Androgen deprivation therapy (ADT) is a common treatment for prostate cancer, aimed at reducing the levels of male hormones (androgens) such as testosterone, which can stimulate the growth of prostate cancer cells. While ADT can effectively slow the progression of prostate cancer, it often causes a number of side effects due to the drastic reduction of testosterone in the patient’s body. Below, some of the more common side effects of ADT are discussed, as well as their impact on patients’ lives.
- Hot flashes
One of the most commonly reported side effects of ADT is hot flashes. These sudden, intense feelings of warmth, often accompanied by sweating and flushing of the skin, are caused by hormonal changes that disrupt the body’s temperature regulation. Hot flashes can vary in frequency and intensity and can affect sleep, leading to fatigue and reduced quality of life.
- Sexual Dysfunction
ADT often results in decreased libido (sexual desire) and can cause erectile dysfunction. The absence of testosterone, which is a hormone critical to sexual function, directly affects the sexual health of men undergoing ADT. Many patients report a decreased interest in sex and may experience difficulty achieving or maintaining an erection. These changes can affect close relationships and may contribute to mental health challenges such as depression and anxiety.
- Bone loss and fractures
Testosterone plays an essential role in bone health, helping to maintain bone density and strength. When testosterone levels drop due to ADT, bones can become weaker and more prone to fractures. Osteoporosis, a condition characterized by low bone density and brittle bones, is a major concern for men on long-term ADT. Bone health management strategies, including weight-bearing exercise and calcium and vitamin D supplementation, are often recommended to help prevent bone loss.
- Cardiovascular Risks
ADT has been linked to increased risks for cardiovascular events, including heart attacks, strokes, and other vascular problems. Lower testosterone levels may contribute to metabolic changes that increase the risk of cardiovascular disease, such as higher cholesterol and triglyceride levels, increased body fat, and increased blood pressure. ADT patients are often advised to maintain a healthy lifestyle with regular exercise and a balanced diet to reduce these risks.
- Weight gain and metabolic changes
ADT can lead to an increase in body fat, particularly around the abdomen, and can also cause muscle loss. This change in body composition, combined with possible changes in insulin sensitivity, can lead to an increased risk of diabetes and other metabolic disorders. Patients may be advised to incorporate strength training and aerobic exercise to help maintain muscle mass and support a healthy metabolism.
- Emotional and Cognitive Changes
Hormonal changes caused by ADT can affect mood and cognition. Many men with ADT report feelings of depression, anxiety, and irritability, as well as difficulty concentrating and memory challenges. These cognitive and emotional changes are thought to result from a lack of testosterone, which plays a role in regulating mood and cognitive function. Counseling, support groups, and, in some cases, medication can be helpful in managing these symptoms.
- Fatigue
Fatigue is a common complaint among men undergoing ADT. This fatigue is likely due to a combination of factors, including low testosterone, sleep disturbances (often due to hot flashes), and the psychological stress associated with cancer diagnosis and treatment. Managing fatigue may require a multifaceted approach, including sleep hygiene, exercise, and stress management techniques.
Conclusion
ADT can be an effective treatment for slowing the progression of prostate cancer, but it comes with a variety of side effects that can affect patients’ quality of life. Understanding these potential side effects helps patients and healthcare providers manage and mitigate the effects of ADT by adjusting supportive therapies as needed. Through preventive strategies, including lifestyle changes and medical interventions, many side effects of ADT can be effectively managed.
References:
Basaria, S., Lieb, J., 2nd, Tang, AM, DeWeese, T., Carducci, M., Eisenberger, M., & Dobs, AS (2002). Long-term effects of androgen deprivation therapy in patients with prostate cancer. Clinical Endocrinology, 56(6), 779–786.
Carneiro, A., Sasse, AD, Wagner, AA, Peixoto, G., Kataguiri, A., Neto, AS, Bianco, BA, Chang, P., Pompeo, AC, & Tobias-Machado, M. (2015) . Cardiovascular events associated with androgen deprivation therapy in patients with prostate cancer: a systematic review and meta-analysis. World Journal of Urology, 33(9), 1281–1289.
Egerdie, B., & Saad, F. (2010). Bone health in the prostate cancer patient receiving androgen deprivation therapy: a review of current and future management options. Canadian Urological Association Journal, 4(2), 129–135.
Nguyen, PL, Alibhai, SM, Basaria, S., D’Amico, AV, Kantoff, PW, Keating, NL, Penson, DF, Rosario, DJ, Tombal, B., & Smith, MR (2015). Adverse effects of androgen deprivation therapy and strategies for their mitigation. European urology, 67(5), 825–836.
