Hormone Therapy (tablets)

Tablets that stop the body from making testosterone or prevent testosterone from reaching the prostate cancer cells. 

What is hormone therapy?

  • Hormone therapy blocks or lowers the amount of testosterone in your body. It can slow down the growth of your prostate cancer. It can also help with some symptoms of advanced prostate cancer, such as bone pain. 

 

Watch our short animation to learn more about hormone therapy.

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Hormone Therapy Tablets

Interesting things to know

What are hormones?

Hormones are made by glands. They act like chemical messengers. They travel around the body in your blood.  

What is testosterone?

Testosterone is a male sex hormone (an androgen). It is made mainly by your testicles. A small amount of testosterone is also made by your adrenal glands. These are on top of your kidneys. Testosterone affects:

  • Appearance
  • Sex drive (libido)
  • Sexual function
  • Muscle mass and bone development
  • Weight
  • Growth of body hair
  • Growth and development of male sexual organs at puberty.

Testosterone usually helps prostate cancer to grow.

What are the main benefits of hormone therapy?

  • It can ease symptoms of more advanced prostate cancer, e.g. problems with peeing
  • Hormone therapy tablets stop you from getting tumour flare if you are having hormone therapy injections
  • It can reach the prostate cancer wherever it is in the body.
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Neville
“The hormone tablets haven’t really affected me too much, but I have felt quite tired in the afternoons. Other than that, they haven’t affected me too much at all.”
Neville
Frequently asked questions (FAQs) about hormone therapy tablets
  • Hormone tablets stop testosterone from reaching the prostate cancer cells. These are called antiandrogens.

Examples of hormone tablets are:

1. First generation antiandrogens

  • Bicalutamide. 
  • Flutamide

These antiandrogens are not used as often now.

 

2. Second generation antiandrogens

These are newer types of antiandrogens.

  • Enzalutamide (Xtandi) two-to-four tablets daily.
  • Darolutamide (Nubeqa) two tablets twice a day.
  • Apalutamide (Erleada) four tablets daily.

     

3. Abiraterone

It works in a different way to the antiandrogens.

It works by blocking the production of testosterone from the:

  • Testicles  
  • Adrenal glands.
  • Tumour

Abiraterone is taken as two-to-four tablets daily.

If you are taking abiraterone you will also need to take prednisolone (a steroid).  This will help to reduce some of the side effects.

 

Your doctor will decide which hormone therapy tablets are the right ones for you. 

Metastatic prostate cancer (cancer that has spread to other parts of the body)

  • You will be given hormone therapy tablets on their own or alongside another treatment, e.g. androgen deprivation therapy (ADT). This is usually given as an injection. It is usually a lifelong treatment at this stage. To learn more about ADT, visit our hormone therapy injections page (this link will open in a new tab)

     

    Syringe indicating hormone therapy injection

  • This can happen if your cancer has started to grow again and your PSA level has started to rise steadily while you are still on hormone therapy injections.

 

  • This is called castration-resistant prostate cancer. 

 

 

Non-metastatic castration resistant prostate cancer (nmCRPC)

  • In some men the cancer will still be contained in the prostate and will not have spread to other parts of the body. This is what is meant by non-metastatic disease. 

 

  • These men may be offered treatment with androgen deprivation therapy (ADT). 

 

 

  • In men with non-metastatic castration-resistant prostate cancer, antiandrogens may be offered as a next course of treatment. If you are already taking hormone therapy injections, you will carry on taking these alongside the antiandrogen. 
  • You should not experience any pain with hormone therapy tablets.
  • You may feel tired or lack energy when you are having hormone therapy.lack of energy 
  • You can carry on working normally if you feel able to do so.
  • You may need to take time of work for regular check-ups with your doctor.
  • Anyone staying on hormone therapy should have a yearly check-up with their doctor. They will check your:tests icon
    • Blood pressure
    • Cholesterol
    • Blood sugars – to test for diabetes.
  • They should also talk to you about your bone health and keeping fit.
  • You will have regular check-up with your doctor or specialist nurse. This will include monitoring of your PSA level. This will probably fall PSA testwhile you are on hormone therapy.
  • If your PSA level starts to rise again, your doctor will talk to you about other treatment options.
  • Visit our page on PSA tests for more information on PSA levels (this link will open in a new tab).
  • When you are on hormone therapy, you will have your PSA level checked regularly. 
  • If the hormone therapy is working, your PSA level will stay the same or go down. 
  • If your PSA starts to go up, it may mean that your cancer has started to grow again. 
  • When the hormone therapy stops working, this is called castrate- resistant prostate cancer. You may also hear it called hormone- resistant prostate cancer.
  • If this happens, your doctor will talk to you about starting a different treatment or mix of treatments. This may include a different type of hormone therapy. 
  • If you are having hormone therapy injections and become resistant, you will stay on the injections. 
  • Hormone therapy may affect your ability to father a child. It will affect your:
    • Desire for sex
    • Ability to have an erection
    • Sperm production.
  • It may mean that you will have problems getting someone pregnant.
  • If you think you may want children, please talk to your doctor before starting treatment. 

