Adverse Effects of Androgen Deprivation Therapy for Prostate Cancer: Prevention and Management

Abstract

The prostate is an androgen-dependent organ. The increase, growth, homeostasis, and function of the prostate largely depend upon the intraprostatic and serum concentrations of androgens. Therefore, androgens are essential for the physiologic growth of prostatic epithelium. Prostate cancer, the second leading cause of death for men, is also androgen dependent, and androgen suppression is the mainstay of treatment for advanced and metastatic disease. In the state of metastatic disease, androgen suppression is a palliative treatment leading to a median progression-free survival of 18–20 months and an overall survival of 24–36 months. Theoretically, the majority of patients will develop hormone-refractory disease provided that they will not die from other causes. Although androgen suppression therapy may be associated with significant and sometimes durable responses, it is not considered a cure, and its potential efficacy is further limited by an array of significant and bothersome adverse effects caused by the suppression of androgens. These effects have potentially significant consequences on a variety of parameters of everyday living and may further decrease health-related quality of life. This review focuses on the aetiology of these adverse effects and provides information on their prevention and management.

Psychological effects of androgen‐deprivation therapy on men with prostate cancer and their partners

“…Many neural centers in the brain, including those critical to cognitive processes, have estrogen receptors, as noted above . This suggests that supplemental E2 may be of some benefit for men on ADT . Estrogen taken orally increases the risk of thromboembolic events and gynecomastia .…”

Men’s strategies for preserving emotional well-being in advanced prostate cancer: An interpretative phenomenological analysis

“…As well as emotional distress on receipt of diagnosis and prognosis (Jonsson et al, 2009), men with advanced prostate cancer experience on-going impairments in psychosocial functioning, for example in relation to the physical consequences of disease progression such as pain and fatigue (De Sousa et al, 2012). The limited research into psychological well-being in men with advanced prostate cancer tends to focus on the sideeffects of ADT, for example clinical reports of depression and mood swings relating to testosterone depletion (Sountoulides & Rountos, 2013). Qualitative research has shown that physical side effects such as hot flushes, sexual dysfunction and breast swelling are linked to loss of identity, feminisation, feelings of self-loathing and reduced self-esteem (e.g.…”

Development of UK guidance on the management of erectile dysfunction resulting from radical radiotherapy and androgen deprivation therapy for prostate cancer

“…ADT can involve orchidectomy, luteinizing hormone‐releasing hormone (LHRH) agonists, gonadotrophin‐releasing hormone (GnRH) antagonists and anti‐androgens . ADT induces a significant reduction in serum testosterone that commonly results in reduced sexual desire and sexual function .…”