy due to treatment backlogs. This is a problem because hormone therapy does not come without side effects.”
Raj Nigam
The Focal Therapy Clinic Consultant
How it works
Your body naturally makes testosterone, which has many functions in your body including how your prostate gland grows. By having injections or taking tablets, the levels of testosterone in your body is reduced, shrinking your tumour. In rare cases, you might be offered surgery to remove your testicles.
Suitability
Lots of people are suitable for hormone therapy, because it can be prescribed in lots of different ways, depending on your cancer.
- Localised (early) prostate cancer:
- Hormone therapy can shrink your tumour and your prostate, making the tumour more accessible. If your tumour is confined within your prostate gland, you might have hormone therapy before radiotherapy (external beam or brachytherapy).
- Locally advanced prostate cancer:
- If your tumour has spread just outside your prostate gland, hormone therapy can also help radiotherapy be more effective. With more advanced cancer, you may continue to take hormone therapy after your procedure to make sure your cancer doesn’t return.
- Advanced (metastatic) prostate cancer:
- When your prostate cancer has metastasised (spread elsewhere in your body), hormone therapy can slow how quickly it spreads and how big it grows. It can also help manage your symptoms.
- Recurrent prostate cancer:
- You are likely to be offered hormone therapy if your prostate cancer comes back.
Success rates
Hormone therapy has been shown to be very effective in controlling cancer, especially for advanced cancer.
- Cancer control: Up to 90% of people with advanced prostate cancer, hormone therapy was able to shrink their tumour. However, there isn’t as much data around hormone therapy for earlier stage prostate cancer. Hormone therapy doesn’t work forever and sometimes your cancer can become resistant to the kind of hormone therapy you’re on – in this case, your doctor might suggest a different kind of hormone therapy or a different therapy altogether.
Side effects
It’s common to experience side effects from hormone therapy. Testosterone is needed to get and maintain erections, so impotence is a common side effect of hormone therapy. A 2001 study showed that 69% of men became impotent after hormone treatment. Around 50% of men don’t regain sexual potency after stopping. Some people have likened it to a ‘male menopause’ that happens overnight, rather than over a number of years. Side effects of hormone therapy include:
- difficulty getting an erection (impotence)
- hot flushes and sweating
- feeling tired and weak
- breast tenderness
- tumour flare
- brain fog, during and for a few months after treatment
- loss of strength
If you are on long-term hormone therapy, you may also experience:
- weight gain
- memory problems
- mood swings and depression
- bone thinning (osteoporosis)
- risk of early heart failure
Many men can find these symptoms distressing. If you want to avoid them, The Focal Therapy Clinic offers minimally-invasive treatments that could be right for you. Find out more>>
On the day
You may take your hormone treatment at your GP’s surgery, at home, or in hospital, as a day patient. If you are on tablets, you are able to take these at home and will take them up to 3 times a day, depending on the tablet.
Injected hormone therapies can be done in hospital or by your GP. Sometimes you can do them at home, if you are confident to do so. You might need injections every 4 weeks to 6 months, depending on the medication.
Recovery
How quickly your cancer responds to the hormone therapy is hard to predict. If you are taking hormone therapy to shrink your tumour so another treatment, such as radiotherapy, can be more effective, you might take it for around 6 months. If you are taking it during or after radiotherapy, you might take it for up to 3 years. If you have advanced prostate cancer, you may take hormone therapy for the rest of your life, to manage your disease and symptoms.
If you want a prostate cancer treatment that’s a same-day procedure, has quick recovery and reduces your likelihood of impotence and incontinence, we can help.
Contact us today
Any questions?
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.
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Frequently asked questions
What are the most common short-term side effects of hormone therapy for prostate cancer?
The most common short-term side effects of hormone therapy (androgen deprivation therapy) include hot flushes and sweating affecting 70-80% of men, profound fatigue and weakness that interferes with daily activities and work, complete loss of erectile function (69% become impotent), loss of libido and sexual interest, mood changes including irritability and emotional lability, brain fog and difficulty concentrating, breast tenderness, and tumour flare (temporary symptom worsening when starting treatment). Many men describe the experience as ‘male menopause happening overnight’ rather than gradually over years. These effects begin within 2-4 weeks of starting treatment as testosterone levels drop rapidly. The intensity varies between individuals but most men experience multiple symptoms simultaneously, significantly impacting quality of life during active treatment.
How does hormone therapy affect erectile function and is the effect permanent?
Hormone therapy causes universal erectile dysfunction during active treatment because testosterone is essential for achieving and maintaining erections. A 2001 clinical study found that 69% of men became impotent during hormone treatment, and approximately 50% did not regain sexual potency after stopping treatment—meaning the effect is permanent for half of all users. Prolonged testosterone suppression can cause irreversible changes to penile tissue, including smooth muscle atrophy and fibrosis. Men on short-term hormone therapy (3-6 months) have better chances of functional recovery. The absence of libido during treatment compounds the erectile dysfunction. For men prioritising sexual function preservation, this permanent risk is a critical consideration.
