What you can expect

LHRH agonists and antagonists

LHRH agonist and antagonist medications stop your body from producing testosterone.

These medications are injected under your skin or into a muscle monthly, every three months or every six months. Or they can be placed as an implant under your skin that slowly releases medication over a longer period of time.

These medications include:

  • Leuprolide (Lupron, Eligard)
  • Goserelin (Zoladex)
  • Triptorelin (Trelstar)
  • Degarelix (Firmagon)

Testosterone levels may increase briefly (flare) for a few weeks after you receive an LHRH agonist. Degarelix is an exception that doesn't cause a testosterone flare.

Decreasing the risk of a flare is particularly important if you are experiencing pain or other symptoms due to cancer because an increase in testosterone can worsen those symptoms. To decrease the risk of a flare, your doctor might recommend you take an anti-androgen either before or along with an LHRH agonist.

Anti-androgens

Anti-androgens block testosterone from reaching cancer cells. These oral medications are usually prescribed along with an LHRH agonist or before taking an LHRH agonist.

Anti-androgens include:

  • Bicalutamide (Casodex)
  • Nilutamide (Nilandron)
  • Flutamide

Orchiectomy

You'll be given anesthetics to numb your groin area. The surgeon makes an incision in your groin and extracts the entire testicle through the opening, then repeats the procedure for your other testicle. Prosthetic testicles can be inserted if you choose.

All surgical procedures carry a risk of pain, bleeding and infection. Orchiectomy is usually performed as an outpatient procedure and doesn't require hospitalization. Typically, no additional hormone therapy is required after orchiectomy.

Other medications

When prostate cancer persists or recurs despite hormone therapy, other medications can be used to block testosterone in the body. Each medication targets testosterone in the body in a different way.

These other medications include:

  • Abiraterone (Zytiga)
  • Corticosteroids, such as prednisone
  • Enzalutamide (Xtandi)
  • Ketoconazole

These other medications are generally reserved for men with advanced prostate cancer that no longer responds to other hormone therapy treatments.

April 26, 2016
References
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  2. Dawson NA. Overview of the treatment of disseminated prostate cancer. http://www.uptodate.com/home. Accessed Jan. 25, 2016.
  3. Niederhuber JE, et al., eds. Prostate cancer. In: Abeloff's Clinical Oncology. 5th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2014. http://www.clinicalkey.com. Accessed Jan. 26, 2016.
  4. Lee RJ, et al. Initial systemic therapy for castration sensitive prostate cancer. http://www.uptodate.com/home. Accessed Jan. 25, 2016.
  5. Roach M. Current trends for the use of androgen deprivation therapy in conjunction with radiotherapy for patients with unfavorable intermediate-risk, high-risk, localized, and locally advanced prostate cancer. Cancer. 2014;120:1620.
  6. Smith MR, et al. Side effects of androgen deprivation therapy. http://www.uptodate.com/home. Accessed Jan. 25, 2016.
  7. Dawson NA. Secondary endocrine therapies for castration resistant prostate cancer. http://www.uptodate.com/home. Accessed Jan. 25, 2016.
  8. Steele GS, et al. Radical inguinal orchiectomy for testicular germ cell cancers. http://www.uptodate.com/home. Accessed Jan. 25, 2016.