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by EBSCO Medical Review Board

Medications for Prostate Cancer—Hormonal Therapy

This is meant to give you a general idea about each of the medicines listed below. Only the most basic problems are listed. Ask your doctor if there are any other steps you need to take. Use each of them as your doctor tells you. If you have any questions or can’t follow the package instructions, call your doctor.
Hormonal therapies are used to treat prostate cancer. For cancer that's spread to the bones, others may be needed.
  • Leuprolide
  • Goserelin
  • Flutamide
  • Bicalutamide
  • Nilutamide
  • Enzalutamide
  • Ketoconazole
  • Abiraterone
  • Zoledronic acid
  • Pamidronate
  • Alendronate
  • Risedronate
  • Ibandronate

Hormonal Therapies

Prostate cells need androgens to grow and work the way they're supposed to. The aim is to lower these amounts in your body. This is done to keep the prostate cells from being stimulated to grow. The best way to do this is by removing the testicles (orchiectomy). This can be done with surgery, but it can't be reversed.
In most cases, hormonal therapies are combined. The types are:
Luteinizing Hormone-releasing Hormone (LHRH) Analogs
  • Leuprolide
  • Goserelin
These will lower the amount of testosterone made by the testicles. These are given as a shot every few months.
Some problems are:
Anti-androgens
  • Flutamide
  • Bicalutamide
  • Nilutamide
These will keep your body from using androgens.
Some problems are:
  • Nausea or vomiting
  • Diarrhea
  • Breast growth or tenderness—gynecomastia
  • Changes in sex drive
Androgen Suppressants
Ketoconazole
This medicine blocks androgens from being made. It's mainly used when other medicines aren't working.
Some problems are:
  • Nausea or vomiting
  • Itchy skin
  • Liver problems
CYP17A1 Inhibitors
  • Abiraterone
This will block an enzyme needed to make testosterone in the organs where it's made.
Some problems are:

Bisphosphonates

  • Zoledronic acid—as an IV
  • Pamidronate
  • Alendronate
  • Risedronate
  • Ibandronate
Prostate cancer usually spreads to the bones. This can cause pain, weakened bones, and a higher risk of broken bones. Bisphosphonates are used to slow bone loss, raise bone density, and lower the risk of broken bones. Most of these are taken as a pill.
Some problems are:

Denosumab

Denosumab boosts the body's immune system. It blocks the development of cells that break down bone tissue. It is given as a shot every 4 weeks.
Possible side effects include:
  • Joint and muscle pain
  • Low calcium levels in the blood—hypocalcemia
  • Flu-like symptoms
  • Headache
  • Nausea or vomiting
  • Jaw bone damage
  • Higher risk of an unusual thigh bone fracture

Special Considerations

If you are taking medicines:
  • Take the medicines as directed. Don’t change the amount or the schedule.
  • Ask what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medicine.
  • Don’t share your prescription medicine.
  • Medicines can be dangerous when mixed. Talk to your doctor or pharmacist if you are taking more than one medicine. This includes over the counter products and supplements.
  • Plan for refills as needed.

References

Denosumab. EBSCO DynaMed website. Available at: https://www.dynamed.com/drug-monograph/denosumab. Accessed October 3, 2020.
Management of bone metastases of prostate cancer. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/management-of-bone-metastases-of-prostate-cancer. Accessed October 3, 2020.
Preventing and treating prostate cancer spread to bones. American Cancer Society website. Available at: https://www.cancer.org/cancer/prostate-cancer/treating/treating-pain.html. Accessed October 3, 2020.
Treatment option overview. National Cancer Institute website. Available at: https://www.cancer.gov/types/prostate/patient/prostate-treatment-pdq#section/%5F142. Accessed October 3, 2020.

Revision Information

  • Reviewer: EBSCO Medical Review Board Mohei Abouzied, MD, FACP
  • Review Date: 09/2020
  • Update Date: 12/15/2020