Health decisions are personal. When deciding on Prostate Cancer (PCa) treatment, understanding the timing, effectiveness, costs, side effects, and alternatives is important. I hope this post helps you make an informed decision that gives you confidence in your medical care.

What is “ADT” and why is it used in treating Prostate Cancer?

ADT stands for Androgen Deprivation Therapy, a form of hormone therapy used to treat PCa. Traveling mainly through the bloodstream, hormones are chemical substances that act like messengers to control how cells and organs do their work. Examples of hormones are testosterone, cortisol, and insulin.

If your doctor recommends a hormone therapy treatment such as ADT for your PCa, this will involve medication to reduce testosterone levels. Made in the testes and adrenal gland, testosterone is one of several male hormones known as androgens, which are important for a healthy prostate and other bodily functions. Unfortunately, testosterone can also help prostate cancer cells grow and spread and may need to be suppressed. Treatment for prostate cancer known as “deprivation” slows or stops the body from making testosterone or blocks it from working. Depriving your body of androgens may cause prostate tumors to shrink or grow more slowly which is a positive benefit for men with PCa. For some patients, ADT may be the only treatment needed; for other patients, it may be added to support additional treatments such radiation.

Different types of ADT

There are 2 longstanding types of ADT:

• (1) Anti-androgens work by blocking testosterone on prostate cancer cells.
• (2) LHRH (luteinizing hormone releasing hormone) interferes with the pituitary gland making luteinizing hormone. Luteinizing hormones direct the testes to make testosterone. Interfering with luteinizing hormone lowers testosterone levels.

Is ADT right for me?

Although this form of treatment can have significant side effects and may lose its effectiveness over the long term, ADT is still a proven therapy against PCa. However, its use has changed and is no longer given routinely for those with a low stage, low-risk prostate cancer such as a Gleason 3+3. Your specialist, oncologist, or cancer clinician will explain which medicine he or she selects for your ADT treatment, how often it is given, and whether it is given orally or by injection.

Myriad Genetics recently added a new feature to their Prolaris^® test that further personalizes decisions regarding ADT by quantifying the benefit for patients. In addition to being able to identify who may be safe to forego ADT, now patients can understand how adding ADT to radiation therapy may reduce their risk of metastasis over 10 years.  Determining how much a patient benefits from ADT versus the side effects is critical to making the best treatment decision. The results of this test can greatly you’re your medical team decide if ADT is needed for in your treatment plan. Learn more about the Prolaris test.

If your medical team does recommend ADT, then you need to consider the long- and short-term/temporary side effects from ADT medications. Some of these side effects may be caused by ADT’s interactions with medications you are already taking, such as those for heart disease or diabetes. Your medical team will address these conflicts and explain changes to your current medications while on ADT.

Possible side effects of hormone therapy

Short-term (6 month to 1-year) ADT effects include:

• Breast pain or enlargement – this can be managed with other treatments but does go away once ADT is stopped.
• Erectile dysfunction (ED)/lower libido – A decrease in the size of the penis and/or testicles, and a thinning of body hair. This is the most typical effect that usually subsides after ADT is discontinued.
• Cholesterol level changes – Are not as typical and may depend on preexisting conditions and medication you take.
• Diarrhea and/or constipation – This is not as typical and can be treated with other medicines.
• Weight gain
• Hot flashes
• Fatigue

Long Term ADT effects (28-36 months):

• Increased risk of osteoporosis or bone thinning, increasing the risk of broken bones and fractures
• Diabetes
• Dementia
• Concentration, learning, and memory problems
• Coronary heart disease.
• Sexual dysfunction

Lifestyle changes to help manage ADT side effects

Knowing about possible side effects is necessary, but the following lifestyle changes can help manage some of these side effects. If you have preexisting problems, continue working with your doctor or specialist. Always discuss with your cancer medical team before making lifestyle changes such as increased exercise or diet changes.

