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Androgens are hormones. Antiandrogens are
drugs that block the action of these hormones. In
prostate cancer, they block the action of
testosterone made by the testicles and/or adrenal
glands. This usually slows prostate cancer growth.
steroidal antiandrogens and "pure" antiandrogens. The steroidal antiandrogens
include megestrol (Megace). The "pure" or nonsteroidal antiandrogens include
bicalutamide (Casodex), flutamide, and nilutamide (Nilandron).
An antiandrogen is often added to
luteinizing hormone-releasing hormone (LH-RH) agonist
therapy to prevent a rise in testosterone at the beginning of LH-RH agonist
therapy. (The rise in testosterone can cause a tumor flare with bone pain,
urinary blockage, or other symptoms of rapid cancer growth. But this growth
does shrink over time.)
Antiandrogens can be used along with
surgery to remove the testicles (orchiectomy).
Antiandrogens may be used before or after radiation for men with intermediate-risk prostate cancer.
Antiandrogens are often used in combination with other hormone therapy
to block the supply of testosterone. This is done to slow the growth of
advanced prostate cancer and ease severe bone pain caused by the spread of
cancer to the bones.
Studies show that taking antiandrogens may provide a small benefit for men who have metastatic prostate cancer and are also taking an LH-RH agonist.1
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
Call 911 or other emergency services right away if you have:
Call your doctor if you have:
Common side effects of this medicine include:
Long-term treatment with antiandrogens may cause
osteoporosis, which causes bones to become brittle and
break more easily. Your doctor may prescribe a bisphosphonate medicine. Zoledronic acid is a bisphosphonate specifically
designed for people who are getting treatment for metastatic cancer.
See Drug Reference for a
full list of side effects. (Drug Reference is not available in all
Research shows that men who take antiandrogens may be able to prevent bone problems by taking medicines such as zoledronic acid and denosumab.2, 3
Antiandrogens may improve a man's
quality of life when bone pain caused by prostate cancer is severe.
Sometimes flutamide has an effect called a "withdrawal response" in which
the tumor shrinks and the PSA level improves when a man stops taking the
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Zelefsky MJ, et al. (2011). Cancer of the prostate. In VT DeVita Jr et al., eds., DeVita, Hellman and Rosenberg's Cancer: Principles and Practice of Oncology, 9th ed., pp. 1220–1271. Philadelphia: Lippincott Williams and Wilkins.
National Comprehensive Cancer Network (2012). Prostate cancer. NCCN Clinical Practice Guidelines in Oncology, version 2.2012. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.
Fizazi K, et al. (2011). Denosumab versus zoledronic acid for treatment of bone metastases in men with castration-resistant prostate cancer: A randomised, double-blind study. Lancet, 377(9768): 813–822.
September 12, 2012
E. Gregory Thompson, MD - Internal Medicine & Christopher G. Wood, MD, FACS - Urology, Oncology
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