Androgen Deprivation Therapy

Androgen deprivation therapy (ADT) is hormone therapy for advanced prostate cancer. Prostate cancer grows in the presence of male hormones called androgens. Testosterone is the main androgen involved.

ADT slows tumor growth by reducing your testosterone levels. Your healthcare provider may recommend it to:

• Shrink tumors and slow cancer growth
• Reduce symptoms of advanced prostate cancer
• Reduce the risk of complications related to tumor growth
• Reduce the chances of cancer coming back after radiation therapy or surgery to remove your prostate

Androgen deprivation therapy by itself can’t cure prostate cancer. But it can help you live longer, with an improved quality of life.

What happens during this treatment?

There are two main treatment options.

• Medications: ADT medicines block signals in your brain that tell your testicles to make testosterone. This is the most common treatment type.
• Surgery: A surgeon may remove your testicles. These organs make most of your body’s testosterone. Some people choose to get prostheses after. They maintain the look and feel of your testicles.

You may receive ADT as part of a combination therapy. You may get ADT along with:

• Androgen synthesis inhibitors: These medicines block an enzyme needed to make testosterone. It stops testosterone production in your testicles and your adrenal glands. (Your adrenal glands make a small amount of testosterone.) The most well-known is abiraterone (Yonsa^®, Zytiga^®).
• Antiandrogens: These medicines prevent testosterone from reaching cancer cells. They include older ones like bicalutamide, or newer ones like apalutamide, darolutamide and enzalutamide.
• Chemotherapy: Chemo kills fast-growing cells (like cancer cells) throughout your body.
• Radiation therapy: Radiation uses high-powered X-rays to help shrink tumors.

What drugs are considered androgen deprivation therapy?

One drug class is called GnRH agonists. Most involve getting a shot. You may need a shot every one, three or six months. Examples include:

• goserelin (Zoladex^®)
• leuprolide (Lupron^®)
• triptorelin (Trelstar^®)

Sometimes, the medicine causes a period of increased cancer growth that causes symptoms. This is called a “flare.” But after a while, tumors shrink and symptoms improve. To prevent flares, your healthcare provider may prescribe antiandrogens before you start ADT.

Another class is called GnRH antagonists. Some you get as an injection. Others come in pill form. They include:

• degarelix (Firmagon^®)
• relugolix (Orgovyx^®)

How long will I need this treatment?

Most people with advanced prostate cancer need continuous treatment. You may get it until it stops working. (Cancer cells eventually build up a resistance to the drugs.) Or you may decide to stop if treatment causes side effects that outweigh the benefits of ADT.

Sometimes, people choose intermittent ADT. This involves taking medicine until your testosterone levels are low enough. Then, you stop treatment to give your body a rest. Once your levels rise again, you continue the meds.

Stopping the medicine can reduce side effects. But it may not be as effective as continuous treatment. This is why it’s important to discuss your treatment schedule with your healthcare provider.

What are the potential benefits and risks of this treatment?

The major benefit of androgen deprivation therapy is that it effectively starves cancer cells of the testosterone they need to grow. This shrinks tumors and helps you live longer. ADT can also ease symptoms of prostate cancer.

But there are also potential side effects, like:

• Fatigue
• Hot flashes and night sweats
• Enlarged breast tissue
• Increased risk of certain conditions, like diabetes, broken bones and heart problems
• Loss of muscle strength and bone density (osteoporosis)
• Low sex drive and erectile dysfunction
• Mood swings and trouble thinking

Your healthcare provider can help reduce the impact of certain side effects. For example, exercise can help combat muscle loss. Medicines can help maintain your bone health.

Your healthcare provider can explain your options.

How long will it take for me to feel better?

Most people notice an improvement in their cancer once their testosterone levels are low enough to starve tumors. This may take several weeks. How long the effects last varies from person to person.

You’ll need regular checkups to keep tabs on how your treatment is working.

When should I call my healthcare provider?

Let your provider know if you have new side effects after starting ADT. They may be able to recommend ways to reduce or manage them. Let your provider know how they’re impacting you. Blood test results and imaging scans provide important information about treatment effectiveness. But your experience of the treatment matters even more.