 

  • You may be able to have some of your sperm saved and frozen. This is called sperm banking or sperm cryopreservation. You can learn more about sperm banking on the Human Fertilisation and Embryology Authority website (this link will open in a new external tab).
  • Cancer Research UK also have information about sperm collection and storage (this link will open in a new external tab).
Sperm banking

Will I need to use contraception?

  • You may still be able to get someone pregnant. You should use contraception. You can talk to your healthcare team for advice about safe sex while on hormone therapy.

About this information

  • This information was published in March 2023. We will revise it in March 2024.
  • References and bibliography available on request.
  • If you want to reproduce this content, please see our Reproducing Our Content page (this link will open in a new tab).

What is risk?

  • Risk is the chance something bad could happen when we do something. Even simple things such as walking down the stairs can have risks. But we take risks because we think it will be worth it. We need to think about both the benefits and risks of what might happen when we do something.
  • You should always ask your healthcare team about both the benefits and risks of any treatment.
  • Remember if they tell you about a risk, it doesn‘t mean it will happen to you. They may say one man in ten who has this treatment will have a side effect. But they can‘t tell you if you will be the ‘one’ man who gets this side effect.
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Risk vs Benefit
What are the risks of the different types of hormone therapy (tablets)?

Very common side effects

Affects MORE THAN

1 in 10 risk
  • Fluid in your legs or feet
  • Low blood potassium
  • Liver function test increases
  • High blood pressure
  • Urinary tract infection
  • Diarrhoea.

Common side effects

Affects UP TO

1 in 10 risk

  • High fat levels in your blood
  • Chest pain
  • Irregular heart beat (atrial fibrillation)
  • Heart failure
  • Rapid heart rate
  • Severe infections called sepsis
  • Bone fractures
  • Indigestion
  • Blood in urine
  • Rash.

 

Electronic Medicines Compendium (EMC)

  • The EMC contains the most up-to-date, approved and regulated prescribing and patient information for all UK licensed medicines.
  • You can find more information about the side effects of this treatment in the leaflet that comes with your medicine or from the Electronic Medicines Compendium (this link will open in a new tab).
  • You can see the official patient information leaflet for Zytiga 500mg (this link will open in a new tab. Please note that the leaflet has been produced by the drug manufacturer and can be found on EMC's website. It is in PDF format so may not be compatible with screen readers).  Listen to the Zytiga 500mg leaflet.

Very common side effects

Affects MORE THAN

1 in 10 risk
  • Excessive tiredness (fatigue)
  • Fall
  • Broken bones (fractures)
  • Hot sweats (flushes)
  • High blood pressure (hypertension).

Common side effects

Affects UP TO

1 in 10 risk

  • Headache
  • Feeling anxious
  • Dry skin, itching
  • Difficulty remembering
  • Blockage of the arteries in the heart (ischemic heart disease)
  • Breast enlargement in men (gynaecomastia)
  • Symptom of restless legs syndrome (an uncontrollable urge to move a part of the body, usually the leg)
  • Reduced concentration
  • Forgetfulness
  • Change in sense of taste.

 

Electronic Medicines Compendium (EMC)

  • The EMC contains the most up-to-date, approved and regulated prescribing and patient information for all UK licensed medicines.
  • You can find more information about the side effects of this treatment in the leaflet that comes with your medicine or from the Electronic Medicines Compendium.
  • You can see the official patient information leaflet for Xtandi 80mg (this link will open in a new tab). 

