Prostate cancer remains the second leading cause of death in males with nearly 3 million males living with or having a history of prostate cancer in the United States alone. Androgen deprivation therapy is the main treatment for symptomatic metastatic prostate cancer and is used in those males who have biochemical relapse after radical prostatectomy. ADT therapy is commonly used in combination with external beam radiotherapy, or EBRT, for intermediate to high-risk prostate cancer. It is estimated that nearly 40% of patients diagnosed with prostate cancer will receive ADT within the first six months of their diagnosis (ACS).
While this therapy is effective in delaying the disease progression and relieving the symptoms from the metastatic disease, androgen deprivation therapy is linked to multiple and very intense side effects. Considering this, many doctors and specialists will only route to ADT when it is necessary or vital in helping to save the patients’ life. Studies on ADT have proven that earlier treatment is best, as treatment begun later in the cancer progression result in more severe side effects.
Some of the most reported complications include extraskeletal metastasis, bone fractures, spinal cord compression, and ureteric obstructions. ADT also carries an assortment of side effects and toxicities that the body will face. Sexual side effects like the loss of libido and erectile dysfunction are recognized and anticipated, other changes in the body are often left unspoken. Some of these changes are gynecomastia, weight gain, reduced muscle mass and tone, and increased overall body fat. There are also reported cognitive effects with memory loss and metabolic disturbances like hyperglycemia, altered lipoprotein profile, decreased insulin sensitivity, and osteoporosis- which are all less commonly referenced or recognized with ADT. Doctors and medical specialists should be discussing all of the known consequences of ADT with patients for better awareness.
Here are details on some of those most reported dangers and complications with ADT:
- The “Flare” Phenomenon. This phenomenon occurs when there is a surge in testosterone levels during the initial treatment with LHRH. This typically happens in those males who also have high-volume metastatic disease.
- Hot Flashes. Hot flashes are one of the most reported side effects for nearly every cancer patient, male or female, with all types of cancer. With ADT therapy, these rates rose for males by nearly 60%. These hot flashes are caused by inappropriate stimulation of thermoregulatory centers in hypothalamus in the brain, resulting in vasodilatation. They are described as flushing of the skin, perspiration, and the chills in the upper half of the body. Anxiety and heart palpitations can also accompany these flashes. These flashes last for varied amounts of time, from seconds to minutes, or even longer. Frequency of these hot flashes varies among patients.
- Sexual dysfunction. ADT involves changing levels of testosterone, which in turn causes varying levels of sexual dysfunction issues. Erectile dysfunction is the most declared sexual side effects, followed by loss of desire and libido. There are various ways to deal with ED symptoms, from prescription medications to therapeutic aids, and surgical procedures. Some of the therapeutic aids available are vacuum devices, support rings, girth enhancers, and wearable harnesses. These devices can help revive sexual function but do take purposeful practice and repetition.
- Skeletal Morbidity. This form of bone metastases, bone pain, osteoporosis, and associated fractures burden males who are facing advanced and metastatic prostate cancer with their ADT. Androgen deprivation causes a 4-5% annual decrease in bone mineral density (ACS). The rates of bone deterioration and fracture risk increases with each year of ADT treatment, and thereafter.
- Anemia. Males who face advanced or metastatic prostate cancer are more susceptible to becoming anemic and will require some form of iron therapy or support from prescription or intravenous medication.
- Psychological and cognitive effects. Most all hormonal therapies have been linked to a decline in cognitive function, which affects memory and attention span. Lower levels of testosterone are also associated with males having increased levels of depression and anxiety. Other factors also worsen the depression symptoms, especially those centering around loss of sexual function and ability.
- Metabolic syndrome and cardiovascular issues. With so many constant internal hormone and metabolic changes, males with prostate cancer on ADT treatment may also face increased cardiovascular issues. With the increased risk of heart disease, the risk of death does increase for certain patients receiving ADT treatment. Some of these changes increasing the risk of heart disease include:
- Insulin resistance
- Increased triglycerides
- Increased high-density lipoprotein cholesterol.
With the growing evidence that ADT negatively affects male’s psychological well-being and, in some cases, physical health, it is vital that medical professionals address all aspects of this treatment with their patients. While there are strategies in place to help control these side effects and symptoms, they can still cause undue stress and worry when the side effects are unknown.
A recent study was conducted via clinic patients which showed more than 70% of newly prescribed ADT treatment patients were unaware of the side effects caused by this treatment (Mayo/Cleveland Clinic). These side effects are why the lack of awareness about ADT treatment results in significant decreases in male’s overall quality of life for themselves, and their partners.
By increasing recognition of the side effects caused by this treatment, you can empower patients to be ready to face what is coming and the changes it will involve within their lives. This will help to improve their overall outlook on life, as well as their physical health and healing.
If you have questions about ADT treatment or its side effect, please contact your doctor or medical care team to get your specific questions answered.