Find out what is androgen deprivation therapy (ADT) and when is it necessary: Prostate cancer cells rely heavily on androgenic hormones, such as testosterone and dihydrotestosterone (DHT), for survival and proliferation. The standard course of treatment for prostate cancer entails hormone therapy, also known as androgen deprivation therapy (ADT) which curtails the supply of these hormones to the cancer cells by either suppressing their production or impeding their action.
What is Androgen Deprivation Therapy (ADT)
ADT or hormone therapy is a crucial treatment option for patients with advanced prostate cancer. However, it is now being used more frequently to treat localized disease as well. It can be administered before radiation to help reduce the size of the tumor or together with radiation if there is a high risk of recurrence after treatment. It is important to note that hormone therapy alone is not enough to cure prostate cancer and it is usually used alongside other treatments.
Androgen Deprivation Therapy for prostate cancer
The following treatments can be used to lower androgen levels in prostate cancer patients:
Orchiectomy is a surgical intervention that entails the complete removal of the testicles, which are the primary source of testosterone in males. This procedure has been shown to be a highly effective method of blocking testosterone release, with the potential to cause prostate tumors to stop growing or shrink for a certain period of time.
Due to its affordability and the fact that it is a one-time procedure, orchiectomy is often performed on an outpatient basis in a urologist’s office. However, it is worth noting that this approach is considered permanent and irreversible, which has led many men to opt for alternative drug therapies.
Orchiectomy is a viable option for those seeking to prevent the release of testosterone in the body. While it may not be suitable for everyone, it is a low-cost and highly effective procedure that warrants consideration.
Luteinizing Hormone-Releasing Hormone (LHRH) Agonist
LHRH is a key hormone released before testosterone production. Blocking it is common in hormone therapy.
Leuteinizing hormone-releasing hormone (LHRH) agonists may be administered through regular injections or subcutaneous implants. These administration methods can be scheduled from a monthly to yearly basis, depending on the individual’s needs.
LHRH agonists may cause a testosterone surge or flare reaction at the beginning of treatment. This can briefly raise testosterone levels, which can be harmful for patients whose cancer has spread to the bones. The surge can cause a temporary increase in tumor growth, leading to bone pain or paralysis. Antiandrogens can prevent flare reactions by blocking testosterone effects on prostate cancer cells.
Certain medications work by blocking LHRH, which is responsible for stimulating testosterone production. Unlike other drugs, these medications do not cause an initial surge of testosterone. One such medication is degarelix (Firmagon), an LHRH antagonist that is administered via a monthly injection. After receiving the injection, patients may experience pain, swelling, and increased liver enzymes at the injection site.
Despite the use of Luteinizing Hormone-Releasing Hormone (LHRH) agonists and antagonists to inhibit androgen production in the testicles, other cells within the body, including those within prostate cancer cells, may still generate small amounts of androgens. These androgens can stimulate the growth of cancer cells, even in the face of hormone deprivation. Abiraterone, sold under the trade name Zytiga, is a medication that impedes the production of androgens by blocking the CYP17 enzyme. This oral medication is administered daily and is commonly employed to treat advanced castration-resistant cancer, a form of cancer that continues to spread despite hormone deprivation.
For patients with intact testicles, the use of LHRH agonist or antagonist therapy is necessary even in the presence of CYP17 inhibitors. These inhibitors do not impact the testicles’ ability to produce testosterone, and thus ongoing LHRH agonist or antagonist therapy is vital to ensure effective treatment. By continuing with this therapy, patients can ensure better management of their condition and improve their overall wellbeing.
Treatments interfering with Androgen Function (Antiandrogens)
Antiandrogens are medications that can be taken daily in pill form. They work by binding to the androgen receptor proteins located in prostate cells, which prevents androgens from being able to function. Antiandrogens can be added to your treatment plan if an orchiectomy, LHRH agonist, or LHRH antagonist is no longer effective by itself, and can help prevent a flare reaction.
Some commonly prescribed antiandrogens include flutamide (Eulexin) and bicalutamide (Casodex).
There is also a newer type of antiandrogen called enzalutamide (Xtandi). This type of medication blocks the signal that the androgen receptor normally sends to the cell’s control center to trigger growth and division. Enzalutamide may be used to treat castration-resistant prostate cancer.
Possible side effects of Androgen Deprivation Therapy
Testosterone is the predominant male hormone responsible for male characteristics and regulation of bodily processes.
Testosterone loss can have various potential effects, including but not limited to:
- Hot flashes
- Erectile dysfunction
- Decreased or absent sexual desire
- Osteoporosis, which can lead to bone fractures
- Weight gain
- Decreased muscle mass
- Elevated cholesterol levels
Many men who undergo hormone therapy often experience several side effects. It is important to consult with your doctor before starting hormone therapy about the impact of testosterone loss and how to minimize its effects. Regular physical exercise can play a crucial role in preventing numerous side effects and is strongly recommended.
Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy. Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.