Androgen deprivation therapy for prostate cancer

Prostate cancer needs testosterone to grow. Reducing how much testosterone your body makes may slow the cancer’s growth or shrink the cancer temporarily. Testosterone is an androgen (male sex hormone made by the testicles), so this treatment is called androgen deprivation therapy (ADT). It is also known as hormone therapy.

How ADT is given

ADT for locally advanced cancer may be used after a radical prostatectomy or with radiation therapy. It may also be given to help control advanced prostate cancer.

There are different types of ADT:

ADT injections – The most common form of ADT involves injecting a drug to block the production of testosterone. Your GP or specialist can give the injections. How often you have injections depends on the type of ADT. They may be given monthly, every 3 months or every 6 months. ADT injections can help slow the cancer’s growth for years.

ADT injections may also be used before, during and after radiation therapy to increase the chance of getting rid of the cancer. They are sometimes combined with chemotherapy.

Intermittent ADT – Occasionally ADT injections are given in cycles and continue until your PSA level is low. Injections can be restarted if your PSA rises again. This is known as intermittent ADT. In some cases, this can reduce side effects. It is not suitable for everyone.

Anti-androgen tablets – Often called hormone tablets, anti-androgen tablets may be given in combination with ADT injections.

Removing the testicle/s (orchidectomy) – This surgery is an uncommon way to lower how much testosterone your body makes. If you have advanced prostate cancer, you may choose to have surgery rather than regular ADT injections or tablets.

Surgery to remove both testicles is called a bilateral orchidectomy. It is possible to have a silicone prosthesis put into the scrotum to keep its shape. Removing only the inner part of the testicles (subcapsular orchidectomy) also lowers testosterone and does not need a prosthesis.

Side effects of ADT

ADT may cause side effects because of the lower levels of testosterone in the body.

Side effects may include:

• tiredness that doesn’t go away with rest (fatigue)
• reduced sex drive (low libido)
• difficulty getting an erection (impotence)
• shrinking of the testicles and penis
• loss of muscle strength
• hot flushes and sweating
• weight gain, especially around the middle
• breast swelling and tenderness
• mood swings, depression, trouble with thinking and memory
• loss of bone density (osteoporosis) – calcium and vitamin D supplements and regular exercise help reduce the risk of osteoporosis
• higher risk of diabetes, high cholesterol and heart disease. These are more likely the longer you have ADT, so ask your doctor about them.

Adjusting to changes in your testosterone levels takes time. For ways to manage side effects, talk to your treatment team and see Managing side effects.

To find out more about ADT, contact the Prostate Cancer Foundation of Australia on 1800 22 00 99. For information about erectile and other sexual health issues, visit Healthy Male.