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Prostate Cancer and Androgen Deprivation Therapy
Prostate cancer and Androgen Deprivation Therapy is a double-edged sword. Meaning, ADT has risks and benefits that PCa patients should be aware of.
Recognizing and Managing Side Effects of Androgen Deprivation Therapy (ADT)
Androgen deprivation therapy (ADT) lowers testosterone to slow prostate cancer growth, but because testosterone affects many body systems, side effects are common. Not every patient experiences all of these, and severity varies with duration and type of ADT.
Most common side effects
1. Hot flashes
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Sudden warmth, sweating, flushing
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Often one of the earliest and most frequent effects
2. Sexual and reproductive effects
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Decreased libido
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Erectile dysfunction
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Reduced semen volume
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Infertility (often reversible only if ADT is short-term)
3. Fatigue and low energy
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Persistent tiredness
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Reduced stamina and motivation
4. Loss of muscle mass and strength
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Muscle wasting (sarcopenia)
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Reduced physical performance
5. Weight gain and body composition changes
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Increased fat mass, especially abdominal fat
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Decreased lean body mass
6. Bone health problems
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Bone mineral density loss
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Osteopenia or osteoporosis
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Increased fracture risk
7. Metabolic and cardiovascular changes
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Insulin resistance or new/worsening diabetes
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Increased cholesterol and triglycerides
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Higher risk of cardiovascular disease (especially with long-term therapy)
8. Mood and cognitive changes
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Depression or low mood
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Anxiety
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Memory or concentration difficulties (“brain fog”)
9. Breast changes
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Gynecomastia (breast enlargement)
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Breast tenderness or pain
10. Anemia
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Mild to moderate decrease in red blood cells
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Can contribute to fatigue and weakness
Less common but important side effects
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Decreased testicular size
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Changes in body hair
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Hot flash–related sleep disturbance
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Reduced overall quality of life with long-term use
My uncle underwent ADT for a diagnosis of PCa. While the therapy had the intended effect of lowering his testosterone, it also had some dramatic side effects on his physical health.
As a long-term cancer survivor myself, I understand the need for toxic therapy. I think it’s important to fully educate the cancer patient about possible side effects.
Scroll down the page, post a comment or question to learn more about evidence-based PCa therapies.
Good luck,
David Emerson
- Cancer Survivor
- Cancer Coach
- Director PeopleBeatingCancer
Optimal Duration of Androgen Deprivation Therapy With Definitive Radiotherapy for Localized Prostate CancerA Meta-Analysis
Key Points
Question What is the ideal duration of androgen deprivation therapy (ADT) for patients with intermediate-risk, high-risk, and very high-risk prostate cancer treated with radiotherapy?
Findings In this patient-level data meta-analysis of 10 266 men with prostate cancer, there was a nonlinear relative benefit of ADT duration, and the absolute benefit varied by risk group. Prolongation of ADT had a differential association with cancer-specific mortality vs other-cause mortality.
Meaning The study results suggest that individualized ADT decisions are needed for patients based on prognostic risk, comorbidities, life expectancy, and patient preferences.
Abstract
Importance The ideal duration of androgen deprivation therapy (ADT) for treating localized prostate cancer is unknown due to variable adherence and treatment durations tested in clinical trials.
Objective To determine the ideal duration of ADT for patients with prostate cancer treated with radiotherapy.
Data Sources This individual patient data meta-analysis of 13 randomized phase 3 clinical trials evaluated the use of radiotherapy alone or with ADT. It included patients with a median follow-up of 11.3 (IQR, 9.5-14.5) years and ADT duration of 0 to 36 months. Most patients (7392 [72%]) included had National Comprehensive Cancer Network high-risk or very high-risk disease.
Study Selection For this meta-analysis, a systematic literature search from 1980 to 2020 was performed in trial registries (Cochrane Central Register of Controlled Trials and ClinicalTrials.gov), MEDLINE (1966-2020), Embase (1982-2020), Web of Science, and Scopus to identify trials.
Data Extraction and Synthesis Intention-to-treat and as-treated analyses were performed. The number needed to treat to prevent 1 distant metastasis at 10 years was calculated based on prognostic risk group. The analyses were conducted from January 5 to August 15, 2023.
Main Outcomes and Measures The primary end point for this study was overall survival, defined as time to death or last follow-up from randomization. Secondary end points included biochemical recurrence, distant metastasis (DM), prostate cancer–specific mortality, and other-cause mortality.
Results The median (IQR) age among the 10 266 male patients was 70 (65-74) years. Longer durations of ADT were associated with nonlinear improvement in relative benefits of DM, prostate cancer–specific mortality, and overall survival, with reduced estimated benefits beyond 9 to 12 months of ADT based on the end point. There was a near-linear increase in other-cause mortality associated with long-term ADT use (hazard ratio, 1.28; 95% CI, 1.09-1.50; P = .002 for 28 vs 0 months of ADT). The optimal ADT duration based on 10-year DM was 0, 6, 12 months, and undefined for patients with 1 intermediate-risk factor, 2 or more intermediate-risk factors, and National Comprehensive Cancer Network high-risk and very high-risk disease, respectively.
Conclusions and Relevance The results of this meta-analysis suggest that, for men with localized prostate cancer treated with definitive radiotherapy and ADT, there are relative and absolute benefits from increasing durations of ADT that help provide individualized risk estimates.
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