Very common side effects

Affects MORE THAN

1 in 10 risk

In patients with non-metastatic castration-resistant prostate cancer

  • Tiredness (fatigue)
  • Blood tests showing reduced number of a white blood cell type called neutrophils
  • Blood tests showing increased levels of substances produced by the liver: bilirubin, alanine aminotransferase, aspartate transaminase
  • High blood pressure (hypertension)

In patients with metastatic hormone sensitive prostate cancer

  • high blood pressure
  • rash
  • blood tests showing increased levels of substances produced by the liver: bilirubin, alanine aminotransferase and aspartate transaminsase.

Common side effects

Affects UP TO

1 in 10 risk

In patients with non-metastatic castration-resistant prostate cancer

  • Rash
  • Pain in arms and legs
  • Pain in muscles and bones (musculoskeletal pain)
  • Broken bones (fractures).

 

Electronic Medicines Compendium (EMC)

  • The EMC contains the most up-to-date, approved and regulated prescribing and patient information for all UK licensed medicines.
  • You can find more information about the side effects of this treatment in the leaflet that comes with your medicine or from the Electronic Medicines Compendium.
  • You can see the official patient information leaflet for Nubeqa 300mg (this link will open in a new tab). 

Very Common Side Effects

Affects MORE THAN

1 in 10 risk
  • Feeling very tired (fatigue)
  • Joint pain (arthralgia)
  • Decreased appetite
  • Hot sweats (flush)
  • High blood pressure (hypertension)
  • Diarrhoea
  • Skin rash
  • Broken bones (fractures)
  • Falls
  • Weight loss

Common side effects

Affects UP TO

1 in 10 risk

  • Muscle spasms
  • Itching
  • Hair loss
  • Change in sense of taste
  • Blood test showing high level of cholesterol in the blood
  • Blood test showing high level of a type of fat called “triglycerides” in the blood
  • Heart disease
  • Stroke or mini-stroke caused by low blood flow to part of the brain
  • Under-active thyroid which can make you feel more tired and have difficulty getting started in the morning, and blood tests may also show an under-active thyroid.

 

Electronic Medicines Compendium (EMC)

  • The EMC contains the most up-to-date, approved and regulated prescribing and patient information for all UK licensed medicines.
  • You can find more information about the side effects of this treatment in the leaflet that comes with your medicine or from the Electronic Medicines Compendium.
  • You can see the official patient information leaflet for Erleada 60mg (this link will open in a new tab. Please note that the leaflet has been produced by the drug manufacturer and can be found on EMC's website. It is in PDF format so may not be compatible with screen readers).  Listen to the Erleada 60mg leaflet.
  • The information on the risks comes from very large clinical studies. These typically involved thousands of people being watched over many years. 
  • There may be local data from your area. You can ask your healthcare team if they have this information too. 

About this information

  • This information was published in March 2023. We will revise it in March 2024.
  • References and bibliography available on request.
  • If you want to reproduce this content, please see our Reproducing Our Content page.

What is impact?

  • We asked real visitors to the infopool to share their experience of this treatment. They told us how this treatment had impacted their everyday lives in a number of different areas.
  • The numbers and images below represent how many people said this treatment had impacted them ‘a lot’ in each of the different areas.
  • For example, imagine it says ‘25 in 100’ underneath ‘physical and social wellbeing'’ This means that 25 out of 100 people who shared their experience of this treatment told us it impacted their ‘physical and social wellbeing’ a lot. However it would also mean that 75 out of 100 people said it had not impacted them a lot.

Physical and social wellbeing

Enjoying activities such as walking or going out to the pub

73 out of 100

Effect on relationships

Ability to make good connections with others

45 out of 100

Sexual activity

Ability to reach sexual arousal, either physically or emotionally

81 out of 100

Sense of self

Knowing who you are and what motivates you

64 out of 100

Wellbeing and quality of life

Feeling good and functioning well in your personal and professional life

63 out of 100

Mental and emotional health

Ability to think clearly, make good decisions, and cope with your emotions

63 out of 100

Fatigue

Feeling of constant physical and/or mental tiredness or weakness

81 out of 100