If you are having LHRH agonist or GnRH antagonist injections, your specialist team may advise you to keep having these even after your PSA level has started to rise. The injections could still be helping, as some cancer cells may still be stimulated by testosterone. So keeping the amount of testosterone in your body low could still be important.

Your specialist team may also be able to adjust your current hormone therapy treatment.

You may start taking another type of hormone therapy, called anti-androgen tablets, alongside your injections, this sometimes called combined androgen blockade or maximal androgen blockade. Being on two types of hormone therapy at the same time could increase the risk of side effects. You can read more about these in our booklet Living with hormone therapy: A guide for men with prostate cancer.

If you were already having injections and anti-androgen tablets at the same time, your specialist team may advise you to stop anti-androgen treatment for a little while to see if your PSA level falls. You may hear your specialist team call this a 'withdrawal response.'

Steroids are a type of hormone therapy. A small amount of testosterone comes from the adrenal glands, which are above your kidneys. Taking steroid tablets such as dexamethasone, prednisolone or hydrocortisone may help reduce the production of testosterone from the adrenal glands. Steroids might also help improve your appetite and in some cases your mood. You might have steroids in combination with other treatments. Side effects of steroids include a risk of developing diabetes, bone thinning (osteoporosis) and water retention, so your specialist team will monitor you for any signs of these.

Diethylstilbestrol (previously called stilboestrol) is a manufactured drug similar to the hormone oestrogen. Oestrogen is found in both men and women, but women usually produce more.

Some studies have shown that diethylstilbestrol may be useful for treating prostate cancer that is no longer responding to other types of hormone therapy. It is not clear exactly how diethylstilbestrol controls this stage of prostate cancer, but in some men it helps lower their PSA level.

Taking diethylstilbestrol tablets can increase your risk of circulation problems such as blood clots so you will usually take aspirin at the same time to reduce this risk.You may not be able to take diesthylstilbestrol if you have a history of high blood pressure, heart disease or strokes. Your specialist team will advise you about this and can explain the potential risks and benefits.

Ketoconazole is a type of anti-fungal treatment that may also help treat prostate cancer by helping to stop testosterone production from the adrenal glands.

If you are taking ketoconazole you may have it at the same time as other treatments such as steroids. Ketoconazole may help lower PSA levels in about three out of ten men (30 per cent), but this varies.

Your specialist team will need to monitor how well your liver is working because ketoconazole can cause liver problems. If there are any problems then you can stop taking the drug and your liver will return to normal. Ketoconazole can also cause a dry mouth and make some people feel very tired.

Chemotherapy uses anti-cancer (cytotoxic) drugs to kill cancer cells. In the UK, docetaxel (Taxotere) is the standard chemotherapy option for men with advanced (metastatic) prostate cancer that is no longer responding to hormone therapy. You may also have another type of chemotherapy, for example mitoxantrone if you do not respond well to docetaxel, or if you or your doctor thinks that you may not be able to tolerate the possible side effects of docetaxel. This might be because you are already quite ill or have other health conditions.

Read more about Chemotherapy.

A clinical trial is a medical research study involving people, who are always volunteers. They may involve testing new drugs and combinations of drugs, as well as new technologies and procedures. There are a number of clinical trials currently looking into treatments for prostate cancer that is no longer responding as well to hormone therapy. Some of these are new treatments and some are looking at combinations of current treatments. They include:

• New types of hormone therapy and chemotherapy
• Chemotherapy combined with medication to treat cancer that has spread to the bones
• Cancer growth blockers that help stop cancer cells dividing and growing
• Antibodies that find abnormal proteins on cancer cells and 'mark' them so the immune system will destroy them (monoclonal anti-bodies)
• Vaccines that stimulate the immune system so that it attacks the prostate cancer (immunotherapy)

You can ask your specialist team or look on the CancerHelp UK clinical trials database to see whether there are any clinical trials that you could take part in.

Read more aboutthe advantages and disadvantages of taking part in clinical trials.

If you have prostate cancer that has spread to the bones or other parts of the body you may also receive treatments to help with this. Sometimes these are called palliative treatments because they aim to reduce symptoms rather than get rid of the cancer. These types of treatments include:

Palliative radiotherapy
Medicines called bisphosphonates
Pain relieving medicines such as paracetamol, ibuprofen or stronger medication such as codeine or morphine

All men are different but if your hormone therapy is no longer controlling your cancer you may feel disappointed, angry or worried about the future. While you may still be able to have treatment to control your cancer, you may find that you feel depressed or anxious during this stage. If you are a partner, family or friend of someone with prostate cancer that is no longer responding to hormone therapy you may also need support in emotional and practical ways.

You may be able to get support through your family or friends, counselling, your specialist or palliative care team, support groups or our one-to-one peer support service. Read our treating prostate cancer after hormone therapy fact sheet online for information.

If my hormone therapy is not working as well, what other treatments are available to me?

Will I still have my original hormone therapy even if it has stopped working as well?

What are the possible side effects of my new treatment (s)?

Will I see any new health professionals?

Are there any clinical trials I can take part in?

What treatments are there to manage symptoms (for example pain or tiredness)?