Male hormones like testosterone and dihydrotestosterone (DHT) fuel prostate cancer cells. Suppressing these hormones can be an effective way to treat prostate cancer alongside other protocols. This particular hormone therapy is known as androgen deprivation therapy or ADT.

We've asked one of our physician assistants, Victoria Webber, to answer common questions about ADT, including when this hormone therapy is discussed with patients, how ADT is administered, and potential side effects.

As with all content on our blog, the following is educational, not medical advice. Always consult your medical provider regarding your unique healthcare needs. 

We gave a brief overview of ADT above. But can you share how you explain to patients what androgen deprivation therapy is and how it's used in the treatment of prostate cancer?

VICTORIA WEBBER: Androgen deprivation therapy (ADT) is a therapy we use to decrease the level of certain hormones known as androgens (testosterone and DHT) circulating in a patient's body. Androgens play a role in stimulating the growth of prostate cancer cells, so by decreasing the androgens circulating in the body, we are helping to slow or stop the growth of the cancer.

In which stages or cases of prostate cancer is ADT typically recommended?

VICTORIA WEBBER: ADT is usually used in addition to radiation therapy in patients with high-risk localized disease (meaning the cancer has not spread outside of the prostate). If a patient has a recurrence after initial treatment, ADT may also be offered at that time.

It is also typically used in any patient that has advanced or metastatic disease (meaning the cancer has spread outside of the prostate). 

How is the decision made regarding the type and duration of ADT for an individual patient?

VICTORIA WEBBER: When ADT is used in combination with radiation therapy, the patient may be kept on ADT for six months or two years. The duration of ADT depends on which "risk group" they are assigned. A risk group is assigned based on factors such as the prostate-specific antigen (PSA) at the time of diagnosis, Gleason Grade, and the number and location of positive biopsy cores, to name a few. 

When ADT is used to treat metastatic cancer, it is typically used indefinitely as a means to keep the cancer undetectable.

What are the different types of ADT, and how do they differ in terms of administration and effectiveness?

VICTORIA WEBBER: ADT can be achieved in two separate ways:

1. Medication: There are multiple classes of medications we can use to decrease the production of testosterone or block the receptors for testosterone on the cancer cells. 

• Most of the time when we speak about androgen deprivation therapy, we are talking about Gonadotrophin-releasing hormone (GnRH) agonists or antagonists. These are typically given in the form of an injection and work on the pituitary gland to decrease the production of testosterone. 
• Another class of medications known as anti-androgens may be used in combination with a GnRH agonist/antagonist in certain cases. These medications work by blocking the testosterone receptors on the cancer cells. 

2. Surgery: Though less common, surgery can be performed to remove the testicles which are responsible for testosterone production.

How effective is ADT generally? Can it cure prostate cancer?

VICTORIA WEBBER: ADT is not a cure for prostate cancer. When combined with radiation for localized disease, ADT effectively increases survival rates and reduces the risk of recurrence. In metastatic disease, it is effective in slowing disease progression, reducing the size of tumors, and prolonging survival. 

What are the most common side effects, and how can they be managed? What should patients expect during their ADT treatment?

VICTORIA WEBBER: Side effects of ADT are often comparable to symptoms a woman would feel during menopause. The most common side effect is hot flashes, but patients may also experience fatigue, muscle weakness, decreased libido, and decreased bone density. 

Most side effects are minor and do not require medical management. 

How long does a typical course of ADT last, and what factors influence the duration of treatment?

VICTORIA WEBBER: Depending on the stage of the cancer, patients can be on ADT for six months, 12 months, intermittently, or indefinitely. 

The length of treatment is determined by the patient's risk group and the extent of the disease. Tolerability may also change the length of treatment. 

How does ADT impact a patient's quality of life, and what strategies can help mitigate these effects?

VICTORIA WEBBER: Patients may experience decreased energy levels, hot flashes, and mood changes while on ADT. However, most patients experience minimal impact on their quality of life. Exercise can help with mood and energy levels. 

How can family members and caregivers best support a loved one undergoing ADT?

VICTORIA WEBBER: Keep the AC on. Be understanding if they have decreased energy. 

What should patients know about the potential for cancer recurrence after completing ADT?

VICTORIA WEBBER: The risk of recurrence after completing ADT depends on the initial stage or grade of the cancer. After completing ADT, the patient's PSAs are typically closely monitored to ensure early detection of any recurrence. 

What key message do you want patients to take away about ADT?

VICTORIA WEBBER: Androgen deprivation therapy is not chemotherapy or a cure for prostate cancer, but it is a well-tolerated treatment that increases survival rates in patients with specific stages of prostate cancer.

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