Hormone Therapy (tablets)
Tablets that stop the body from making testosterone or prevent testosterone from reaching the prostate cancer cells.
Hormone therapy tablets for prostate cancer?
This page explains what hormone therapy tablets are, when they may be used, and how they can help treat prostate cancer. The information will help you understand your options.
Image
There are two main types of hormone therapy tablets. These are often called ARPIs
ARPI stands for androgen receptor pathway inhibitor.
These tablets help slow down the growth of prostate cancer.
Image
“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
What are the main benefits of hormone therapy tablets?
Hormone therapy tablets are taken alongside hormone injections or relugolix tablets.
Compared to hormone injections or relugolix on their own, hormone therapy tablets can:
Help you live longer
Control the cancer for longer
Delay the cancer getting worse
Frequently asked questions (FAQs) about hormone therapy tablets
How do hormone therapy tablets work?
They work in two main ways:
They lower testosterone levels
They reduce the amount of testosterone made in the body.
This includes testosterone made by the adrenal glands and, in some cases, by the cancer itself.
Abiraterone works in this way.
Or
They stop prostate cancer cells using testosterone.
These tablets stop prostate cancer cells from using testosterone to grow.
These include:
Apalutamide
Darolutamide
Enzalutamide
Your oncologist or urologist will talk with you about which tablet may be suitable for you and explain why. This depends on your type of prostate cancer, your overall health, and your preferences
When are hormone therapy tablets used?
When are hormone therapy tablets used?
You may be offered hormone tablets as well as hormone injections or relugolix if one of the following applies to you:
- Newly diagnosed high-risk prostate cancer
You have just been diagnosed with high risk prostate cancer and
- The cancer has not spread to the bones or other distant parts of the body.
High-risk prostate cancer means:
- The cancer has spread to nearby lymph nodes in your pelvis
OR
If it has not spread to the lymph nodes, you have two or more of the following:
- The tumour is more advanced (stage T3 or T4)
- The Gleason score is 8 to 10 (Grade Group 4 or 5)
- Your PSA blood test is 40 or higher
2. Newly diagnosed metastatic prostate cancer
- The cancer has spread to the bones or other organs.
This is called metastatic prostate cancer.
3. Prostate cancer after previous treatment
- You have had surgery (radical prostatectomy) or radiotherapy, and
- It has been more than 12 months since your treatment finished, and
- The cancer has not spread to the bones, and
- If it has spread to lymph nodes, they are near the prostate (pelvic lymph nodes), and
- One of the following applies:
- Your PSA is 4 or higher and it has doubled in the last 6 months, or
- Your PSA is 20 or higher.
4. Metastatic castration-resistant prostate cancer (mCRPC)
- You are already having hormone injections or relugolix, and
- Your cancer is growing, and
- It has spread to other parts of your body.
This is called metastatic castration-resistant prostate cancer.
Will I have pain during or after hormone therapy tablets?
- You should not experience any pain with hormone therapy tablets.
Will I need to take time off work during or after my treatment?
- You may feel tired or lack energy when you are having hormone therapy.
- 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.
Are there any special instructions I need to be aware of?
- Anyone staying on hormone therapy should have a yearly check-up with their doctor. They will check your:
- Blood pressure
- Cholesterol
- Blood sugars – to test for diabetes.
- They should also talk to you about your bone health and keeping fit.
How will I know that the hormone therapy is working?
- You will have regular check-up with your doctor or specialist nurse. This will include monitoring of your PSA level. This will probably fall
while 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).
What happens if my hormone therapy stops working?
- 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.
Will I still be able to have children?
- 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).
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 reviewed in March 2026. Date of next review: March 2028.
- 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.
Image
What are the risks of the different types of hormone therapy (tablets)?
Abiraterone acetate (Zytiga)
Very common side effects
Affects MORE THAN
- 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
- 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.
Enzalutamide (Xtandi)
Very common side effects
Affects MORE THAN
- Excessive tiredness (fatigue)
- Fall
- Broken bones (fractures)
- Hot sweats (flushes)
- High blood pressure (hypertension).
Common side effects
Affects UP TO
- 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).
Darolutamide (Nubeqa)
Very common side effects
Affects MORE THAN
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
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).
Apalutamide (Erleada)
Very Common Side Effects
Affects MORE THAN
- 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
- 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.
Where does this information on risk come from?
- 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 reviwed in March 2025. Date of next review: March 2027.
- 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
75 out of 100
Effect on relationships
Ability to make good connections with others
48 out of 100
Sexual activity
Ability to reach sexual arousal, either physically or emotionally
78 out of 100
Sense of self
Knowing who you are and what motivates you
66 out of 100
Wellbeing and quality of life
Feeling good and functioning well in your personal and professional life
66 out of 100
Mental and emotional health
Ability to think clearly, make good decisions, and cope with your emotions
66 out of 100
Fatigue
Feeling of constant physical and/or mental tiredness or weakness
81 out of 100
