Androgen Deprivation Therapy, or ADT, is a therapy used to treat prostate cancer. Prostate cancer cannot thrive or grow without androgens, which include testosterone, follicle-stimulating hormone, and luteinizing hormones. This hormone therapy works to decrease the number of androgens within a male’s body, which thusly slows the growth of the cancer, and in some cases, can even shrink their tumor.
ADT hormone therapy is often used under the following circumstances:
- When prostate cancer is found outside of the prostate and in other parts of the body, or metastatic, at the time of diagnosis,
- When prostate cancer has returned,
- Or along with, or after, radiation treatment when there is a higher risk of the cancer returning.
While on hormone therapy and the androgen levels are down, the male will also see his prostate-specific antigen (PSA) numbers drop. The PSA test is a good marker to test if the androgen deprivation therapy is working.
Medications Used for Hormone Therapy
Specific medications can work towards lowering androgens in the body. Some, like those luteinizing hormone-releasing hormone help to do this job. Here are some facts about these medications:
- LHRH agonists. These drugs stop the body from making testosterone. They include Goserelin (Zoladex), Histrelin (Vantas), Leuprolide (Lupron), and Triptorelin (Trelstar).
- LHRH antagonists. These drugs stop the body from making testosterone. They avoid the flare caused by LHRH agonists, which can make symptoms worse for several weeks. One LHRH antagonist is Degarelix (Firmagon).
- Androgen inhibitors. These are medicines that block enzymes that the body needs to make testosterone. They include Enzalutamide (Xtandi), Ketoconazole, and Abiraterone (Zytiga), which is given along with prednisone- which is a steroid.
- Antiandrogens. These drugs often are used along with LHRH agonists. Antiandrogens help block the body's supply of testosterone. There are steroidal antiandrogens and "pure" antiandrogens. The steroidal antiandrogens include Megestrol (Megace). The "pure" or nonsteroidal antiandrogens include Bicalutamide (Casodex), Flutamide, and Nilutamide (Nilandron). (Information from ACS)
Other hormone therapy can include other medications like corticosteroids, estrogen, megestrol, or hydrocortisone which are usually combined with aminoglutethimides.
Surgical Hormone Therapy
A less-often sought treatment plan is surgery to remove the testicles, which is called an orchiectomy. This specific surgery is considered a “hormone therapy” because it removes the testicles, where more than 90% of a male’s androgens are made, as well as decreases testosterone levels. Removing the testicles is the simplest way of reducing androgen levels, but it very permanent.
Effectiveness of Hormone Therapy
This hormone therapy typically works to stop the cancer growth, but in many cases, the cancer begins to grow again within a five-year time frame. At this point in the males’ cancer journey, the cancer is then described as “hormone resistant,” which means it is no longer responding to any standard hormone therapy treatment. When these treatments are no longer working as they should, the cancer is then called “castrate-resistant prostate cancer,” or CRPC. Certain treatments like chemotherapy, immunotherapy, and other medications are then used to help the male live longer.
Alternative Therapies to Conventional Hormone Therapy
These therapies are common alternatives used by specialists throughout the world regarding treating prostate cancer:
- Combined androgen blockade (CAB). Sometimes androgen deprivation (orchiectomy or an LHRH agonist) and an antiandrogen are used together for treatment. This blocks the testosterone made by the testicles and the adrenal glands.
- Intermittent androgen deprivation (IAD). This involves cycles of hormone therapy medications. Taking breaks during hormone therapy gives men the chance to recover their ability to function sexually. It also gives relief from the other side effects of hormone therapy, including hot flashes, body sweats, and the effects on energy as well as the loss of bone and muscle mass. The long-term survival outcome of IAD compared to conventional ADT is not yet known.
- Antiandrogen monotherapy. Antiandrogens are medicines that block the action of androgens in the body. Antiandrogen monotherapy means taking antiandrogens without other hormone medicines.
Common Side Effects of Hormone Therapy
For those males who take medications for their hormone therapy, the side effects will worsen over time. Some side effects may disappear after the medications have been stopped, but other side effects may include:
- Increased risk for diabetes and heart disease.
- Emotional ups and downs.
- Low red blood cell count, anemia, and fatigue.
- Increased body mass (BMI) and higher levels of fats in the blood.
- Reduced muscle mass.
- Osteoporosis, brittle or thin bones.
- Erectile dysfunction.
- Loss of libido.
- Hot flashes and full body sweats.
- Breast enlargement.
- Cognitive impairment.
- Depression and anxiety.
For those males who opted for the surgical route to treat and control their cancer for hormone therapy, two side effects happen quickly upon the start of treatment and are permanent. Those are becoming sterile and an extreme loss of libido.
Aside from those two main surgical side effects, surgery has fewer side effects than the medications.
Hormone Therapy & Living Life
A male’s quality of life will be affected by whatever treatment he chooses to go with on his journey. For many of the side effects listed above, there are other therapies, activities, and treatments that can help to ease those side effects to retain the quality of life they desire. Here are some examples:
- For those males who suffer from sexual dysfunction, seeking out holistic therapies and the use of therapeutic aids can help them to reclaim their intimacy.
- For males who suffer from depression and anxiety, seeking out a qualified therapist can help to control those feelings and work towards better self-care practices.
- For males who feel overly fatigued and face the loss of muscle mass, exercise can help.
- There is secondary medication that can help with things like diarrhea, nausea, bone loss and hot flashes. Simply speak to your doctor about these options.
- For those seeing breast development during treatment, low-dose radiation or taking Tamoxifen can help slow or reduce this enlargement.
- Finding a support group in your area where males who are going through the same or similar journey can share tips, tricks, and life stories.
The important thing to remember is to discuss any and all symptoms you are having with your doctor or medical care team. If you have questions about androgen deprivation therapy, surgical treatment, or otherwise, reach out to your medical care team without delay.
Look for our article on “The Dangers & Complications with Androgen Deprivation Therapy” to better understand the complications of ADT therapy.