Hormone Therapies & Other Systemic Therapies for Prostate Cancer

Doctors may prescribe hormone therapies to affect the levels or activity of testosterone, which fuels prostate cancer, in the body.

Androgen Deprivation Therapies

Doctors may prescribe androgen deprivation therapies, such as leuprolide (Lupron) or degarelix (Firmagon), for prostate cancer that has spread or has returned after treatments.

Androgens are male hormones, such as testosterone. Sometimes, these therapies are prescribed for early prostate cancer in combination with radiation therapy. They work by suppressing the gonadotropin-releasing hormone, or GnRH, preventing it from stimulating the production of androgens. These medications are injected monthly or every three months.

Antiandrogen Therapies

Antiandrogen therapies may be prescribed for men with hormone-sensitive or hormone-resistant prostate cancer that has spread or returned after treatments. Hormone sensitive means that the prostate cancer has not been treated with or remains vulnerable to androgen deprivation therapy. Hormone-resistant prostate cancer grows despite androgen deprivation therapy.

Antiandrogen therapies block the ability of testosterone to fuel tumor growth. One type is abiraterone, a CYP17 inhibitor which prevents certain genes from producing testosterone in the body. It can typically lower testosterone levels more effectively than androgen deprivation therapies. Abiraterone is often prescribed with a low dose of the steroid prednisone to help prevent side effects, such as fluid retention and high blood pressure. The other antiandrogens—enzalutamide (Xtandi), apalutamide (Erleade), and darolutamide (Nubeqa)—are potent inhibitors of testosterone’s ability to stimulate prostate cancer growth and proliferation.

For men with advanced hormone-resistant prostate cancer with minimal noticeable symptoms, doctors may prescribe an immunotherapy called sipuleucel-T, or Provenge. This treatment helps your own immune system to attack prostate cancer.

Chemotherapy, such as docetaxel (Taxotere) and cabazitaxel (Jevtana), may be given to some men with hormone-sensitive or hormone-resistant prostate cancer. These prostate cancer medications work by disrupting the ability of cancer cells to grow. They are typically administered by injection into a vein every two or three weeks.

When hormone-resistant prostate cancer has spread despite treatment with chemotherapy, doctors may prescribe radionuclide therapy, which uses radioactive substances called radiopharmaceuticals that target and destroy cancer cells in specific organs or tissues.

The radiopharmaceutical lutetium-177 PSMA-617 (Pluvicto) is a prostate-specific membrane antigen (PSMA) radionuclide therapy. This therapy targets PSMA receptors, or proteins, that sit on the surface of prostate cancer cells. They can be detected in the body with a PSMA PET/CT or PET/MRI scan. For this treatment, the therapy is injected into a vein and then seeks out and attaches to PSMA receptors on prostate cancer cells. These cells then absorb the radioactive material. 

Our researchers are developing promising new treatments for prostate cancer through clinical trials. This includes immunotherapies and targeted drugs, which treat specific genetic mutations detected in an individual person’s cancer. You and your doctor can discuss whether a clinical trial might be right for you.