• Sexual – Talk with your partner and your healthcare providers about ED. Ask for help from a urologist trained in the treatment of ED. Finally, consider seeing a sex therapist, which can be helpful for couples facing these side effects. If you prefer confidentiality about this topic, let your medical team know.
• Preventing and treating bone loss – it’s best to get calcium in a balanced diet, including calcium-rich foods. Examples of calcium-rich foods are low-fat milk, yogurt, cheese, green leafy vegetables, nuts, seeds, beans, legumes, and calcium-fortified foods and juices.
  • Ask your doctor or physical therapist about bone strengthening exercises. Your provider can refer you to a physical therapist or a physical medicine and rehabilitation physician for guidance regarding bone-strengthening exercises.
• Try 30-40 minutes of weight-bearing exercise 3 times a week. Weight-bearing exercises are those in which your feet or legs bear your body’s weight while the bones and muscles work against gravity. Examples are walking, jogging, Tai Chi, yoga, and dancing.
• Limit or stop drinking caffeine.
• Quit smoking. This will help your overall health, too.

Additional treatments to help you tolerate the side effects of ADT can be found here and may be necessary and customized for you based on your overall health. Your doctor may prescribe these medications and explain why you need them to offset side effects. Remember to ask questions if you don’t understand your doctor’s explanation.

Prevent muscle loss & weight gain, high cholesterol, stroke and heart attack.

• Maintain a healthy weight through diet and exercise.
• Eat a diet high in fruits and vegetables. Eat unrefined whole grains, fat-free or low-fat dairy, lean meats, and fish.
• Try not to eat processed foods, foods high in trans-fats, cholesterol, and sodium, red meats, sugary drinks, soda, and alcohol.
• Your provider can refer you to a physical therapist or a physical medicine and rehabilitation physician for more guidance.
• See your primary care provider at least once a year to keep track of your blood pressure, blood sugar (glucose and Hemoglobin A1C), and cholesterol.

Coping and Mental Health Care

Life has tradeoffs, and one you should not make is a time-driven decision about a cancer treatment such as ADT.  ADT may have some heavy lifts, and it is best to look the tiger in the eye. We still fear cancer, as we should. We can look up or down, left or right, but we all should agree about taking on the fight if ADT is your best choice. Ask questions, read on, and stop and weigh the options.

Coping is how we control our reactions to change, such as a diagnosis of PCa and any treatments if needed. “Change happens”, as the bumper sticker reads. You have choices, so don’t rush. Have confidence in your primary care doctor and specialist teams, urologists, oncologist, and radiologist. Remember that tests such as Prolaris give your team the right information to treat your PCa. Here are some tips to get you to a better place, help you cope, and win the race against PCa:

• Confide in family and close friends about your treatment. Be human. Admit your fears but accept help from those who love you and want the cancer treated.
• If you have a history of depression or another mental illness, ask your doctor for referral to a licensed therapist or psychiatrist before beginning ADT.
• Seek a local or national prostate cancer support group. There are several such as ASPI and many others. Most groups provide online education and live events that allow you to submit questions about PCa and ADT.
• Ask your doctor or treatment team if you can take a break from ADT treatments if you do not feel well. Some treatment options allow for a lower dose or a break. Share and confide about your side effects and worries with your medical team.

One of my favorite songs from musician Louis Armstrong’s rendition of “What a Wonderful World” can be found here. Listen to the words, the voice, the message. If you have questions about the Prolaris test and how it can help with ADT decisions, please reach out to [email protected].

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Geoff McLennan, MPA, Prostate Cancer Patient and Advocate

Author Bio:

Geoff is dedicated to helping families and friends support a prostate cancer patient. He joined the board of Active Surveillance Patients International (ASPI) in 2018 and is an 11-year PCa patient. As a PCa patient advocate, he envisions providing a broad understanding of how patients can collaborate with clinicians for realistic medical care. He enjoys meeting and learning from his clinicians, cancer researchers, providing free online programs for patients, and reminds us that “to live, learn and thrive with PCa” is the motto of ASPI. He is glad he took science courses for understanding a healthy lifestyle that includes exercise and diet.

Geoff also volunteers as a board member and past chairman of the Placer County Mental Health Advisory Board where his interest includes therapy and resources for AS men, and a broad oversight of community mental health programs and innovations. He is married to Constance McLennan, a fine artist, has a grown son, and lives in Northern California.

*Disclaimer: The views expressed in this blog are solely those of the author, and do not represent the views or opinions of Myriad Genetics or its affiliates. It is important to consult with your healthcare provider.