When is hormone therapy necessary, and what are the main risks if used long-term?
Hormone therapy is necessary in several clinical scenarios: for localised prostate cancer before radiotherapy (6 months) to shrink the tumour; for locally advanced disease extending beyond the prostate capsule (6 months to 3 years) to enhance radiotherapy outcomes; for metastatic cancer (lifelong) to slow progression and manage symptoms; and for biochemical recurrence when cancer returns after initial treatment. Long-term use carries risks including significant weight gain (5-15kg), progressive muscle loss (sarcopenia), bone thinning (osteoporosis), cognitive decline, mood disorders including depression, increased cardiovascular risk, and metabolic syndrome. Cancer often becomes hormone-resistant within 18-24 months for metastatic cases, requiring escalation to chemotherapy or newer agents.
How does the recovery time for hormone therapy compare to focal therapy or radiotherapy?
Recovery from hormone therapy differs from other prostate cancer treatments because it’s systemic rather than localised. Hormone therapy requires ongoing administration for months to years with side effects persisting throughout treatment and often for 6-18 months after stopping as testosterone levels recover—50% never recover sexual function. Men on short-term ADT (6 months) may take 12-24 months to return to baseline. Focal therapy allows return to normal activities within 3-5 days, preserving sexual function in over 90% of men. Radiotherapy requires 4-8 weeks of daily treatments, with cumulative fatigue peaking 2-4 weeks post-completion, followed by gradual recovery over 3-6 months, but 40% develop permanent urinary problems and 50% progressive erectile dysfunction.
Is it possible to receive focal therapy after undergoing hormone therapy?
Yes, focal therapy remains possible after hormone therapy and is a potential treatment pathway for certain patients. Hormone therapy may be given before radiotherapy to shrink the prostate, but for men with localised MRI-visible focal lesions, focal therapy can be performed instead—avoiding radiation and continuation of hormone therapy. Prior short-term hormone therapy (3-6 months) does not affect focal therapy outcomes. This flexibility preserves future options and allows focal therapy as an initial treatment to avoid hormone therapy entirely for localised disease.
What percentage of men with advanced prostate cancer respond to hormone therapy?
Up to 90% of men with advanced prostate cancer experience tumour shrinkage when starting hormone therapy. However, this response is typically temporary. For most men with metastatic prostate cancer, disease becomes hormone-resistant (castration-resistant prostate cancer) within 18-24 months, requiring alternative therapies such as chemotherapy, newer hormone agents (abiraterone, enzalutamide), or radiopharmaceuticals. Short-term hormone therapy for localised disease serves as an adjunct to improve definitive local treatment rather than as standalone therapy.
Can hormone therapy be stopped if side effects become intolerable?
Stopping hormone therapy depends on the reason for treatment and disease characteristics. For localised disease receiving short-term ADT (3-6 months), stopping after the planned duration is standard, though some side effects persist as testosterone recovers. For metastatic or recurrent disease, stopping typically allows rapid cancer progression. Intermittent ADT may be used for metastatic disease to provide ‘hormone therapy holidays,’ but this is controversial. The key decision is whether side effects are more tolerable than allowing cancer progression. For localised disease, this supports considering focal therapy to avoid hormone therapy entirely.
How does hormone therapy compare to focal therapy for localized prostate cancer?
For localised prostate cancer, hormone therapy and focal therapy serve different roles. Hormone therapy is temporary (6 months) to shrink the prostate before radiotherapy, causing universal erectile dysfunction. Radiotherapy adds its own side effects. Focal therapy is curative in a single procedure, avoiding hormone therapy entirely. In appropriately selected patients (Grade Groups 1-3, PSA ≤20 ng/mL, MRI-visible lesion), focal therapy achieves 88-90% cancer control at 5 years, preserves erectile function in over 90%, and continence in 98-100%. Recovery is 3-5 days versus months of treatment and side effects.
What are the alternatives to hormone therapy for men who want to avoid its side effects?
Alternatives depend on disease stage. For localised prostate cancer, focal therapy (HIFU or NanoKnife) avoids hormone therapy, preserves sexual and urinary function, achieves equivalent cancer control (88-90% cancer-free at 5 years), and allows quick return to normal activities. Candidates usually have Grade Groups 1-3 disease, PSA ≤20 ng/mL, MRI-visible lesions. For locally advanced disease, radiotherapy with shorter hormone therapy may be possible for select patients. For metastatic disease, hormone therapy remains essential, though newer agents (abiraterone, enzalutamide, apalutamide) may improve side effect profiles. Active surveillance is an option for very-low-risk disease.
