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Some types of cancer grow in response to hormones in the body. In cases where a cancer of unknown primary (CUP) is likely to be a breast or prostate cancer, hormone therapy may be an effective way to slow the growth of the cancer, or perhaps even shrink it, and may help you live longer.

Most breast cancers have proteins called estrogen receptors and/or progesterone receptors on the surface of their cells. These cancers grow faster when exposed to the hormone estrogen. Likewise, most prostate cancers grow in response to male hormones called androgens, such as testosterone.

If the unknown primary is most likely a breast cancer

For a CUP that is suspected to be breast cancer, hormone therapy should be included in treatment, following guidelines for treatment of metastatic breast cancer. Multiple hormone agents are available, including

• Tamoxifen
• Toremifene (Fareston)
• Fulvestrant (Faslodex)
• Luteinizing hormone-releasing hormone (LHRH) agonists like leuprolide (Lupron) and goserelin (Zoladex)
• Aromatase inhibitors like anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin)

These drugs either lower estrogen levels or prevent cancer cells from being able to use it. For more information on how these drugs are used and their potential side effects, see Hormone Therapy for Breast Cancer.

If the unknown primary is most likely a prostate cancer

For a CUP that is suspected to be prostate cancer, hormonal therapy should follow guidelines for the treatment of advanced prostate cancer. Some commonly used drugs include:

• LHRH agonists such as leuprolide (Lupron, Eligard), goserelin (Zoladex), and triptorelin (Trelstar)
• Anti-androgens such as flutamide (Eulexin), bicalutamide (Casodex), enzalutamide (Xtandi), and apalutamide (Erleada)

These drugs either lower the testosterone level or prevent cancer cells from being able to use it. Surgery to remove the testicles (orchiectomy) is another option. For more information, see Hormone Therapy for Prostate Cancer.