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Posted, 12 June, 2019
There are two stages of advanced prostate cancer, which may require slightly different treatment options
Treating Locally Advanced Prostate Cancer
What are the options?
What is locally advanced prostate cancer and how is it treated?
The spread of cancer is sometimes described in terms of ‘T’ or tumour stages. When cancer has spread through the capsule of the prostate or the seminal vesicles (T3) or into the surrounding structures (T4), it is called locally advanced prostate cancer. Men with locally advanced prostate cancer have a higher risk that cancer cells may have already spread. You may be offered other treatment to kill any cells that could have spread beyond the prostate.
You may be offered radiotherapy treatment to include the surrounding structures (as well as the prostate), usually in combination with 2-3 years of hormone therapy. Hormone treatment can delay or prevent the cancer coming back in other places and is given by tablets or injections.
There are three types of hormone therapy:
- Surgical removal of the testicles (called ‘orchidectomy’)
- Injections of drugs called ‘LHRH agonists’
- Anti-androgen drug therapy
You can read more about orchidectomy on our Treating Late Prostate Cancer Page.
Some men with locally advanced prostate cancer are treated with hormone therapy alone. The choice depends on factors that you will discuss with your doctor. There are two types of hormone treatments that can be used to treat locally advanced prostate cancer. They are the luteinising hormone-releasing hormone agonists or LHRH agonists and anti-androgens. LHRH agonists are given by injection and anti-androgens by tablet.
To grow, the prostate cancer cells need the male hormone testosterone. These hormone treatments work in different ways to prevent testosterone stimulating the prostate cancer cells. The LHRH agonists will prevent testosterone from being produced by the testicles and are given as an injection. The anti-androgens block the action of testosterone on the prostate cancer cells and are given as tablets. They are both effective in treating this stage of prostate cancer but have different side effects.
LHRH agonist injections (‘luteinising hormone-releasing hormone’)
These drugs stop the release of a hormone that sends signals to the testicles to produce testosterone. It is a roundabout way of switching off testosterone and so helps to stop prostate cancer from growing. This treatment is as effective as an orchidectomy. The first injection is usually given at the hospital, but further injections can be given by your GP. The injections are repeated every month or three months.
LHRH agonist drugs cause an initial surge in the testosterone level, which is counteracted by a short course of anti-androgen tablets before and after the first injection.
What are the risks and side effects of anti-androgen drug therapy?
These drugs allow some men to maintain their sex drive and activity and do not cause any reduction in bone strength, which can be a side effect of LHRH agonists. In some men, the drugs can cause sore nipples and enlarged breasts.
We are not yet sure at which stage of prostate cancer introducing hormone therapy is most effective. All men suffering from symptoms should start immediately. However, some doctors like to prescribe hormone therapy for patients with no symptoms. So, you may be asked to decide whether to begin hormone drug therapy immediately or wait until symptoms appear.