Prostate cancer needs testosterone to grow. Slowing the production of testosterone may slow the growth of the cancer or shrink it temporarily. Testosterone is an androgen (male sex hormone), so this treatment is called androgen deprivation therapy (ADT). It is also known as hormone therapy.
ADT is also used to manage advanced prostate cancer, when disease has spread beyond the prostate. In this case, the treatment will not cure the cancer but can keep it under control for months and even years. It may also reduce or eliminate the symptoms of cancer (temporary remission) and help with symptoms such as pain caused by the cancer spreading.
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The most common form of ADT involves injections of drugs that block the body’s production of testosterone. They are usually given monthly, four-monthly or six-monthly. These injections will not cure the cancer but may slow its growth for years.
ADT injections are often used before, during and after radiation therapy. They are the main treatment for advanced prostate cancer, often combined with chemotherapy.
Intermittent ADT – Occasionally ADT injections may be given in cycles, with treatment continuing until your PSA level is low, and then stopped for a period of time. It can then be restarted if your PSA rises again. This is known as intermittent ADT. In some cases, this can reduce side effects without affecting long-term prostate cancer outcomes. However, it is not suitable for all men.
Often just called hormone tablets, anti-androgen tablets are taken by mouth. While ADT injections work by blocking the body’s production of testosterone, anti-androgen tablets stop the testosterone reaching the cancer cells. Anti-androgen tablets are sometimes used on their own. More often, they are used with ADT injections. This combination is known as a complete or combined androgen blockade.
Removing all or part of the testicles permanently reduces testosterone levels. This surgical approach is no longer commonly used, but some men with advanced prostate cancer may still prefer it over regular injections or tablets.
The removal of both testicles is called a bilateral orchidectomy. Some men have a silicone prosthesis put into the scrotum after surgery to keep its shape. The removal of only the inner part of the testicles (subcapsular orchidectomy) does not need a prosthesis.
Side effects of ADT
ADT may cause a range of side effects because of the reduced testosterone levels in the body. These can include:
- reduced sex drive (libido)
- erection problems
- loss of muscle strength, weight gain
- hot flushes, breast growth and tenderness
- mood swings, depression, trouble with thinking and memory
- loss of bone density (osteoporosis) – your doctor may monitor myour bone mineral density, calcium and vitamin D levels
- increased risk of other problems such as obesity, diabetes and heart disease – your doctor will assess these risks with you and it may be helpful to seek advice from a dietitian.
Although the side effects of ADT can be significant, your treatment team can help you minimise the impact. To read more about this treatment, see Understanding Hormone Therapy for Prostate Cancer, available from the Prostate Cancer Foundation of Australia. Visit prostate.org.au or call 1800 22 00 99.