Androgen Deprivation Therapy (ADT) is a treatment approach in urology, primarily for men with prostate cancer. Also known as hormone therapy, ADT targets male hormones, called androgens, which influence prostate cancer cell growth. Its main purpose is to slow the progression or reduce the size of prostate tumors by altering the body’s hormonal environment. ADT helps manage various stages of prostate cancer.
What Androgen Deprivation Therapy Is
Androgen Deprivation Therapy reduces the levels of androgens, such as testosterone and dihydrotestosterone (DHT), or blocks their action on prostate cancer cells. Prostate cancer cells rely on these male hormones for growth. By limiting this hormonal supply, ADT can slow cancer progression or shrink tumors.
The body primarily produces androgens in the testes, with smaller amounts from the adrenal glands. ADT targets these sources or the pathways where androgens interact with cancer cells.
Reasons for ADT
Urologists prescribe Androgen Deprivation Therapy for various prostate cancer scenarios. It is a standard initial treatment for advanced or metastatic prostate cancer. In these cases, ADT helps control cancer growth and alleviate symptoms by reducing tumor size.
ADT is also used when prostate cancer recurs after initial treatments, such as surgery or radiation, indicated by a rise in prostate-specific antigen (PSA) levels. It can also be combined with other therapies, like radiation therapy, for men with high-risk localized prostate cancer. This combination enhances radiation effectiveness and improves long-term control by shrinking the tumor before or during treatment.
Methods of ADT Delivery
Androgen Deprivation Therapy can be delivered through medical or surgical approaches, each designed to reduce or block androgen activity. Medical ADT involves various pharmaceutical agents:
LHRH agonists (e.g., leuprolide, goserelin) work by desensitizing the pituitary gland, leading to decreased testosterone production from the testes. These are typically given as injections.
LHRH antagonists (e.g., degarelix) directly block LHRH receptors in the pituitary gland, causing a rapid and sustained drop in testosterone levels without the initial “flare” effect.
Anti-androgens (e.g., bicalutamide, enzalutamide) are oral medications that block androgen receptors on prostate cancer cells, preventing their growth stimulation.
Surgical ADT involves an orchiectomy, the surgical removal of the testicles, which are the primary source of testosterone production. This procedure results in an immediate and permanent reduction in androgen levels.
Common Side Effects of ADT
The reduction in androgen levels due to ADT can lead to several common side effects. Hot flashes are frequent, manifesting as sudden sensations of heat, sweating, and flushing, similar to menopausal symptoms in women. Many men also experience fatigue, which can range from mild tiredness to profound exhaustion that interferes with daily activities. This fatigue is believed to stem from the body’s adjustment to lower testosterone levels.
Sexual side effects are prevalent, including a marked decrease in libido (sex drive) and erectile dysfunction, as testosterone plays a direct role in sexual function. Long-term ADT can also contribute to bone density loss, increasing the risk of osteoporosis and fractures, because androgens help maintain bone health.
Muscle mass often diminishes, accompanied by an increase in body fat, which can lead to weight gain. Additionally, mood changes, such as irritability, depression, and anxiety, are reported, reflecting the hormonal influence on brain chemistry. There is also a potential for increased cardiovascular risks, including changes in cholesterol levels and blood sugar regulation, making heart health monitoring important during treatment.
Managing ADT Side Effects
Managing the side effects of Androgen Deprivation Therapy involves a combination of lifestyle adjustments and medical interventions to improve quality of life. For hot flashes, medications like venlafaxine or gabapentin may be prescribed, and some men find relief through maintaining a cool environment and avoiding triggers. Regular physical activity, including aerobic exercise and strength training, can help combat fatigue, preserve muscle mass, and manage weight gain. Exercise also contributes to bone health, and bisphosphonate medications or denosumab injections may be used to mitigate bone density loss.
Addressing sexual side effects often involves open discussions with the urology team, who might suggest strategies like vacuum devices or penile injections, though libido changes can be more challenging to reverse. For mood changes, counseling, support groups, or antidepressant medications can be beneficial. Close monitoring of cardiovascular health, including blood pressure, cholesterol, and blood sugar, is also important, with dietary modifications and medication as needed. Maintaining clear communication with the healthcare provider is paramount to personalize management strategies and address specific concerns throughout the treatment period.