For a lot of men with prostate cancer, an important treatment option to consider is something called androgen deprivation therapy (ADT). I. Alex Bowman, MD, a medical oncologist at Banner MD Anderson Cancer Center at Banner Gateway Medical Center in Gilbert, AZ, who specializes in cancers of the urinary tract and genitals, explained what it is, how it works and when it might be a good option.
Prostate cancer needs “male” hormones such as testosterone to grow. So, when you have less of these hormones, it can slow the spread of prostate cancer. Lower levels of these hormones can also make radiation treatments more effective.
ADT uses injected medications to reduce the amounts of these hormones by stopping the testicles from producing testosterone. Often, injections every three to six months can keep the hormone levels in check.
In men with prostate cancer that has not spread, doctors may recommend ADT for four months to three years, combined with radiation. Prostate cancer that has spread will likely require ADT for life.
Watch for these possible side effects of androgen deprivation therapy
The injections can cause local pain and swelling for a few days. The testosterone-lowering effect, however, can cause long-term side effects including:
- Hot flashes
- Metabolism changes such as weight gain, increased blood sugar and cholesterol
- Loss of muscle mass
- Enlarged and tender tissue beneath the nipple
- Lower bone density
- Depressed mood
- Worsening cognitive function over time
- Increased risk of heart disease
- Loss of libido and erectile dysfunction
How to minimize or eliminate side effects
“Having a plan in place when ADT starts can help you avoid the long-term side effects,” Dr. Bowman said. “It is important to have a frank conversation with your doctor.” He said your plan should include:
- A workout routine that includes weight or resistance training to help maintain bone and muscle mass
- A diet and exercise plan to help reduce the risk of weight gain, diabetes and cardiovascular disease
- Calcium and vitamin D supplements as directed by your doctor
- A bone density scan at the start of treatment and every 1 to 2 years during treatment
- Medication for low bone density as needed
- Medication for severe hot flashes, if needed
- Consultation with a psycho-oncology provider for mood issues such as depression and anxiety or for cognitive issues
Men who need lifelong treatment may sometimes take breaks from ADT periodically to alleviate any long-term symptoms. They may also be candidates for surgical removal of the testes, which eliminates the need for injections or medications.
In addition, a newly approved oral medication, Orgovyx, can rapidly suppress testosterone. It’s a good option for men with heart disease, since it causes fewer cardiovascular complications than ADT. Men who only need a short course of ADT may also want to consider Orgovyx. That’s because with ADT injections the testosterone level bounces back slowly after treatment stops. With Orgovyx, levels recover in several weeks.
The bottom line
Androgen deprivation therapy is a good treatment option for a lot of men with prostate cancer. While the low testosterone levels can cause long-term side effects, a good plan can keep them to a minimum.
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