Myriad Genetics Blog Blog > Hormone Therapy For Prostate Cancer – Androgen Deprivation Therapy (ADT) Hormone Therapy For Prostate Cancer – Androgen Deprivation Therapy (ADT) November 8, 2024 Patient Blog Patients Urology 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 hormone therapy, and when is it used? Hormone therapy is an important treatment option in the management of certain cancers. It works by altering the levels or activity of specific hormones in the body. Hormones act as messengers in the body, influencing various functions, including the growth of some cancer cells. In prostate cancer treatment, hormone therapy often focuses on reducing testosterone levels. Prostate cancer cells rely on testosterone for growth and proliferation, making this approach an effective strategy in many cases. Your doctor may recommend hormone therapy in several situations: When cancer has spread beyond the prostate As a complement to radiation therapy, either before or after treatment In cases where surgery or radiation are not optimal choices To reduce tumor size prior to surgery For recurrent cancer after initial treatment It’s important to understand that treatment decisions are highly individualized. Your medical team will consider multiple factors when determining if hormone therapy is appropriate for your situation, including: The stage and grade of your cancer Your overall health status Your personal preferences and goals for treatment Hormone therapy is not a universal solution. Advanced diagnostic tools, such as Myriad Genetic’s Prolaris® test, provide insights into your cancer’s specific characteristics. Prolaris is the only test that can quantify a patient’s potential benefit from adding hormone therapy to radiation therapy. This allows doctors and patients to weigh the benefits against the side effects of hormone therapy. With this information, your doctor can tailor a treatment plan best suited to your individual case. 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. 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 glands, 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. How does it work? ADT prostate cancer ADT employs two primary mechanisms to combat prostate cancer: Suppressing androgen production – ADT medications can significantly reduce the body’s ability to produce androgens, not just in the testes but also in the adrenal glands and even within the prostate cancer cells themselves. Blocking androgen action – Some forms of ADT work by preventing androgens from interacting with prostate cancer cells. These medications, known as androgen receptor inhibitors, bind to the androgen receptors on cancer cells, effectively blocking testosterone and other androgens from stimulating cancer growth. The impact of ADT on prostate cancer management ADT can be an important component of prostate cancer treatment, but its use should be carefully considered. While it offers potential benefits for some patients, it’s important to understand that many men who receive hormone therapy may not actually benefit from it. Potential benefits for select patients include: Symptom relief, particularly for bone pain in cases of metastatic disease Management of metastatic prostate cancer Enhanced efficacy when combined with other treatments like radiation Possible survival benefits in certain cases of metastatic prostate cancer However, it’s essential to recognize that ADT can lead to significant reductions in quality of life, including: Decreased energy levels Muscle loss Weight gain Other side effects that may impact daily functioning Given these considerations, ADT should only be used for select men who would truly benefit from the therapy. Factors such as the stage of cancer, overall health, specific genetic markers, and the Gleason score (a measure of cancer aggressiveness determined by examining prostate tissue samples) can influence how well a patient responds to this treatment. Advanced diagnostic tools, like Myriad Genetic’s Prolaris® test, can provide valuable insights into a patient’s specific cancer characteristics, helping doctors and patients make more informed decisions. 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 as radiation. In some cases of low-risk prostate cancer, active surveillance or surgery might be recommended before considering treatments like ADT. Different types of ADT There are 2 longstanding types of ADT: (1) Anti-androgens work by blocking testosterone in 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 it is no longer given routinely for those with 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 help your medical team decide if ADT is needed 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 of 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 months 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 – These are not as typical and may depend on preexisting conditions and the 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 How to manage and cope with the ADT side effects ADT can have various impacts on your body and daily life. Addressing these effects often requires a multi-faceted approach, including lifestyle adjustments, medical interventions, and emotional support. 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. 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, oncologists, and radiologists. 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 a 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]. Read more like this: Types of Prostate Biopsies: Your Biopsy and Gleason Score 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 and cancer researchers, providing free online programs for patients, and reminding us that “to live, learn, and thrive with PCa” is the motto of ASPI. He is glad he took science courses to understand 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.