Androgen deprivation therapy

Androgen deprivation therapy (ADT), also known as androgen suppression therapy, is a medical treatment used primarily to treat prostate cancer. Prostate cancer cells usually require androgen hormones, such as testosterone, to grow. ADT reduces the levels of androgens in the body, aiming to slow down or shrink the cancer.

Mechanism of Action

ADT works by interrupting the body’s ability to produce or utilize androgens. This can be achieved through several methods:

• Surgical castration: Removal of the testes, which are the primary source of testosterone production in males.
• LHRH agonists: Drugs that eventually decrease androgen production by overstimulating the body's own regulatory system, leading to a shutdown of testosterone production.
• LHRH antagonists: These drugs directly block the action of luteinizing hormone on the testes, immediately reducing testosterone production.
• Antiandrogens: Medications that block the action of androgens at their receptor sites in the tissue.

Indications

ADT is primarily used in the treatment of prostate cancer. It may be employed:

• As a primary treatment for prostate cancer, especially in cases where surgery or radiation is not suitable.
• In combination with radiation therapy for intermediate to high-risk localized or locally advanced prostate cancer.
• To treat or prevent symptoms in men with metastatic prostate cancer.

Side Effects

While effective in managing prostate cancer, ADT is associated with a range of side effects due to the lowered androgen levels, including:

• Hot flashes
• Reduced sexual desire and erectile dysfunction
• Loss of bone density, increasing the risk of fractures
• Muscle mass loss and increased body fat
• Emotional and cognitive changes
• Increased risk of cardiovascular disease and diabetes

Monitoring and Management

Patients undergoing ADT require regular monitoring to assess the effectiveness of the therapy and to manage side effects. This includes:

• Regular PSA (prostate-specific antigen) testing to monitor cancer activity.
• Bone density scans to assess the risk of osteoporosis.
• Lifestyle modifications and medications to manage side effects such as cardiovascular risks and bone health.

Future Directions

Research is ongoing to improve the efficacy of ADT and reduce its side effects. This includes the development of new drugs, intermittent ADT strategies to minimize side effects, and combination therapies with other cancer treatments.

See Also

• Prostate cancer
• Hormone therapy for cancer
• Luteinizing hormone-releasing hormone agonist
• Antiandrogen