Androgen Deprivation therapy - Cancer Science

What is Androgen Deprivation Therapy?

Androgen Deprivation Therapy (ADT) is a treatment primarily used in prostate cancer to reduce the levels of male hormones, or androgens, which can stimulate the growth of cancer cells. The primary androgens are testosterone and dihydrotestosterone (DHT).

How Does ADT Work?

ADT can be achieved through surgical methods like orchiectomy (removal of the testes) or through medical therapies that either reduce androgen production or block androgen receptors. Medications such as LHRH agonists and antiandrogens are commonly used.

When is ADT Recommended?

ADT is recommended in various stages of prostate cancer, including advanced, recurrent, or metastatic cases. It is also used in combination with other treatments like radiation therapy for better outcomes in localized high-risk prostate cancer.

What are the Different Types of ADT?

There are several approaches to ADT:

Surgical ADT: Orchiectomy is a permanent solution to reduce androgen levels.
Medical ADT: This includes medications like LHRH agonists, LHRH antagonists, and antiandrogens.
Combined Androgen Blockade (CAB): This involves using both LHRH agonists and antiandrogens to block androgens more effectively.

What are the Side Effects of ADT?

ADT is associated with multiple side effects due to the reduction of androgens:

Hot Flashes: These are one of the most common side effects.
Bone Density Loss: Leading to increased risk of fractures and osteoporosis.
Cardiovascular Risks: Increased risk of heart disease.
Metabolic Changes: Including weight gain and insulin resistance.
Cognitive Effects: Potential impacts on memory and cognitive function.

How is the Effectiveness of ADT Monitored?

The effectiveness of ADT is monitored through regular PSA tests and imaging studies. A declining PSA level generally indicates that the treatment is working. However, some patients may develop castration-resistant prostate cancer, where the cancer progresses despite low androgen levels.

What are the Alternatives to ADT?

Alternatives to ADT include active surveillance, surgery (prostatectomy), radiation therapy, and newer targeted therapies like PARP inhibitors and immunotherapy. The choice of treatment depends on the stage and aggressiveness of the cancer, as well as the patient’s overall health and preferences.

Conclusion

Androgen Deprivation Therapy remains a cornerstone in the management of prostate cancer, especially in advanced stages. While it is effective in controlling cancer growth, it comes with significant side effects that need to be managed. Continuous research is being conducted to find better methods to optimize the benefits and minimize the risks associated with ADT.